Personal Injury

Long-term disability insurance part 2: the denial

By Kirsten McMahon, Managing Editor

In the second installment of a three-part series, Toronto personal injury lawyer Andrew M. Lee explores what to do if your LTD claim is denied.

If your long-term disability (LTD) claim is denied, Toronto personal injury lawyer Andrew M. Lee recommends consulting with a lawyer right away.

“If you're disabled or injured, this is likely your first LTD claim. You’re up against an experienced claims handler who knows the process and is acting for the insurance company’s best interest — not yours,” says Lee, principal of Lee & Associates.

“You should immediately consult a lawyer who specializes in this area and get some timely advice,” he tells AdvocateDaily.com. “There are limitation periods, deadlines and next steps to take."

He says an insurer will often ask the applicant if they want to appeal the denial.

“Consult a lawyer before agreeing to an appeal. In most cases I've seen, the appeals process rarely reverses the insurance company’s initial decision. If you appeal, it can just create a further delay and allows the insurer to gather more evidence against you.”

Lee says there is an exception where the denial is very early on in the claims process where the insurance company might be missing relevant information to assess or evaluate the case accurately.

“In that type of situation, I might encourage the person to consider the appeal process, but for most other cases, there are strategic reasons to bypass it and go straight to litigation,” he says.

The initial, free consultation is a chance to carefully review the circumstances of the person’s work, education, experience, the nature of the disability or injury, the physical or mental demands of the job and the details of the denial.

“Each person’s circumstances are different so we advise accordingly. At our firm, we often see LTD denial cases where litigation is inevitable and feel that, in these cases, any delay in initiating a lawsuit only the increases the emotional and financial toll on the disabled or injured person,” Lee says.

He says this is why it’s essential to get legal help fast.

“If you’re injured or have a disease or condition where you can't work then you cannot provide for your yourself and your family. The longer you delay in fighting the insurer, the more precarious your position will become,” Lee says.

He says it’s also easy for a rejected claimant to give up hope.

“People feel defeated when their claim is denied. They are overwhelmed at the process and feel they are not able to continue the fight.

“We’re mindful of the fact that the longer the case goes on, the longer the client is without benefits, so we’re pushing toward a settlement or trial as the case may be. In the meantime, we’re also encouraging clients to be under the continuous care of a doctor.”

Stay tuned for part three where Lee will illustrate how being creative and thinking outside of the box can successfully resolve these types of cases.

To read part one, click here.

To Read More Andrew M. Lee Posts Click Here