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'Lawyer up' if denied LTD benefits: Goldfinger

In the second instalment of a three-part series on long-term disability insurance, Toronto personal injury lawyer Brian Goldfinger discusses the steps policyholders must take to successfully challenge an insurance company’s denial of their claim.

A denial of long-term disability (LTD) benefits can be devastating for someone who is sick or injured, which is why Toronto personal injury lawyer Brian Goldfinger advises claimants to “lawyer up.”

"Many people don't know that if an insurance company denies you LTD benefits, you can challenge that decision,” says Goldfinger, founder of Goldfinger Injury Lawyers.

However, it takes effort by the claimant to carry out a challenge, including providing medical data in a timely manner to prove the illness or disability, he says.

"There are a number of steps that a person must take on their own before launching a claim," Goldfinger tells AdvocateDaily.com.

The legal challenge could begin when a claimant receives a denial letter, he says.

"If you have been denied, you are given an opportunity to appeal the claim,” Goldfinger says. "All those appeals are internal. It's not a judge or a neutral arbitrator looking at it — it's reviewed by somebody who is directly employed by the insurance company.

"You can appeal all day long, but it's like bringing a rubber knife to a gunfight," he adds. 

Since the appeal process is not mandatory, he doesn’t recommend claimants go that route. 

"You can hire a lawyer and litigate," Goldfinger says. "That way, you are in an impartial forum."

Using the internal appeal process may also establish a pattern of denials that could later be used against you in court, he says.

"If you appeal several times internally, for example, at trial the insurance company could hypothetically call four or five adjusters who will all say they looked at the claim with a fresh set of eyes and concurred with the initial adjuster to deny the claim," Goldfinger says.

He says the clock starts ticking once the letter of denial is issued. Generally, it's a two-year time frame to launch a suit, but he warns policies vary and time limits could be shorter.

"It's in the insurance company's best interest to delay because, with every day that goes by, it's a day closer to the limitation period expiring," Goldfinger says.

A lawyer will review the plaintiff's file, medical records and memos to determine what occurred within the insurance company and whether they retained any medical experts to review or assess the claim, he says.

"Insurers will frequently send files out for review to a medical assessor," a person who may be directly employed by the insurance company, Goldfinger says.

"The tone changes once you retain a lawyer," he says. "The first step is to lawyer up. The insurance companies have thousands of lawyers at their beck and call. That's what you're up against.

"You're fighting a very big battle so don't do it on your own," Goldfinger says.

Stay tuned for part three where Goldfinger will highlight the unique challenges of filing an LTD claim related to mental health issues.

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