When applying for long-term disability (LTD) benefits, there is always a chance your claim could be denied. Insurance providers are not looking to make a payout and almost always search for ways to avoid paying you the LTD benefits we know you deserve.
If your LTD claim is denied, you have three options. You can file an appeal, file a lawsuit, or do nothing. Our experienced LTD lawyers will tell you that if your claim is denied, you should never give up and always fight for the benefits you’re entitled to. Challenging the decision of a powerful insurance company can be intimidating. By knowing the process, understanding your rights, and with the help of an LTD lawyer, you might successfully reverse the decision made by your insurer.
To challenge the decision for denial, you can file an LTD lawsuit or an LTD appeal. These involve different steps, and it is crucial to understand the variations of the two options before deciding which process is right for you.
The Difference Between an Internal Appeal and an LTD Lawsuit
If you appeal an insurance company’s decision for denial, you are not having the reconsideration made by a neutral third party. Instead, you are leaving it up to that company’s employees and internal processes to review your case once again and consider reversing their decision. Since this is the agency that has already looked at your situation and made the decision, it is unlikely that they would even consider changing their decision without substantial new evidence.
By starting a lawsuit, you are putting the decision in the hands of a court of whether you are entitled to the LTD benefits after all. Faced with your lawsuit, your insurance company will either have to start paying your benefits or agree to a settlement. Otherwise, they will have to allow the final decision to be made by the court. By having your case reviewed by a neutral third party, the chances your claim will be perceived differently is much more likely. An insurance company has the strict guidelines they follow when reviewing your case. The reviewal by a court follows a different process and provides a fresh opinion on your case.
Deciding which option has the best chance at getting you your LTD benefits depends on a variety of factors.
When Should you Appeal STD/LTD Denial?
LTD appeals can sometimes be the easiest and most straightforward way to settle an LTD claim. Certain conditions exist when filing an appeal might be a better option. If you know your insurer is missing substantial information about your case, then submitting this information along with your appeal could earn you a quick reversal of the denial.
If you had been seeing a medical specialist your insurance company was not aware of, they might be able to provide the missing information your insurance company needed to approve your claim. By only talking to your family doctor, they would be missing the expert opinion regarding your disability. Your family doctor likely would not share the same knowledge of your debilitating situation as a specialist and likely could not provide the same level of information regarding your current circumstance.
Another reason to appeal the decision rather than make an LTD lawsuit would be if new information has come to light since you applied. If your disability has undergone further testing or imaging and a defined diagnosis has been produced, then providing your insurer with this information would likely help your appeal succeed.
Even with additional medical information, appeals are most often not successful. Unless you can provide unwavering and substantial new evidence, it’s unlikely an insurance company will be willing to change their decision.
Filing an appeal is always in favor of the insurance company. An appeal keeps your case internal, quiet, and away from the public eye when they have wrongfully denied your claim. Wrongful denials happen far more often than any insurance company would admit. Denying claims helps insurance company’s first priority: their shareholders.
How Long is the Appeal Process for Disability?
After the extensive initial paperwork, meetings with your doctors, and anxiety-inducing wait to receive the decision of your application, only to receive a denial, applying for an appeal is likely the last thing you feel like doing. If you do decide to go through the effort of filing an appeal, you are probably wondering how long the process will take.
Preparing your application and gathering new evidence and medical information could take you months depending on your doctor’s and specialists’ availability and the willingness to cooperate with your insurer or previous employer. Once the appeal has been filed, receiving the reconsideration from your insurer could take another 3 to 4 months. While undergoing the lengthy appeal process, your chance to file the more likely successful option of an LTD lawsuit is coming to an end.
Altogether, depending on your individual situation, the appeal process can take anywhere from 4-8 additional months.
Are Disability Claim Appeals a Waste of Time?
Our disability lawyers typically do not recommend clients appeal more than once, especially since LTD claims are subject to a limitation period. Most insurance companies will allow you to file an appeal two or three times. They will happily waste their time and yours dealing with multiple appeals for the same case to keep you from going the route of an LTD lawsuit. While you are busy filing your appeals and waiting for the outcome, your window to file a lawsuit is closing.
If you cannot provide substantial new evidence or information or your first appeal is denied, filing for another appeal will likely be a waste of your time and effort.
If you would like to appeal your disability insurer’s decision, our LTD lawyers can help you prepare a persuasive appeal letter with all the supporting medical information we can get. Our team can help increase the chances of your appeal being approved the first time.
When to File a Lawsuit for Disability Insurance Denial
If your insurance company has all or almost all of the crucial medical documentation you can provide them, it’s not likely that they will change their decision just because you file an appeal. Starting a lawsuit might be the only option to get your LTD benefits if you think your insurance company has made a misjudgment. Having a team of experienced disability lawyers present your case to a court stands a much better chance of having your claim approved than leaving it up to the insurance company once again.
The manner your case is presented can have a lot of bearing on how others perceive it. Not asking the right questions or forgetting to include vital information could be the factor that led to your LTD benefit denial. An experienced disability lawyer has dealt with many LTD denial lawsuits before and has the expertise to make sure your case is impeccable before being reviewed. Your lawyer will also know what questions to ask and how to get the information needed to help prove the severity and reality of your disability, even without new information.
Stepping right into a lawsuit can help you avoid wasting time with appeals when we know they often have a bleak chance of being approved. Spending months filing multiple appeals means months without receiving a salary or disability benefits. As your financial situation worsens, you may feel compelled to go back to work before you’re ready, compromising your health even further. There are also tight time limitations to filing your lawsuit for a denied LTD claim due to the limitation period. The sooner your lawsuit is filed, the less you worry about making your LTD lawsuit before the time limit expires.
Disability Lawsuit Limitation Period
The provincial government of Nova Scotia has set out legislature that defines the limitation period as two years for most LTD claims. It would keep things simple if this legislation were the be all end all, but the two-year limitation period in Nova Scotia does not apply to all claims.
Your time limit for an LTD lawsuit may differ from the legislation because of your LTD contract. Often, an LTD contract has a limitation period of its own, which is typically one year. It can be challenging to decipher precisely how long you have to fight your long-term disability denial because of the different limitation periods applicable to various insurance policies and claims.
When comparing the outlined two-year limitation period to the period defined by your LTD contract, you may be wondering which time limit takes priority. In a recent case of Nova Scotia resident Angela Cameron v. Nova Scotia Association of Health Organizations Long Term Disability Plan, it was decided that the two-year limitation period was superseded by the one-year period defined in the LTD contract. In other words, a court of law decided that Angela Cameron’s limitation period was only one year, not two, because of the LTD contract she signed.
It’s essential to understand the rights you have to sue for LTD benefits. If you are unsure of the length of your limitation period, contacting a legal counsel for assistance might be your best chance at getting the clear and defined answer you’re looking for.
What we want you to take away here is that, even though the Nova Scotia provincial government has set out legislature that defines the limitation period as two years for most LTD claims, this may not be true for you because of the terms of your LTD contract. Every LTD contract is different, and the terms can be confusing, but a long-term disability lawyer can help make sense of your contract.
How to Get Your Disability Claim Approved
Occasionally insurance providers will admit they made a mistake in denying an LTD claim. However, this rarely happens unless you can provide substantial new evidence. If this isn’t possible in your case, it’s unlikely they will change their mind just because you asked them to.
If your disability claim was denied, you should fight to have the decision reversed. With the consultation of a lawyer who specializes in long-term disability, you can get an expert opinion on whether an appeal or lawsuit for denied disability is the best choice. For help filing an LTD appeal, LTD lawsuit, or to get a second opinion on your case, contact one of Valent Legal’s experienced disability lawyers.