A breakdown of the legal process involved when your insurance company denies your long-term disability benefits
If you submit a long-term disability claim and your insurance company denies it, you then have two options; appeal or sue. At this point, it’s always wise to consult a lawyer regardless of your decision. A lawyer can advise you on which decision is the best option for your case and will be able to help you with an appeal or with starting a lawsuit. Typically, unless there’s additional, valuable documentation or information that your insurance company hasn’t received, you won’t have much luck appealing their decision. Once you’ve concluded that you would like to sue, it’s vital for you and your lawyer to take action promptly.
Starting a lawsuit
In Ontario, you have two years from the date your insurance company denied your long-term disability claim to file a lawsuit. However, just because you have that time doesn’t mean you should wait. As soon as your disability claim gets denied, contact a lawyer as quickly as possible. You never know what issues or obstacles you may run into during the process, so getting started as soon as possible is your best option. The sooner you can settle your case, the sooner you can begin receiving your benefits.
For your lawyer to start a long-term disability lawsuit, they’ll need all of the medical documents you have to support your claim. They’ll go over your insurance policy with you and ensure that you understand your rights. Once they have all the information they need, they’ll submit a Statement of Claim to the insurance company, informing them of impending legal action. The insurance company has 20 days from receiving the claim to respond – they will either decide to issue benefits, settle the case, or take the claim to court. The good news is that it’s more common for insurance companies to settle cases rather than going to court.
The next step: discovery and mediation
After the insurance company responds to the Statement of Claim, there will be two steps that follow. Mediation and an examination for discovery are two separate processes that occur on different days. Discovery is a process that allows your lawyer and the insurance company’s lawyer to ask each other questions about your long-term disability case under oath. Discovery dates are usually booked within eight months.
Mediation is a settlement meeting where each party sits in different rooms (you and your lawyer in one and your insurance company in the other). During this meeting, an experienced disability lawyer will be present to act as the mediator. The mediator’s job is to communicate settlement offers between both parties. If you agree upon a settlement, your case is closed; however, the case will proceed to court if there’s no settlement.
Generally, discovery is followed by mediation, but it is possible to go to mediation first. Suppose both parties come to a settlement agreement in early mediation. In that case, you may not have to go through the discovery process at all.
Don’t be scared to take legal action over a denied long-term disability claim.
It can be overwhelming, stressful, discouraging, and frustrating to have your insurance company deny your long-term disability claim. Insurance companies want to make and keep their money and find any reason to avoid paying out. A denial does not mean you don’t deserve or qualify for benefits. This is a common legal issue that many people have encountered before, and long-term disability lawyers see it all the time. Don’t be scared to stand up for yourself and fight back; your lawyer will help you get the justice and financial support you need to get back on track.