Disability Denied: The First Time

Many people are denied after going through the claim application and filing for a long term disability or personal injury insurance claim. This is seen time and time again, whether a claimant is filing directly through through an employer, insurance broker, or personal health insurance company.

Unfortunately, decade trends show that it is not in the interest of an Insurance company to have to pay for any claim, therefore grounds for denial are often presented as being final and undisputable. There are many reasons why an insurance company may deny your short term or long term disability claim, but remember – Take a deep breath – you, like many others, are probably not at fault.

If you are considering writing a disability appeal letter on your own behalf, and do not have adequate legal representation from a disability claim lawyer, there is an increasing chance that an insurance company will deny your letter of appeal for your claim. They do not flinch to the little man. This again, is a quick attempt for insurance companies to disregard your claim and instill doubt, with hope that you will not proceed with an appeal.

We highly recommend contacting PW Lawyers in order to sort out the difficulties you may be encountering with the filing of your claim. In the long run, your disability claims process will, traditionally, be a less stress-inducing endeavour, and a quicker process given our years of experience with dealing with disability claims. Your role at this time is to focus on healing and obtaining financial and medical support.

A typical breakdown of the process leading to denied claims

After an initial claim has been submitted, your insurance company’s case manager, or, disability examiner, will review your submitted information. A file may contain items such as:

• Medical Records from Doctors, Hospitals, Clinics and Rehab Centres
• Medical Professionals visited by the Claimant
• Letters of Support & Authorizations for Sick Leave
• Medical Facilities visited by the Claimant
• Medical Report Forms
• Employer Forms

Below are a few forms from the Government of Canada you may have already submitted in your claims application:

• Claim for DI – Employee’s Statement Policy No. 12500-G (TBS 330-302)
• Claim for DI – Employer’s Statement Policy No. 12500-G (TBS 330-303)
• Claim for DI – Employee’s Medical Information and Attending Physician’s Statement Policy No. 12500-G (TBS 330-304)

The Initial Review of a disability claim – Denied

This is the lowest level of decision-making on behalf of an insurance company. This process usually takes two weeks at minimum. A manager, or, case representative, may request records from medical entities in order to verify your claim. Your case representative may also contact your employer to ensure the truthfulness of your statements.

It is at this point that PW Lawyers highly suggest you retain legal council and further your claim appeal process with legal representation and guidance. We do not want anyone to give up, feel defeated, and resort to disability loans.

After a claim is denied, you will be advised in writing about your Insurance Company’s decision, how they came to this conclusion, and whether there are further levels of appeal that you, the claimant, can pursue.

Regardless of the options of appeal presented by the insurance company, whether after the first claim denial, or denial at the final appeal process, this does not mean that:

1. The Insurance Company is in the right
2. You do not qualify for the financial and medical security and support that you should be receiving from the Insurance Company, after filing your claim

If your long term disability claim has been denied, or you feel that you or a loved one have been wrongfully denied long-term disability, then we highly suggest you contact a Disability Claim Attorney.

Further, if you have any questions or concerns regarding a filed disability claim, or how to begin the appeal process to a denied disability claim, PW Lawyers are here to help. Please Contact Us for any questions.

PW Lawyers highly suggest that you avoid disability claim internal appeals. You do not have to go through the insurance appeal process before you can contact a disability claim lawyer.

It is important to remember it is in an insurance companies’ financial interest to not supply you with the benefits and coverage you are entitled to, especially in during the time of healing.

If your long term disability claim has been denied, or you feel that you or a loved one have been wrongfully denied long-term disability, then we highly suggest you contact a Disability Claim Attorney.