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You need to fight for your disability rights and appeal OTIP's decision if you find yourself facing any of the following:

  • OTIP LTD termination
  • Denied OTIP LTD claim
  • Facing an OTIP RAEO Denial

If you are already in the midst of an OTIP LTD appeal, we highly suggest you contact a disability lawyer to speak about your case. The appeal process is the pivotal last step you can take in pursuing your required disability benefits. If you mismanage your appeal, whether be by a filing error or lack of proper evidence, your disability case may be prematurely closed and you will have to start the claims process all over again. Not only will this put a delay in your access to benefits, but this will be financially, emotionally and physically draining. A long-term disability lawyer will be able to properly assess your disability claim, OTIP insurance policy, and the claim process you have already been through. No matter what stage of the OTIP LTD appeal process you are in, a disability lawyer can greatly aid your case and bring important insight that will ensure maximum benefit payout.

A long-term disability lawyer who has a thorough understanding of OTIP LTD Appeals, and the OTIP LTD claims process, will be able to successfully address any technicalities presented in your case and before an administrative law judge. A long-term disability lawyer will represent you in the appeals court and get you the results you are looking for, without the exhaustion and defeat that a self-represented claim can bring. Whether be through litigation or arbitration, a long-term disability lawyer is the best choice.

Article Overview

In this article, we will talk about the OTIP LTD Appeal process, as well as the next best steps you should take if your OTIP LTD benefits have been denied or terminated.

If you have any questions or concerns about a denied OTIP LTD claim, or the LTD appeals process, do not hesitate to contact our firm. Our long-term disability lawyers are ready to offer our insight to any Ontario teacher who has had their disability rights violated. Whether you are in a remote part of the province, a small town or major city, we will fight for what is rightfully owed to you in a time of a sudden illness or injury.

OTIP LTD Denied / OTIP LTD Termination

When you submit an OTIP LTD claim, and a decision has been made, OTIP will provide you with a written notice of assessment. In this letter, you will be informed:

  1. If your OTIP LTD benefits have been approved or declined.
  2. Whether further information is required to properly assess your claim
  3. If you are facing an OTIP LTD denial, or an OTIP LTD termination, the reasons for such will be outlined in the letter along with what course of action you can follow for an OTIP appeal.
  • If you were already receiving OTIP LTD benefits, and have received a "Notice of Benefit Termination", OTIP must provide you with one month's written notice before your actual OTIP LTD termination takes effect and your benefits suspended.

OTIP LTD benefits are denied or terminated for a number of reasons:

  • Incomplete filing process (missing required claim forms / documents)
  • Clerical error, such as misspelling a doctor's name, incorrect dates or policy number
  • Missed deadline or incorrect adherence to filing timelines
  • Insufficient evidence (such as medical documents) validating the legitimacy of your LTD claim
  • Identified misrepresentation or case of false evidence
  • Dispute over the definition of "disability"
  • Injury or Illness is exempt from the policy's terms and conditions for benefit access

If your OTIP LTD claim has been denied or your are facing an OTIP LTD termination because of a clerical error (ex.missing form), you can typically remedy this situation easily on your own. If your OTIP policy representative requests that you supply more extensive medical documentation, be sure to supply such to OTIP in a timely manner.

If your OTIP LTD claim was denied, or you are facing an OTIP LTD termination due to a dispute over the definition of "disability", or because your injury or illness is exempted from your OTIP LTD policy coverage, speak with a disability lawyer as soon as possible. This may be a technical tactic played by OTIP to deny your claim, but could be argued against and pursued as a wrongful denial of disability benefits.

Many claims that have been filed properly - following OTIP deadlines, have all completed forms, and medical documents that the OTIP LTD claims process requires, are still denied. Regardless of an abundance of evidence and doctor statements, Ontario teachers with valid OTIP LTD claims are still denied and have the validity of their disability scrutinized. This is unfair, and unjust, but happens regularly.

OTIP does not differ from any other insurance company; their primary concern is to save and make money. If they were to grant every LTD claim that is filed, they would have to pay many policy holders for extended periods of time. They are not interested in paying out policies based on their terms and conditions; they are looking to dissuade as many valid claims as possible and still receive monthly premiums.

Insurance companies will wrongfully deny claims and terminate benefits by imposing rather convoluted barriers in front of claimants to dissuade any further pursuit of disability benefits, or to settle on a smaller amount than what is rightfully owed to claimant. A long-term disability lawyer will be able to properly assess your claim and OTIP's reasons for denial, identifying any wrongdoing, as well as the benefit amount that should be legally owed to you at this time. Insurance companies make your denied disability claim a priority when it is represented by a professional and experienced lawyer. Disability lawyers, especially those specializing in long-term disability, will pursue damages on behalf of a claimant who has been mistreated by their insurance provider during the duration of their LTD claim. If an appeal results in further denial, a disability lawyer will launch a lawsuit against your insurance provider to escalate the matter even further.

From the beginning to the very end, a good long-term disability lawyer will fight for your rights and what is rightfully owed to you as a result of a denied OTIP LTD claim.

Before You Start An OTIP Appeal

If you are considering to appeal a denial of benefits from OTIP, speak to one of our lawyers before initiating the appeals process. We will offer insight regarding the quickest and easiest way for you to get access to the benefits you deserve; this may not require you to engage in an appeal. If an OTIP appeal is identified as being the best route to your benefits, our lawyers will be able to identify the needed evidence for your case and have the resources to collect such in a timely manner.

It is also important to our firm that we make sure our clients have an ongoing and stable financial and social foundation during the duration of their case. We will make sure you and your family have proper support during this time, as well as receive the needed medical care (physical and psychological) you require as a result of your illness or injury.

OTIP LTD Appeal Notice

DO NOT meet for ANY of the following, as per an OTIP Disability Specialist during an appeal process, before speaking with a disability lawyer:

  • an "Independent Medical Evaluation"
  • Vocational Expert ("A Functional Abilities Evaluation")
  • Medical Consultant Review

The medical and vocational "experts" who you will meet with are hired by OTIP (an insurance company) to find reasons to further deny your claim. They are hired by OTIP to save OTIP money and meeting with them prior to seeking advice from an experienced LTD lawyer can harm your case and dislodge your pursuit for benefit access. A disability lawyer should be contacted as soon as possible if you are in a disability appeals process for an OTIP LTD claim and are asked to take part or provide any of the items listed above.

OTIP LTD Appeals Process

When you receive a denied OTIP LTD claim / termination of OTIP benefits, and wish to dispute an OTIP denial of all or part of your insurance/benefit, you have the right to file an appeal:

  1. An appeal must be first submitted in writing and sent as a registered letter. This OTIP appeal letter must be sent within two years after notice of an OTIP denial and needs to include the policy holder's reasons for believing that the denial of benefits is incorrect.
  2. Your letter for appeal will be reviewed by an OTIP appeal committee. The OTIP appeal authorities will approve claims on a one time, without prejudice basis, or they will stand by the initial decision for denial/termination.

If you receive a second denial of benefits, after appealing an OTIP LTD denial or OTIP LTD termination, speak with an LTD lawyer as soon as possible. If indeed, you are disabled and need the provided disability benefits offered through your OTIP policy, then we can represent your denied claim / termination and legally pursue your LTD disability benefits on your behalf through litigation or arbitration.

Contact Our LTD Lawyers for a Free Consultation

Our LTD lawyers a have thorough understanding of insurance law and the disability rights of Ontario teachers and policyholders of OTIP. We have successfully represented:

  • Denied LTD claims
  • OTIP LTD termination
  • OTIP Appeals
  • OTIP RAEO disability disputes

We provide personalized and professional legal services and representation for any type of OTIP appeal, at any point in the appeal process. Our lawyers have the legal esteem, knowledge and experience to successfully represent your OTIP LTD claim. We work on a contingency fee basis and do not require our clients to provide a retainer or ongoing payments during the duration of their case. We only get paid when a settlement is successful - we are ready to take on that risk.

Contact our OTIP LTD specialists today; PW Lawyers is always there for you.

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otip OTIP Appeals & The OTIP Appeal Process for Long Term Disability Claims Long Term Disability Lawyer Toronto & Disability Lawyers, Ontario

Paul Wilkins

Principal Partner

Paul is a member of the Ontario Trial Lawyer’s Association and the Advocates Society. Frequently involved in pursuing his clients’ claims, his areas of focus include statutory accident benefits, short term and long term disability benefits, disability claims and Canada Pension Plan disability benefits.

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