LTD, or long term disability, insurance is an income protection policy designed to cover severe injuries and illnesses that prevent you from working for three months or longer.
Permanent disabilities that leave you unable to return to work are included.
However, approximately 40% of applications for disability insurance are declined, rated, or are only accepted with an exclusion.
If you are one of the 40 per cent, this might leave you with a problem.
Claims are denied due to missing medical records, legal technicalities, or conflicting evidence collected during your insurance company’s investigation of your claim.
Let’s take a quick look at what you should do if your LTD claim is denied or challenged by the insurance company.
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Know Your Adversary
Insurance companies exist for one reason: To make a profit for their shareholders.
It is worth bearing this in mind when you enter the arena of denied claims.
It is a well-known fact that insurance companies use several tactics to extract information from you, which they later use to deny your claim. This includes telephone conversation recordings and forms they require you to complete.
There is an in-house appeal process for denied claims. However, the insurance company’s appeal process is biased and unfair. Therefore, you need to be aware of this inherent conflict of interest.
Get an Attorney to Represent You
It is a good idea to appoint an LTD lawyer to assist you with your appeal. These LTD lawyers are highly specialized and experienced and will do their utmost to achieve a reasonable settlement for you.
If you consider taking out LTD insurance, the best thing to do is consult with an attorney before entering the agreement. This improves your chances of having a robust LTD insurance policy which is not easily denied when you need it the most.
Steps to Take After a Denial
Firstly, it’s a good idea to see a lawyer as soon as possible.
To assist your lawyer, you might be able to provide them with the following:
- A denial letter from the insurance company
- The deadline before which you must appeal
- Documents, medical information and other evidence to support your appeal
Discuss your appeal options and decide which is best for you.
- Options may include:
- an internal appeal or administrative review,
- appeal hearing or arbitration (if your workplace is unionized),
- commencing litigation.
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What Will Your Lawyer Do?
Your attorney will assist you throughout the appeals process and go some way towards leveling the playing field.
Such assistance includes:
- Ensuring all deadlines are met.
- Advising you on the probabilities of a successful appeal
- Leveraging their experience of appeals to maximize your chances of a successful appeal.
- Amassing the correct evidence to overcome the denial or exclusion.
- Litigating if necessary.
Many LTD claims are initially denied.
Consult with a specialist LTD law firm to ensure your best chance of challenging the denial and getting a reasonable award.
Nearly all LTD denials are settled long before the matter gets to court. So see your lawyer, get advice on probabilities, and then act.