The Disability Insurance company has denied your claim, and they have told you that you can appeal the decision: What do You Do Now? Unfortunately, the so-called "Appeal" is with the same disability insurance company that has already denied your claim on the first go. This really is not much of an appeal process, as you will not have an independent adjudicator reviewing the file and determining whether the Disability Insurance company acted appropriately or not. In our experience, when a person is denied disability benefits, the decision is rarely overturned where the person attempts an appeal on their own. Disability insurance companies are experienced in reviewing claims and determining those circumstances where a claim may be denied. The denial of claims saves thousands of dollars for the Disability insurance company. Those applying for disability benefits may feel that their claim has merit, and they are genuinely disabled and unable to continue working. Unfortunately, this is not always enough to be successful in a disability claim. That is why an appeal of the denial, without more, is rarely successful.
At its core, the disability claim is seeking to enforce a contract. In exchange for premiums paid on the policy, the Disability Insurance company has promised to pay benefits where specific conditions are met. It is all in the details of the policy. In order to be successful, you must be familiar with the terms of the policy and the conditions upon which the insurer is responsible to pay. That is why a disability insurance claims lawyer can be so helpful in the process. We can review the circumstances of your disability, and look carefully at the terms of your contract to assess the strength of your claim. With the right guidance and information, our experience has been that claimants are ultimately paid for their disability claim. Of course, every case and circumstance is different and that is why it is important to have a lawyer look at the particular details of your claim.
To learn more about your rights following a denied Long Term Disability claim, or for a FREE CONSULTATION with a disability claims lawyer call us at 416-900-1070. We help with disability claims throughout Ontario.
In the context of a disability insurance policy, the term "total disability" usually does not mean that the person is completely incapable of carrying on a normal life. Although insurance companies will often stress the significance of totally disabled, the test is not as restrictive as they may have you believe. Instead, a total disability refers to the person's ability to engage in the essential or important tasks of employment or occupation. In disability insurance policies, total disability will depend on the contract definitions.
Often, in the first two years following the onset of a disability, the test for total disability may focus on the person's ability to perform the duties of their own job. The test for total disability may be met if the person is unable to perform the important or essential parts of their own occupation.
Following the first two years, the test may change to be more restrictive. Often, to obtain disability benefits beyond two years, a total disability may be established where the person is unable to work in any occupation for which they are suited by education, training or experience.
There are many court decisions interpreting the meaning of a total disability for a person's own occupation and any occupation. If an insurance company has declined disability benefits, you should consult with a lawyer about your rights. Iacobelli Law Firm may be able to assist you in recovering disability benefits if you have been unfairly denied benefits. For a FREE, no obligation, Consultation call us 24/7 at 1-866-234-6093 or complete our online contact form here.
Ontario personal injury lawyer, Andrew Iacobelli, has dedicated his practice to helping individuals and families that have sustained serious personal injury as a result of an accident, or who have been denied insurance benefits. If you or a loved one has been seriously injured as the result of an accident, or if you have been denied insurance benefits, you may have a claim. Andrew Iacobelli serves Toronto and the GTA, including Bramptom, Mississauga, Scarborough, Thornhill, Richmond Hill, Vaughan, Woodbridge, Newmarket, and Aurora Ontario.