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.
Dealing with insurance companies can be frustrating. This is particularly true when you are also dealing with the loss of a loved one. Life insurance policies are often purchased by individuals in order to provide financial security for their loved ones in the event of untimely death. Life insurance is supposed to give peace of mind. Sometimes, however, life insurance companies delay or deny payment on valid claims.
In Ontario, life insurance providers sometimes deny benefits on the basis that the deceased made misrepresentations in the application for insurance. In particular, when a person dies within two (2) years of purchasing a life insurance policy, the insurance company may investigate to determine whether the application for insurance was accurate and truthful. The life insurer will review medical records of the deceased and look for any inconsistences between the medical records and application for insurance. Although an insurer may argue that just about any inconsistency voids the insurance policy, this may not be the case.
If a life insurance company has denied the policy and refunded the premium, you should immediately contact an Ontario insurance lawyer for an opinion. An Ontario lawyer with expertise in insurance law can review the life insurance policy and provide you with an opinion about your rights. There are deadlines in insurance law and, as such, the wait-and-see approach can be detrimental to your rights.
Iacobelli Law Firm recently recovered on a life insurance policy that had been denied by the insurer, on the basis that the deceased had made misrepresentations in her life insurance application. The life insurance company investigated the deceased's application and medical records for more than 2 years before finally denying the claim. With the assistance of our firm, the life insurance company agreed to pay the entirety of the life insurance proceeds plus additional money for interest and costs.
If an insurance company is leading you on, delaying or denying your insurance claim, contact Iacobelli Law Firm for a free consultation.
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