How To Respond To Denial of Long-Term Disability Benefits?

When someone that has purchased a long-term disability insurance policy becomes disabled, then he or she expects to obtain coverage from the insurer. If that same policy holder is then denied that coverage, he or she might want to take some quick action. Unfortunately, that might only result in delaying resolution of the problem.

Why lawyers caution against making an immediate request for an appeal:

The appeal sought from an insurance agency is called an internal appeal. The policy holder that decides to pursue that route simply asks for a second opinion from the same people who have issued the denial. The chances for the decision being reversed are quite small. Because the chances for reversal of the initial decision are small, the act of seeking an appeal causes further delay. It increases the amount of time that must pass before the problem gets resolved.

Most denials come in the form of a letter. That letter does not explain why the disability benefits have been denied. It becomes difficult to seek and win an appeal, if you have no idea why the benefits were denied in the first place. In order to win an appeal, the person seeking benefits should know the exact terms of the policy issued by the insurance company. Someone that cannot study those terms has little hope for winning a request for a second opinion.

A denial of long-term disability benefits normally follows a look at the report from the doctor that has examined the policy holder, the person seeking those benefits. Unfortunately, a denial letter never offers any clues as to what that doctor has said. In the absence of those sorts of clues, it becomes hard to fight for a reversal of the insurance company’s decision.

The approach suggested by lawyers

Accident Lawyer in Vancouver have become familiar with alternative methods for seeking the reversal of a decision made by a company that has sold a client a long term disability policy. That method may involve pursuing an external appeal. That means initiating a lawsuit against the company that sent the upsetting letter.

Why would an external approach be better than any internal appeals? In a courtroom, a lawyer for the denied policy holder can question the insurance company’s readiness to show good faith towards its policy holder. In a courtroom, an attorney should be able to present gathered evidence, such as the terms of the policy and the opinion of the doctor that did the examination. Ideally, that attorney would also have learned the exact reason for the initial action (denial). Such evidence should work to aid in creation of a stronger case. A plaintiff has a better chance for winning a stronger case.