Before the denied applicant takes any obvious action, he or she should sit down and study the insurance company’s denial letter.
It should give the company’s definition for a disability and list the policy provisions. Additionally, it should give the reason for the denial. That part of the letter ought to receive the largest amount of concentrated study.
The letter should mention any facts in the medical report that served as a basis for the company’s denial of disability coverage. Note the date on which the letter was written. That is the date that the insurance company will use, when setting the deadline for an appeal.
In Ontario, someone that has been denied disability benefits has the chance to pursue 2 different types of appeals.
The internal appeal: The insurance company agrees to take another look at the denied claim. It makes sense to pursue an internal appeal, if the original application had some missing or confusing medical information, and it would be easy to add to or alter the information in that original application.
An external appeal: Case gets viewed by impartial observer. That observer has a neutral opinion, as to whether or not the applicant gets deemed eligible for disability benefits. An external appeal is recommended, if the insurance company has already had their doctor examine the applicant that was then denied the opportunity to receive disability benefits.
If an appeal proves unsuccessful, it may be necessary to sue the insurance company. At that point, the steps to take depend on the nature of the representation available to the initiator of the lawsuit. If the initiator is the member of a union, then he or she will be represented by the union. There will be a tribunal hearing.
If the initiator of the lawsuit is not member of a union, then it would appear that a trial needs to be scheduled. Although not every applicant for disability benefits realizes this fact, the finding of the examining doctor does not have to be the final word. That finding can be challenged. That is one of the purposes of a lawsuit against an insurance company.
The role of the lawyer for the denied applicant.
The Personal Injury Lawyer in Vaughan should support that applicant as the application gets completed, and when an examination gets scheduled. A lawyer can accompany the applicant to the examination by the insurance company’s doctor. The lawyer’s chief role should concern explaining how to proceed, following receipt of a denial letter.
In the absence of a clear explanation, the applicant may feel compelled to return to the workplace. Then the lawyer’s role changes. It concerns communicating with the human resources department, in anticipation of problems, due to the job-related challenges.