Long term disability claims –
Appeals and Legal Action
Vancouver Long Term Disability Lawyer
BC Insurance Claims Law Firm
Call us today for a free consultation 604-684-4300
Vancouver & Surrey Offices
Reasons (or excuses) for why the insurance company has denied your claim
If your claim for disability benefits has been denied, you have probably received a letter from the insurance company. The letter probably states that your claim was denied for one of the following reasons:
- There is not enough medical evidence to support that you are totally disabled
- A more detailed medical report is required from a doctor setting out information to support your claim for disability
- You are capable of doing the duties of your “own occupation”
When reviewing the reasons why your claim was denied, it is important to remember the following:
- Insurance companies are a business. They are in the business of making money.
- Insurance companies lose money when they pay out disability claims
- It is easy to find a “reason” to deny any claim. If an insurance company can find a reason to deny your claim, they will do so.
Appeals
The insurance company has likely told you that you can appeal their decision. In our experience, these appeals seldom work. Remember, the appeals process is not independent and objective. The appeals process is run by the same insurance company who denied your claim. The insurance agent who decides the appeal is paid by the insurance company. In other words, the appeals process can often by biased and unfair.
It is also important to remember that the appeals process is not legally binding. In this process, the legal system is not involved. There is no impartial judge to look at your evidence objectively and come to a fair decision.
The Importance of Legal Action
If your disability claim has been denied, it is important to hire a lawyer and take legal action against the insurance company. In other words, suing the insurance company may be your best chance of getting your disability benefits paid.
Suing the insurance company puts pressure on them
Suing an insurance company gives you leverage. You put pressure on them by forcing the insurance company to start incurring costs. When you sue them, the insurance company has to hire lawyers and start paying out money to defend the claim. In many cases, the insurer may find it easier and more cost effective to simply pay out your benefits rather than spend thousands of dollars defending against your legal action.
A Fair assessment of your claim
Suing the insurance company also results in a more fair assessment of your case. Once you take legal action, the insurance company is forced to weigh the pros and cons of your case more objectively. They know that if your claim is not paid fairly, they may be forced to go to Court and explain their decision to a judge. Insurance companies do not want to be accountable to a judge in Court. As such, in most of our cases, suing the insurance company forces them to pay out disability claims.
Forcing the insurance company to answer tough questions
Legal action is also important because it gives you an opportunity to force the insurance company to answer questions about why your claim was denied. Normally, you speak to someone on the phone or via email or letter. When that happens, the insurance company may feel they can say whatever they wish. However, when you sue the insurance company, your lawyer gets an opportunity to question the insurance agent who denied your claim under oath. This means that the insurance agent must swear to tell the truth and honestly answer direct questions asked by your lawyer, face-to-face. Through this process, you get an opportunity to hear the insurance agent try and explain why they made an unfair decision. Your lawyer can ask tough questions that you want answered.
Punishing the insurance company
If you have been treated very badly by the insurance company, the legal process can also be used to punish the insurance company and get you more money. Every insurance company is obligated to treat its customers with good faith when making decisions to deny claims. If your claim was denied in a high handed manner, or if you were treated very unfairly, you may be entitled to legal award for bad faith insurance dealings. Again, one can only get this award if they choose to sue their insurance company using an experienced lawyer.
Suing the insurance company: Will I have to go to Court?
Just because you sue the insurance company on your disability claim does not mean you will have to go to Court. We take legal action against insurance companies in most of our cases. However, even though we sue the insurance companies, the vast majority of these claims settle without the need for Court. In other words, suing the insurance company helps put pressure on them to settle the claim but it does not automatically mean you will have to go to Court.
Limitation Periods: Early action and Legal Advice are Important
Many people do not realize that there is a very limited time to sue an insurance company which has denied a claim. In British Columbia, there are limitation periods which state that you only have a set amount of time to sue. If you fail to sue the insurance company within the applicable limitation period, they are no longer obligated to pay your claim. You may be left with nothing if you do not sue quickly.
Remember, the appeals process of the insurance company is completely separate from the limitation period. In other words, while you are appealing with the insurance company, the clock is running on your time period to sue. If your disability claim has been denied, it is imperative that you speak with a lawyer as soon as possible to ensure you know when your limitation period expires.
Vancouver Long Term Disability Lawyer
BC Insurance Claims Law Firm
Call us today for a free consultation 604-684-4300
BACK to: Vancouver Long Term Disability Lawyer main page
Author: