Denied Long Term Disability? How to Appeal Your LTD Claim in Ontario?
If your long-term disability claim was denied, you’re not alone and you’re not out of options. Many employees are left wondering how to appeal a long-term disability claim that was denied, especially when the insurance company provides little guidance beyond a standard form letter.
Whether your claim was denied due to insufficient medical documentation or an insurer’s narrow interpretation of your condition, understanding the LTD appeal process is key to protecting your right to benefits. Knowing how to appeal a denied LTD claim, what timelines matter in Ontario, and why speaking with a disability benefits lawyer can help strengthen your case and preserve your legal rights is imperative when going up against an insurance company that has denied your LTD claim.
What is long term disability?
Most employees don’t know what disability coverage is until they need it. Through your employers group benefits policy, you’ll have coverage for short- and long-term disability (“STD” and “LTD”). Disability coverage is intended to provide you with income replacement if you become unable to work due to sickness, injury or illness.
How do I apply for long term disability?
A long-term disability application is submitted to your insurance company. You can request the application package from the insurer (ie: the case manager) and you’ll receive two forms, while your employer will receive one form. They are as follows:
- A Plan Member Statement form. This form is filled out by you (the employee). The form will ask for some background information, details of your job and the medical condition that is preventing you from working.
- An Attending Physician Statement. This is a form to be completed by your doctor. The form asks your doctor to fill out particulars about your medical diagnoses, treatment and anticipated recovery.
- The Plan Sponsor Statement is a third form sent directly to your employer. The form asks your employer about your salary, details of your job and hiring date.
Once you’ve submitted the completed forms, the insurer will decide on your LTD claim.
What to do if your long term disability claim was denied
If your insurance company has denied your LTD claim, the reasons for the denial will be outlined in the denial letter provided to you. Near the end of the letter, there will be information on some options for next steps. If the letter is drafted properly, you should see a section outlining steps to appeal and you’ll also see a section noting the Limitations Act, 2002.
How to appeal my LTD claim denial?
To appeal or not to appeal, that is the question. The LTD denial letter will provide steps on how to appeal the decision to deny you LTD benefits. If you elect to appeal the decision, you’ll need to submit further medical information in support of your condition and hope it is enough to overturn the original denial. Appeals must be delivered to the insurer within a specific time. The denial letter will outline how much time you have to deliver an appeal.
What are the Limitation Periods to Appeal an LTD claim in Ontario?
In Ontario, you have two years from the date of denial to legally pursue a claim against your insurer in challenging the denial of your benefits. Once that initial denial letter is delivered, the clock starts on the two years. To ensure you preserve your rights to pursue a claim against the insurer, speak to an experienced disability lawyer who can advise you appropriately of your rights.
Why should I contact a disability insurance lawyer?
Appeal reviews are often conducted by the same case manager who originally denied your LTD claim. Depending on how much time has passed, appeals may impact your ability to legally pursue your entitlement to benefits. Going up against an large insurance company can feel overwhelming, especially when you are already not well. Speaking to a experienced disability lawyer could make all the difference.
The disability legal team at Whitten & Lublin offer free consultations for short- and long-term disability claims. If your STD or LTD claim has been denied and you are considering an appeal, contact us. If your LTD claim has been denied and you are unsure if you are within the time frame to appeal, call us, we can help. Take back control with the help of our disability team in your corner. Contact us online or call 416 640 2667.
Author – Aman Chaggar