Denied Claims/Appeals

Contracts of insurance come with a duty of good faith. This means the insurer must consider claims promptly and fairly. There is also an obligation on the insured person, to fulfill legitimate requests from the insurer for documentation related to the claim. Claims are often denied for reasons such as “insufficient medical information,” that the “applicant is not disabled,” or the applicant made “misrepresentations in the insurance application.” When a denial is issued, the insured person has the right to know why and the right to appeal.

Appeals are often pursued with legal assistance. A lawyer is usually best able to pinpoint what went wrong and advocate for the insured person’s needs. Since initial appeals are often just to another staff member of the insurance company, it is useful to contact a lawyer early. Representation will be required if the denial is upheld, and the claimant has to take the insurance company to court.

Taking Steps Toward A Successful Claim

Since the duty of good faith goes both ways, it is important to provide the insurance company with the information they ask for. If any of the company’s requests make you uncomfortable, ask your lawyer if they are appropriate. In general, however, claimants must provide completed physician’s statements and additional medical information as requested. This can include why the doctor feels the person is unable to perform the work he or she was doing before. Even after a denial, it is important to keep giving the insurer medical information, since the insurer has a legal obligation to consider it.

Contact Us

If your long-term disability claim was denied, our appeals lawyers in Toronto may be able to help you. To schedule a free consultation, call us at 416-703-2077 in Toronto or 1-888-215-5319 toll free in Ontario or send us an email.