A denial letter is not the end of the claim. It is the start of a different process, and what you do in the first few weeks matters more than almost anything that follows.
This page explains what the letter actually is, what to gather, and what the realistic options are. If you would rather just talk it through, call 905-409-2438.
First, read what the letter actually says
Denial letters are rarely a simple no. They usually say one specific thing, and the thing they say determines everything about what happens next. Look for which of these it is:
- You do not meet the definition of disability in the policy. This is a dispute about the policy wording and the medical evidence, and it is the most common.
- The medical information is insufficient. Sometimes this is a genuine gap that can be filled. Sometimes it means the insurer did not ask the right people.
- A pre-existing condition or an exclusion applies. These turn on the policy text and the dates.
- You missed a deadline or did not cooperate. Often fixable, but not by waiting.
- You were approved and then cut off. That is a different situation, covered on our page on benefits being cut off.
Get three documents before you do anything else
- The full policy or booklet, not the summary. The definition of disability is the whole case, and summaries leave it out.
- The complete claim file. You are generally entitled to ask the insurer for the file it used to make the decision, including any medical opinions it obtained.
- Your own medical records from your family doctor and every specialist you have seen.
We request all three as a matter of course, and we pay for them as the case runs rather than asking you to. In most cases we arrange insurance that covers those costs if the claim is unsuccessful.
The internal appeal question
Most insurers invite you to appeal internally. An internal appeal is sometimes worth doing, and I have had claims reversed by nothing more than a letter from my office. But an internal appeal is not a court proceeding, and it does not stop the clock on your right to sue.
How long you have
The deadline to start a lawsuit on a disability policy depends on the wording of your policy and on the date your claim was denied. It is the first thing we check, and it is not something you should have to work out on your own. Exceptions may apply – legal advice is strongly recommended for your particular situation.
What it costs to find out
Nothing. The first conversation is free, and in disability cases I try to reach a fee arrangement that makes sense for the client as well as the firm. I have waived my fees in past cases where a denial was reversed after an initial letter from my office. I will also never pressure you to take a cash out instead of reinstatement.
For qualified long term disability claims with considerable ongoing benefits at stake, we will often reduce our contingency fee to 25%.
Our full fee schedule is on the Fair Fees page.
Read more
- Long term disability: the main page
- When your long term disability application is denied because it is late
- Long term disability insurance claim denied, here is what you should do
- Benefits approved, then cut off
Speak to a lawyer about a denied disability claim
Initial consultations are free. Our fee schedule is published in full, by stage of the case, on our Fair Fees page. Call 905-409-2438, send a text, message us on WhatsApp, or use the contact form.
Steven Polak is licensed as a lawyer in Ontario and practises with Lerners LLP at 123 Athol Street, Whitby.