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The answer is that it depends on your circumstances. You may want to head straight for the legal system if your deadline is fast approaching. However, if you don’t mind dealing with the insurance company for eternity and want to receive monthly payments, then an internal appeal is your best bet.
You may get a buyout offer from the insurance company after submitting an LTD application. Don’t act upon it without first consulting a personal injury lawyer. That offer tends to be a very small portion of the actual settlement that you can win if your case goes to court and you win. As deadlines are always ticking when you’re appealing your denial. So, there are some things that you should understand about the injury law process timeline.
There are some times when you have to go through the formal court system and hire a lawyer if you want your initial denial to be reversed:
● A doctor from the insurance company examined you. You need to fight the decision based on this evidence since it may be biased. Also, keep in mind the insurance company won’t reverse their initial decision once they have what they feel is sound evidence to back it.
● There is a technicality like a pre-existing medical condition or a missed deadline. There is no way an internal appeal will get you out of this one.
● The insurance company claims that you are not under medical care.
Limitations Act
Ontario has shorter time limits than the rest of Canada. The thing is that some cases in Ontario may be subject to the 2-year deadline since they’re governed by a different set of rules.
Steps to Take to Start Your Appeal
• Find your letter or get a copy of your denial letter
• Get a copy of your insurance policy
• Get a copy of your file from your insurance company
• Hire a personal injury lawyer – it would be in your best interest to do so
• Figure out the exact reasons for the claim’s denial
• Make sure to provide the information that your initial application didn’t have
• Hire independent experts
• Get a functional capacity report
• Get a vocational expert report
• Get a medical expert report – it will help support your disability
• Get the extra evidence that will overturn your initial denial
• Missing medical records
• Extra medical tests
• Written statements from your doctors
• Make sure that certain parts of your claim are clarified when necessary
You will need to include testimonies from nonmedical experts such as your friends, family, co-workers and vocational experts. The vocational experts are invaluable since they can provide insights into what people with your disability can and can’t do.
Use Supporting Evidence to Build Your Case
• To appeal for your disability claim, you will need to
• Clarify the functional limitations of your disability
• Clarify your job’s requirements
• Explain how your disability prevents you from doing your job properly
• Give new evidence to further describe your diagnosis
You should hire a good personal injury lawyer in Sudbury to help you review your case and determine if your deadline is nearing. Remember that you usually can’t file a case once the deadline has passed.