If an insurance company has denied your request for long term disability benefits, you seek either an internal or an external appeal. A policy holder should know something about each type of appeal, so that he or she can make a sensible choice.
What happens during an internal appeal?
A new agent from the same insurance company reviews your claim. Unlike the external appeal, there is no involvement of an outside party. If a first internal appeals prove unsuccessful, it is possible to appeal to an arbiter, or to the courts.
What factors might suggest that it would be better to appeal to an arbiter or the courts, rather than to seek a second internal appeal?
Injury Lawyer in Kitchener may ask to review your application. Is there any section that contains vague information? An insurance company might deny a request for long term disability payments if the required form does not offer complete answers to every question.
Study the medical information. Does it contain any obvious gaps? An insurance company might suspect that such a gap represents an attempt to cover-up the existence at that time of a medical problem.
Does the application reveal the fact that you failed to follow-through with all of the doctor’s recommendations? Does it indicate the you failed to get the requested treatment? If that is the case, then that fact probably explains why you lost that first internal appeal.
What you should do if you have discovered the presence of any of the listed factors?
In that case, you should try to correct them. Fix the vague sections so that they offer more clarity. Fill-in any gaps in the medical information. If possible, arrange to receive the requested treatment, or any scheduled test. Add the results to your application.
If you want to pursue a second internal appeal. Send the corrected application to your insurance company.
What should you do if you cannot correct the mistakes in your application?
If that is the case, then you should not pursue a second internal appeal. Speak with your lawyer about scheduling a meeting with an arbiter. Alternatively, talk with your attorney about fighting the insurance company in court. That might be your best course of action.
Remember that at the end of a trial, a jury will make the decision. The jurors are as unfamiliar with the practices in the insurance industry as you are. Their views will tend to be more objective than those of a reviewer that works for the insurer. Also, at a trial, your lawyer may elect to place a medical expert in the witness stand. If that is the case, that expert should be able to erase any confusion that was caused by vague answers.