A Step-by-Step Guide to Appealing a Disability Denial in Canada
Has your disability claim been denied? Are you in panic mode wondering what your next move should be? Are you still getting benefits, but worried they could be cut off soon? Are you in the process of appealing a disability denial?
If this sounds like you, then you are in the right place. In this article, we give you the big picture about what is involved in appealing a disability denial.
Finding out your disability claim has been denied is like getting punched in the stomach. Many people are caught off-guard because they know they are legitimately disabled and assumed their claim would be approved. Once the denial sinks in, panic mode begins; however, blindly charging ahead with your appeal is rarely a recipe for success.
Before we get into the steps you should follow, it is important to keep in mind that successfully appealing a disability denial is very much like solving a difficult puzzle. You have to identify the missing pieces and figure out where they fit in to your overall claim and appeal.
Finally, the following steps are a based on on our Resolute 4-Step Disability Appeal System. This is the system we when appealing a disability denial for our clients. We believe our Disability Appeal System maximizes the your chances of success.
1. Gather critical documents and information about the appeal denial
You need to understand why your claim was denied. You do this by gathering as much information as possible about the claim denial. You want to gather as much of the following information as you can:
- denial letter from claim representative, with written reasons for denial
- copy of the insurance policy, rules or regulations that govern the appeal process
- copy of the disability benefits providers internal claim file
Gather as much information as you can about the denial. You need to get written reasons for the denial. Where possible you want to get a copy of the disability claim representative’s claim file, so you can see all the information they have, which you don’t know about.
2. Enforce your ongoing sick leave status with your employer
Some employers will try to take advantage of the fact your disability claim has been denied. Even though you are appealing a disability denial, they will demand that you return to work, or threaten they will view you has being on an unapproved leave.
You can stop your employer’s bad behaviors immediately by having your doctor write a letter to your employer confirming that you are still disabled from work. Once you doctor has confirmed you continue to be disabled, your employer must continue to recognize you are on disability or sick leave, regardless of insurance company’s decision to deny your claim.
3. Identify other disability benefits you could apply for
Take stock to see if there are any other disability income benefits you can apply for while you are appealing a disability denial. Employment Insurance Sickness Benefits are a common benefit that is available to people who have had a denial of disability insurance benefits or workers compensation benefits.
4. Take stock of your financial resources
No one wants to do this, but you must plan for the worst. Take stock of your expenses, savings other income sources to figure out how long you can last while this appeal is ongoing. Don’t assume that the appeal will be overturned quickly. You may have to make hard choices like using up savings, RRSP, selling your house, etc. Appealing a disability denial can take several months so you need to have a plan for how to survive.
5. Identify the deadline to do your appeal
Some appeal deadlines are soft (no big deal), while other appeal deadlines are hard (miss them and you are screwed). You need to figure out the deadline for your appeal. The deadline is usually written on the denial letter you received. If it isn’t there you have to call your claim representative to ask them to confirm it for you in writing.
6. Analyze the claim documents to identify the gaps you need to fill
The most effective way to appeal a disability claim denial is to identify the gaps in the information and to then go about filling those gaps. Unfortunately, this is easier said than done.
Common gaps that need to be filled are as follows:
- clarifying a medical diagnosis
- clarifying functional limitations
- clarifying information about job requirements or physical demands
- providing copies of records or reports from other treatment providers
- obtaining new medical evidence
- obtaining information from co-workers or family members
- clarifying your work history
7. Decide on a Game Plan for your appeal
There is no one-size-fits-all way to appeal a disability denial. Depending on your situation, and the type of disability claim you are appealing, you will want to prepare a custom game plan for your appeal. The Game Plan involves both the strategy and the tactics you plan to use with your appeal. You must customize both if you want to maximize your chances of winning.
The key parts of an Appeal Game Plan are as follows:
- what is the theme or story of your claim
- what is the best venue to do the appeal (if you have a choice of venues)
- what is the best ways to get the supplemental information needed to fill the gaps you identified
8. Execute the Appeal Game Plan
In this stage, you go about gathering the information and medical documents. You prepare written submissions for your appeal. Written submissions should explain how you have filled the gaps and show why the previous reasons for denial no longer apply.
9. Wait for the a decision on the appeal
Once you have submitted your appeal, you will normally get a response in 30 days or less from most disability plans and programs. Normally, you will get an appeal decision much faster than the original claim decision. Sometimes the appeal is handled by the same claims representative and sometimes it is sent to another claim representative in the organization.
You will get a decision that the appeal is denied, which means you lose again. Or they will say that the appeal was allowed, which means you won!
Still Feeling Unsure About Your Disability Appeal? Sometimes a quick call with us can answer your concerns and help you move forward with confidence. Call us now at 888-732-0470 for a free consultation or click here to book online.