Denial of long-term disability (LTD) benefits can be a significant setback, especially when you are relying on these benefits to support yourself and your family during a period of illness or injury. While appealing the insurance company’s decision is often the first step, if that proves unsuccessful, filing a lawsuit against the insurer might be the next necessary step.
Understanding the Basis of the Lawsuit
When filing a lawsuit against an insurer for denied LTD benefits, you are essentially arguing that the insurance company has breached its contractual obligations by failing to provide the benefits you are entitled to under your policy. This can be due to various reasons, such as misinterpreting the policy’s terms, ignoring relevant medical evidence, or acting in bad faith.
Steps Involved in Filing a Lawsuit
- Consultation with a Lawyer: The first crucial step is to consult with an experienced lawyer specializing in disability law. They will assess the strength of your case, advise you on your legal options, and guide you through the entire litigation process.
- Gathering Evidence: Your lawyer will meticulously review your insurance policy, medical records, and any correspondence with the insurance company. They will gather additional evidence, such as expert opinions, to support your claim and strengthen your case.
- Filing the Statement of Claim: Once the evidence is collected, your lawyer will prepare and file a Statement of Claim with the appropriate court. This document outlines your claims against the insurance company and details the relief you are seeking, such as payment of past and future benefits, damages for pain and suffering, and legal fees.
- Discovery Process: After the Statement of Claim is filed, both parties will engage in the discovery process. This involves exchanging relevant documents and conducting oral examinations under oath (Discoveries). The discovery process aims to uncover all relevant facts and information related to the case.
- Mediation or Settlement Negotiations: Before proceeding to trial, the court may order the parties to participate in mediation or settlement negotiations. This is an opportunity for both sides to attempt to reach a mutually agreeable resolution without going to trial.
- Trial: If a settlement cannot be reached, the case will proceed to trial. During the trial, both sides will present their evidence and arguments before a judge (or judge and jury). The judge will then render a decision based on the evidence presented and applicable law.
Key Considerations When Filing a Lawsuit
- Statute of Limitations: It is crucial to be aware of the statute of limitations, which is the time limit within which you must file a lawsuit. In Ontario, for example, the limitation period for LTD claims is usually two years from the date of denial.
- Legal Fees: Litigation can be expensive, so it’s important to discuss legal fees with your lawyer upfront. Some lawyers may work on a contingency fee basis, meaning they only get paid if they win your case.
- Emotional Toll: Litigation can be a stressful and emotionally draining process. It’s important to have a strong support system in place and to be prepared for the emotional toll it may take on you.
Benefits of Filing a Lawsuit
While filing a lawsuit is a significant decision, it can offer several benefits, including:
- Recovering the Benefits You Deserve: If successful, you can recover the LTD benefits you are entitled to, ensuring your financial security during your disability.
- Holding the Insurance Company Accountable: By taking legal action, you are holding the insurance company accountable for its actions and ensuring that they fulfill their contractual obligations.
- Deterring Future Bad Faith Practices: Your lawsuit may deter the insurance company from engaging in similar bad faith practices in the future, protecting other policyholders.
Filing a lawsuit against an insurer for denied LTD benefits can be a complex and challenging process. However, with the help of an experienced disability lawyer, you can navigate the legal system and fight for the benefits you rightfully deserve.