LTD approved : don't give up, that's what they are counting on!

Hello,

I want to thank you for your helpful advice, guidance and especially your encouragement. I have just been approved after many many months of stress, anguish and struggle following the denial of my claim.

After initially opting to prepare an appeal to the denial, I eventually realized it was pointless. After spending months trying to get answers and clarifications from my case manager (unsuccessfully) until they refused to cooperate entirely, i decided to file a complaint with the ombudsman’s office via the governing organization in my province.

I am ecstatic to announce that I received my approval letter today, advising me that I would receive retroactive payments.

There were some brutally low moments, I was made to doubt myself and I have struggled to cope with the damage to my life, notably the financially devastating consequences. I lost my apartment, most of my belongings, was forced to do a consumer proposal, destroyed my credit, my dignity and my self worth. All while I was severely ill. But I refused to let the insurance company win.

I want to tell anyone who is going through the same situation not to give up. It may take a while and it will be hard but you can do it.

  • Read the policy and the denial letter in detail. Many many times and understand them. By going back to the letter and policy repeatedly is how I was able to figure out how to react. I caught something that I had missed almost every time.

  • Find similar cases on CanLII to get an idea of your options and what the law says about situations similar to yours. Search using all kinds of applicable search terms.

  • Read this site, forum and everything you can find online.

  • Challenge the insurance company’s explanations, they are creative with their interpretation of the policy and your claim. They seem to work in reverse. They start with conclusions and then cherry pick the information to make it appear correct. They even twist the actual basis of your claim and change the premise to confuse you. They have all the power and they don’t even put much effort into justifying their decision.

  • Beware of follow-up requests to your doctor for additional information. Watch out for the wording. They may seem identical to questions from the initial doctor form but they are not. The difference in wording is very subtle and it’s a trap.

  • Question them on everything that is not clear or illogical demand that they back up what they say with specific text in the policy. Make them clarify. If your situation deviates from the norm and what the policy text specifically addresses, they need to be able to justify their conclusions.

  • If it’s not in the policy, challenge it. They make up rules and interpretations that are convenient for them. Don’t assume they are correct even if you might expect them to know more than you do because they are experts. They will tell you whatever suits them.

  • Get everything in writing. They won’t give you much but you can write it yourself and it’s up to them to respond, otherwise what you summarize is unchallenged and presumably accurate.

  • Back them into a corner. The claim manager is really limited in what they can say or do.

  • Beat them with logic and arguments. They fail at this if you make the right arguments.They will avoid most of your questions but the act of persistently challenging their statements and requesting clear definitions or interpretations gradually makes their reasoning sound absurd.

  • Document everything, write up a detailed Timeline and keep records.

  • Be polite, don’t get angry. The claims manager really doesn’t have much power in what they can say or how they can decide to deny or approve. If there is any ambiguity or any way to deny, they have to. And they can’t say much when you ask questions. They have a terrible job and probably feel bad for you. Keep a good rapport but be persistent and thorough.

  • If you hit a brick wall and believe that appealing is pointless because the insurance company is not playing fair, don’t waste your time.

  • Take all the information you have gathered and make a formal complaint detailing everything or if you can, get a lawyer.

Don’t let them beat you down. That’s what they are counting on and they know all the tricks in the book.

Feel free to contact me privately for any questions or comments.

Good luck!

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Well done! Congratulations! I think a lot of people will find this helpful.

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Well done and congrats! Your story brings me much joy to read, but also makes me sad because I realize that the current system is extremely broken. No one should have to go through what you went through. Also, you are clearly an articulate and intelligent person (as are many on this forum) who knows how to advocate for themselves and seek out info. However, lots of people are not like that and just “give up” like you said because they become too overwhelmed. That makes me furious because these are benefits they are ENTITLED to! It is what the insurance companies count on.

One big thing I would add to your suggestions list is… ask your insurance company to never contact you by telephone - only by postal mail or email. This takes away the main advantage they have which is SURPRISE tactics. When I first was going on LTD they wanted to do phone interviews and those interviews are incredibly favoured towards them since they can catch you off guard easily and they are fully recorded. Say one wrong thing and you are cooked. Also, they know the questions ahead of time and you don’t. Now they have to send me all the questions they have via email and I can take my time and reply with a proper response and make sure it is what I actually want to say. If your LTD company puts up a fight and insists you must talk to them on the phone that is a LIE. You have a right to insist everything be done via mail or email.

Anyways, congrats again and hopefully now they will leave you alone. Sounds like you really dealt with a scummy shady LTD company for them to ignore you like that.

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Yes, I’d give this post 100 likes if I could.

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I need to reread OP’s thread every week . Thank you for sharing! You save lives

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