Most effective step after denial

In the documents I have from my employer and the insurance company, the give specific steps once someone who’s claim is denied.

1) There is a first appeal with the insurer/Case Manager

2) There is a second level of appeal, still with the insurer/Disability appeals team

3) Then there is a review by the DI plan board of management (employer+union)

4) I’m also able to make a complaint directly with the insurer’s ombudsman

It never ends…

5) Finally, while it is not included in the documents I was provided, I believe there is also the option of filing a complaint with the OmbudService for Life and Health insurance.
https://www.olhi.ca/complaints/submit-a-complaint/

Not much information about timelines and delays. Obviously following all of these steps could easily take many many months. Meanwhile I still have no income. I’m assuming I don’t have to go through each steps…

6) Of course there is also the legal route, whether through small claims court (which has a max amount I can claim).

7) There is also court, which is not really possible when you’ve been without income for almost 6 months.

What do most people choose to do? Any recommendations?

Unless you are very close to retirement age I think small claims would be a mistake, because you have to abandon the rest of your claim. Have you looked through David’s guides in his blog?

I haven’t seen the blog, do you have a link?

I get a lot of information here, but I’m in Québec and we have a different legal system (code civil) than the rest of Canada (common law).

Some things are similar but in this case, I guess it’s different. It is possible to make consecutive claims for specific periods of time, maximum $15 000 per claim.

So if I was owed $3000/month, I could file a claim for 5 months. Then I could file another 5 months later.

I highly doubt I’m going to take that route. I don’t have the energy for what it entails, I’m barely functioning.

Here it is https://www.resolutelegal.ca/blog it is full of great information. I hope some of it helps you in your situation.

I’m pretty much convinced that it’s pointless to appeal and that my best option is to get a lawyer. I’ve started the process of finding one.

From what I understand and have read, I think they would probably have a difficult time convincing a judge that my claim should be denied. It’s complex and my only chance at having my claim being evaluated fairly. I’m just worried about how much it will cost. Anyway, I think the internal appeals would be a waste of time. I’m glad I’ve made my decision.

Not sure about Quebec but most lawyers in other provinces work on a contingency basis. They only charge a percentage of the insurance payment that you receive.

Often when they know they have little recourse they will try and beat you down mentally and financially until you give up. https://www.amazon.ca/Delay-Deny-Defend-Insurance-Companies/dp/1591843154

Been on this road myself and know.

Get a lawyer at this stage is my recommendation. Regularly see your doctors and add to your documentation.

I would consult with a lawyer. Depending on your age, having a benefits claim until 65 is better than having a small claims court ordeal with a small lump sum.
It may just be the opportunity of having a lawyer put together a letter of appeal with the supporting documentation.

You should also apply for CPPD if you meet the application requirements.

The CPP operates throughout Canada, except in Quebec, where the Quebec Pension Plan ( QPP ) provides similar benefits.

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