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.
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 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.
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.
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.