Second Appeal with LTD Insurer Denied


#1

Sigh.

Yesterday I received the news that my second appeal for LTD through group insurance with my LTD Insurer was denied. Following the denial of my first appeal, I retained a lawyer to help with the second in order to make sure I had all of my ducks in a row. I have the full backing and supporting documentation from my specialist, my GP, an occupational therapy assessment, all confirming that I cannot return to work and am unable to perform my specific job duties, or any at this time.

I have been unable to work for close to 16 months due to the onset of chronic intractable migraine, and had first applied for LTD 13 months ago. My initial application was denied in December 2016, first appeal denied in May 2017, and now the second. They did not specify any reason for denying my appeal, simply maintained their position.

I feel defeated (but am not giving up), as my hands are effectively tied from taking this to court as I have no source of income. I have applied for CPP Disability as of last month, but am not hopeful for that as I’ve been discouraged by the outcome with my LTD insurer


#2

Did you request a complete case file from your insurer so you can see the reasons for denial? They must have made some notes on what they think about your condition and if anything is missing in heir point of view.

Most disability lawyers work on a contingency basis. They will charge only if they are successful in recovering your money. Find the right lawyer and take your case to court.


#3

Never heard of it.
Is that an internal sunlife thing?

I would just sue sunlife (actually I would ask your lawyer for advice).
Is your lawyer one that specializes in disability claims?


#4

This is the section regarding the review after 2 appeals have been denied. It is external.

I am still waiting on advice from my current lawyer. I think asking for my complete case file is an excellent idea.


#5

It sounds like it is some fed gov thing.
It is not binding so I don’t know how useful it will be.
I would definitely contact your union rep, they are there to help with disability claims.


#6

I likely will, despite having slightly less than zero faith in them.


#7

One reason that I am wary of taking it to court is that I have no way of knowing if I will physically be able to be present on any particular day, given my disability. I suppose getting some good advice will be valuable. I haven’t yet heard back from my lawyer as to how I should proceed.


#8

I am not familiar but did look it up and saw that there is a 50% success rate with their appeals. In a perfect world your Union rep should be helping you. Often unions fail their disabled members but worth a shot. Has your lawyer sent a letter of representation to your Insurer?

Once your Insurer is aware you are represented then all communications and file requests should come from your lawyer unless your lawyer advises you that it is ok to communicate.

If your Insurer does not know you are speaking with a lawyer—move quickly to request your full and complete claim file and all related documents!! Send with proof of receipt.


#9

Yes, my lawyer has represented me since after my first appeal was denied, and any communication goes through her. She isn’t strictly a disability lawyer however, so I’ve been thinking of switching. :thinking:


#10

Not sure how your agreement with her goes. I had a really bad experience with a jack of all trades kinda lawyer–wasted years on a home insurance claim. So bad that I was booked for a second examination and my lawyer told me I was not. I called the court reporter from my first examination and sure enough a date was booked. ( an examination for discovery is the oral testimony of a Plaintiff or Defendant taken under oath before trial. )

If I did not show up I could have lost my claim. Got a new lawyer and settled for almost 10 times more than the bad lawyer said I could get. Sounds far-fetched that your own lawyer might do something like that—but I met a girl online that said it had happened to her–she lost her claim because her lawyer told her that her examination was cancelled. I thought she might be crazy—then it almost happened to me.

I strongly advise you want a lawyer who deals with Insurance and disability as their main focus. They know the players, the game and the tricks the other side plays. They also have a game plan and caselaw already in place. You don’t want a family doctor doing surgery–you don’t want a lawyer who just dabbles with disability.

Insurance companies are professional litigators–and if they send their litigation to an outside firm–you have lawyers who are above excellence.

The fact that David Brannen of Resolute Legal is a specialist in Disability and was an Occupational Therapist is a fantastic choice for effective representation and will cut time and costs.

Go with your gut feelings. It all comes down to if you can afford to switch lawyers. Has she gotten anywhere so far with your claim?


#11

Oh good grief - I am so sorry that happened to you! Unbelievable…

I hired mine on retainer that gets topped up as we go. Right after my first appeal was denied, my doctor suggested that I consult a lawyer. She is fine, actually a student-at-law for the firm I hired. Everything goes through her senior council. She’s done the legwork, got me to see an occupational therapist for an assessment which I found very helpful…but she’s not a disability lawyer. She was hoping that with all of the information we gathered, that we would win on this appeal. I don’t believe I have any obligation to stay with them or proceed further based on the retainer.

From what I’ve learned, David Brannen sounds like a very competent, educated, and trustworthy person, however as I am located in the prairies, I wouldn’t be dealing with him directly I don’t believe, as he is based in the East.


#12

I am in Manitoba–so I am out of range as well for Resolute. A law student can be an asset if she is motivated, and may try harder than a senior lawyer. However a lawyer who specializes in disability cases has a game plan already mapped out and researched for most claims. Insurance Companies do take into consideration who the lawyer on the other side is.


#13

Ah, How did you find your current lawyer? :slightly_smiling_face:


#14

My husband is self represented right now. Not recommended! I did my research and in Manitoba our court registry is online-so a person can type in an Insurance Company by name and see who the regular lawyers are against the Insurer.

I know you can ask Resolute if they have a good contact in your province.


#15

Thanks so much!!! You’ve been so helpful.


#16

Yes you can appeal to the Disability Insurance Plan Board of Management which is part of the National Joint Council for Federal Employees Pensions. That will likely take some time and I am not sure how effective they are in rendering decisions for Plan Members. They are the ones responsible for setting up these contracts with Insurance Companies so I am skeptical. It would not hurt to do so, but I would also have the disability lawyer rattle the cage to Sunlife also.


#17

Wow…I appreciate these kind words. Resolute legal represents people Canada-wide for CPP disability (except for Quebec), but we only directly handle LTD cases in Ontario and Atlantic Canada. In other provinces we have affiliated lawyers hand picked by me who share our firm’s values and no-win, no-fee etc. If you end up hiring our affiliated lawyer I remain involved as a co-counsel and you contact me if there are any problems with communications with that other lawyer, etc.

My plan is that Resolute Legal will eventually have a lawyer in every province. We expanded fully to Ontario for all LTD cases in 2017.


David Brannen

Disability Lawyer with Resolute Legal

_The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliabile manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team._strong text


#18

David, do you personally work on LTD or CPP-D cases in Ontario? What about meditations and depositions and court appearances?

Does someone need to send all the materials to you by mail or any other method?


#19

Mr. Brannen - thank you kindly for your response, I very much appreciate it! Is there a way that I would be able to contact your affiliate for Saskatchewan (I’m in Saskatoon)? I understand that it would be up to them as to whether to take my case or not, but I would be happy to initiate contact with them. I do currently have my initial self-submitted CPP disability claim in progress, I imagine it will take some time. However it is my LTD claim through my employer’s group benefits which has been a year long struggle and frustration thus far. Again, thank you! I have put in a request for a free consult with Resolute a few days ago, so perhaps I can discuss this when I speak to someone. :slightly_smiling_face:


#20

Hi Elaine, we use a team approach that includes me, a second lawyer and case manager. I oversee the strategy and negotiations on all cases. I have created a system that all lawyers and employees must follow. I have described some of that system in the CPP Blueprint method and touch on it in my Disability Claims in Canada Book. Our second lawyers are is a Resolute Legal employees and they handle routine court appearances, mediations, depositions and some court motions. I attend all trials and complex court appearances and mediations together with the associate lawyer, etc. Ninety percent of what is done with a disability case is done with paperwork.

People who hire us have access to a secure online portal that allows them to view all documents, upload documents, download documents, see case milestones and get case updates. We arrange for couriering of any documents that can’t be scanned or faxed.

Resolute Legal is not run like a sterotypical law firm. We don’t have offices per se and most of our staff and lawyers work remotely. I intentionally designed the firm and our processes to allow people to easily hire us from just about anywhere without having to leave their home. We file all court proceedings through your local court and require the insurance company people to hold meetings and legal proceedings in your home down, not in downtown cities where they have offices. We have successfully represented people in very remote areas of the country who could otherwise not find a disability lawyer.