LTD Internal Appeal
Representation in the insurer internal appeal process.
What is included
- Reviewing the policy, the denial or termination letter and your claim history
- Requesting the insurer's claim file and medical reviews
- Gathering medical evidence that answers the insurer's reasons
- Preparing the internal appeal and written submissions
- Explaining the deadline to sue and the options if the internal appeal does not succeed
What is not included
- Charges from doctors and other providers for reports, forms and records, and other disbursements
- Later stages, such as an appeal after a reconsideration, unless agreed in writing
- Medical assessments or treatment
- A court action in the Superior Court of Justice, such as a long-term disability lawsuit, which needs a lawyer
- Financial, tax-planning or investment advice
Who this service is for
- Employees with group long-term disability coverage whose claim was denied or cut off
- People with an individual disability insurance policy in dispute
- Someone refused long-term disability after short-term disability ended
Information to have ready
- 1Your policy or group benefits booklet
- 2All letters from the insurer, including the denial
- 3Medical records and reports from your doctors
- 4Your job description and pay information
Frequently asked questions
How much does it cost?
The fee is $1,250 plus 13% HST ($1,412.50 in all) for the work described on this page. Court, tribunal or government fees and other disbursements are extra. We confirm the scope and the fee in a written retainer agreement before any work starts.
What happens when I check out?
You book a time for your intake call, then save a card on Stripe's secure page. Nothing is charged today: the card is only charged later, for an invoice for work already done, as your retainer agreement sets out. A licensed paralegal confirms the details, checks for conflicts of interest and, if we can act for you, sends the retainer agreement. Fees paid before the work is done are held in our trust account.
Should I use the insurer's internal appeal?
Sometimes it helps, especially when there is new medical evidence. An internal appeal does not always stop the time limit to sue, so we look at both together.
Can you take my long-term disability claim to court?
A claim within the Small Claims Court limit of $50,000 may be handled by a licensed paralegal. A larger claim is lawyer work in the Superior Court of Justice, and we can refer you to a lawyer.
General information only, not legal advice. NEO Legal Services Professional Corporation is a licensed paralegal firm regulated by the Law Society of Ontario.
Important limitations
- No outcome can be guaranteed; each program decides eligibility
- Programs rely heavily on medical evidence, which only your health providers can give
- Review and appeal deadlines are strict, so tell us about any decision as soon as you receive it
- Some disability work may be outside what a licensed paralegal is permitted to do, such as a court action against an insurer in the Superior Court of Justice; before any work starts we confirm that your matter is within that scope, and we can refer you to an Ontario lawyer for anything that is not.
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