For so many individuals, the recovery of their insurance benefits happens without a hitch. But there are times when the insurer will deny a claim for one reason or another.
This can seem unfair to the claimant and could lead to serious financial repercussions.
If you are in this situation, meaning your insurance company is denying your compensation, you have legal options to consider.
It may not be the end of the road – speak to experienced insurance lawyers in Ontario to evaluate your case and find a remedy.
Our vast network of lawyers can help you tremendously! Fill out the short online form on this page to receive free quotes with no obligation.
The Common Reasons Insurers Deny Claims
When you take out an insurance policy, you expect to get protection against a certain risk. Individuals with disability insurance trust that their policy will provide benefits if they suffer a disability.
Unfortunately, it does not always happen. Every policy has exclusions and maximum benefit amounts that a policy owner should be aware of.
An insurer can deny a claim for long-term disability benefits for reasons such as:
- Late filing of claim
- Errors in the application submitted
- Pre-existing medical conditions that you failed to disclose in your claim;
- The reason for your disability is an activity excluded in your coverage;
- The absence of lack of required medical evidence
- The insurer has proof that contradicts your disability
- Missed payments of premiums
- Findings by a medical professional that your disability does not prevent you from working
- Discrepancies in the information provided by your employer
- Failure to meet the insurer’s definition of “disability”
- Failure to get regular medical treatment or check-ups
- The insured is in prison or a similar institution
The Duty of the Insurer
The insurance company is obligated to process and investigate claims and to arrive at a decision within a reasonable period.
The reason for the status of a claim and the denial of a claim must be given in a timely and transparent manner.
If your insurer has not acted on your claim or failed to update you or denied your claim without a justifiable reason, you can dispute and file an appeal with a lawyer.
What to do if your insurance claim is denied?
Has your insurer denied your claim? Have your disability benefits been terminated? You have several options if you disagree with your insurer.
- File an appeal with the insurer
- File a lawsuit in court
- Negotiate a Settlement
The best option to choose will depend on the reason for the denial of your benefits. If you have a problem with long-term disability insurance, you can look for a disability insurance lawyer to help you receive compensation.
Bad Faith Claim: What does it mean?
A bad faith claim may arise when an insurance claim is denied without proper investigation. An insurance company can be accused of bad faith if the client believes the company acted unfairly or unreasonably.
In any insurance contract, the insurer must process claims in good faith. Should the insurer breach the obligation to treat its clients in good faith and such breach is proven in court, the insured can be awarded additional compensation on top of the loss claimed.
The Ontario Insurance Act cites bad faith as a conscious wrongdoing or dishonest act with an illegal or inappropriate design. It is different from negligence as it involves an illegal intent rather than just an exercise of bad judgment.
An insurer may show bad faith in a disability or accident claim in the following examples:
- Failure to give a decision about benefits within a reasonable time;
- Denial of benefits without medical certification stating that the insured person is fit to return to work;
- Interpretation of insurance policies in an unreasonable manner.
- Making false statements to the insured
- Refusal to return emails or take phone calls
- Offering an unreasonable or too-low settlement
Establishing bad faith in Ontario cases
Bad faith is demonstrated by an insurer when it acts unreasonably or denies, delays, or underpays a claim without a legally valid reason.
Insurance companies have an obligation to their policyholders to provide clear and accurate information regarding their coverage and how to file a claim.
Is your insurance company giving you a hard time?
Connect with reputable and experienced legal professionals from JuriGo if you suspect your insurer of bad faith.
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How to File a Bad Faith Claim in Ontario
An insured must present evidence that the actions of an insurer violated the terms of the policy and its duty to exercise good faith in handling a claim.
There is no standard for determining bad faith in insurance as the facts of each case are different.
Find a lawyer to get his expert opinion on your denied insurance claim and discover your legal recourse for compensation!
Steps to Take to File an Insurance Dispute
If you are being given the run around by your insurer or if your insurance claim was denied without clear grounds, you can take steps to file an insurance dispute.
Keep accurate records of all communications with your insurer such as phone calls, emails, texts, letters, etc. Note down the names of everyone you spoke with and when concerning your case.
Always use the same method of communication with your insurer. If you prefer to use email, make sure to ask for updates via email.
Find a bad faith insurance lawyer to assist you in filing an insurance dispute or a bad faith claim. You can sue your insurance company with help from your lawyer.
Why hire an Insurance Dispute Lawyer?
Insurance dispute lawyers have helped hundreds of people recover compensation even when the odds seemed against them. The right lawyer with experience and expertise can fight for you to get full and fair benefits for injuries so you can rebuild your future.
A good lawyer will gather evidence to review options for settlement if the insurance company offers one.
Lawyers for denied insurance claims will review the case and assess the best way to recover compensation, especially if the insurer failed to act appropriately.
Filing an insurance dispute can be stressful and difficult because insurers use confusing jargon for the wording of their policies. Insurance companies know that filing a claim is tedious and time-consuming and hope you will just give up.
By hiring an insurance dispute lawyer, personal injury lawyer, or accident lawyer, you will increase your chances of getting the best outcome for your claim.
Understanding Accident Insurance Laws
The fact is that accident insurance laws are complex and difficult to comprehend. They also change constantly.
Multiple accident benefits forms are difficult to manage when a victim is seriously injured or recuperating from these injuries.
Accident Insurance Lawyers are knowledgeable about these laws and know how to apply them in the context of your case. They can find ways to make an insurer pay for medical bills or negotiate a settlement in your favor.
All of these reasons make it imperative for you to hire an insurance lawyer to assist with your insurance claim.
Take the first step today to fight back against your insurer!
Fill out the short online form on this page to find a denied insurance lawyer near you.
Suing an insurer for denied insurance
If the insurer denied a claim because of more complex reasons, appealing the decision using the insurer’s internal process may not work. You may need to file a lawsuit.
If the insurer terminated your insurance benefits because of time limitations or because they say you failed a medical assessment, a lawsuit may be more successful than an appeal.
The next step is to consult an experienced insurance lawyer who can examine the facts of your case and give you legal advice.
Compare lawyers for denied insurance using our short online form today!
How much compensation to expect for a bad faith insurance case?
As a victim of a bad faith insurance case, you could get compensation.
The court can award damages if the insurance company’s breach of duty caused them to treat you unfairly. Punitive damages may also be awarded by the court against the insurer. If the insurance company’s actions caused extreme emotional distress, the court may award compensation for aggravated damages.
In December of 2023, the Court of Appeal of Ontario reaffirmed punitive damages of $1.5 million awarded by a jury in the Baker vs. Blue Cross case. This is a confirmation that insurance companies will be held accountable for grave errors in processing long-term disability claims.
Your lawyer can evaluate your case to find the legal remedy that would allow you to receive compensation.
Insurance companies don’t want to risk their reputation with a bad faith insurance claim! Whether your case goes to court or you receive a settlement offer, your lawyer will assist you every step of the way.
The lawyers in JuriGo have the experience and track record that can significantly increase your chances of success!
Who can you sue for denied long-term disability benefits?
You may be surprised to hear that you can sue 3 parties for denied long-term disability benefits:
- The insurer
- The insurance broker who sold the policy
- The employer
A disability insurance lawyer can evaluate the case and advise you on whom to sue to get compensation. Usually though, lawsuits are filed against the insurer who denied or terminated the benefits.
Denied Disability Benefits: What can you receive from a lawsuit?
By taking the case to court, you can claim:
- Payment of the benefits by the insurer;
- Compensation for bad faith (if the insurer acted in bad faith)
- Interest on the amount being claimed before and after the judgment
- Legal fees.
Your lawyer will prepare a Statement of Claim that details the allegations you are making against the insurer.
You may be required to undergo medical evaluations by your doctor and the designated doctor from the insurer. You and the insurer can choose to negotiate a settlement or undergo mediation.
Need help with a lawsuit for denied disability benefits? Compare lawyers who specialize in disability insurance claims in your area using our short online form.
Is it possible to settle out of court?
Both parties can arrive at an agreement during negotiations before the case goes to court. A settlement can include a lump-sum payment for the disability benefits that were denied and future benefits.
If an agreement is not reached, the case will most likely go to trial.
Get Help from Expert Insurance Lawyers Near You
Appealing a claim or filing a lawsuit for denied insurance is a lengthy and complex process. Every insurance policy is different.
If you file an incomplete or less-than-compelling claim, you are likely to lose!
A denied insurance lawyer is the best ally you can get to guide you through this difficult process. He will inform you of deadlines, prepare the paperwork, and deal with the insurer. His primary goal is to ensure you receive the compensation you deserve.
Fill out the short online form below, free of charge, to start your appeal or legal action. Don’t miss your chance and act quickly so you can receive compensation.