What to Do If Your Disability Claim Is Denied

Receiving a denial for your disability claim can be a disheartening experience, especially when you are already dealing with health issues and financial stress. However, a denial does not mean the end of your pursuit for benefits. Here’s a step-by-step guide on what to do if your disability claim is denied, ensuring you can navigate the appeals process effectively and increase your chances of a successful outcome.

1. Understand the Reason for Denial

The first step after receiving a denial is to carefully review the denial letter. This letter will outline the specific reasons why your claim was denied. Common reasons include insufficient medical evidence, failure to meet the eligibility criteria, or missing documentation. Understanding the specific reason(s) for your denial is crucial as it will guide your next steps.

2. Gather Additional Evidence

One of the most critical factors in a successful disability claim is comprehensive medical evidence. If your claim was denied due to insufficient evidence, work with your healthcare providers to gather additional documentation. This might include:

• Detailed medical records
• Updated test results
• Statements from doctors or specialists
• Detailed descriptions of your condition and how it impacts your ability to work

Make sure the new evidence directly addresses the reasons for the initial denial.

3. File an Appeal

In Canada, the process for appealing a denied disability claim varies depending on whether you are dealing with the Canada Pension Plan (CPP) Disability Benefits, provincial disability benefits, or private insurance. Here’s a brief overview:

CPP Disability Benefits:

• Reconsideration: You have 90 days from the date you receive your denial letter to request a reconsideration. During this stage, you can submit new evidence and a written explanation of why you disagree with the decision.
• Social Security Tribunal (SST): If your reconsideration is denied, you can appeal to the SST. This involves a more formal process, and you may want legal representation at this stage.

Provincial Disability Benefits:

• Each province has its own appeal process. Typically, it involves an internal review, followed by an appeal to an independent tribunal if necessary.

Private Insurance:

• Internal Appeal: Most private insurers have an internal appeals process. Review the denial letter for specific instructions and deadlines.
• External Review: If the internal appeal is unsuccessful, you may have the option to request an external review or arbitration.

4. Seek Legal Assistance

Navigating the appeals process can be complex and time-consuming. A disability lawyer can provide valuable assistance, including:

• Reviewing your denial letter and identifying weaknesses in your initial application
• Gathering and organizing additional medical evidence
• Preparing and submitting appeal documents
• Representing you in hearings and negotiations

Disability lawyers are experienced in dealing with both government programs and private insurers, and their expertise can significantly increase your chances of a successful appeal.

5. Keep Detailed Records

Maintain a comprehensive record of all communications, medical appointments, and documents related to your disability claim. This includes:

• Copies of all letters and emails from the insurance company or government agency
• Notes from phone calls and meetings
• Medical records and test results
• Documentation of any new treatments or changes in your condition

Having an organized record will help you stay on top of deadlines and provide necessary information quickly during the appeals process.

6. Stay Persistent and Patient

The appeals process can be lengthy, often taking several months or even years. It’s important to remain persistent and patient. Keep in regular contact with your lawyer (if you have one) and stay proactive in gathering and submitting required documentation.

Conclusion

Receiving a denial for your disability claim can feel like a significant setback, but it is not the end of the road. By understanding the reasons for denial, gathering additional evidence, filing a timely appeal, seeking legal assistance, keeping detailed records, and staying persistent, you can effectively navigate the appeals process and improve your chances of receiving the benefits you deserve.

If you need expert guidance and support with your disability claim, contact the experienced lawyers at Hilborn and Konduros. We can help you understand your rights, build a strong case, and advocate on your behalf to ensure you receive the support you need.