Don’t be surprised if the appeals process takes several months to a few years. One of the reasons why it’s lengthy is that the guidelines can be hard to understand and the deadlines are often vague and not set in stone. Just keep in mind that you may miss other important deadlines while you are going through the internal appeals process.
Canadian law requires insurance companies to offer the internal appeal process to all applicants whose applications they deny. Therefore, you could be going through the entire appeals process for nothing since your appeals application may be rejected at the end.
Well, in legal speak, you ‘start an action’ when you do an external appeal. In essence, you take your appeal to a neutral third party. Believe it or not, the chances of having your denial reversed improve dramatically when you do an external appeal. The reason is that, unlike as is the case with the people in the insurance company who may review your appeal, the third party has a completely neutral outlook.
In most instances, the neutral third party is Canada’s legal court system. However, it can sometimes be a tribunal court where an adjudicator hears your case. In case you were wondering, you are suing your insurance company when you do an external appeal.
You have lots of legal rights concerning your case now since you’re working within the context of a formal legal system. Just keep in mind that doing an external appeal may be the only way that you can have your initial denial reversed. That’s why it happens all of the time.
Tribunal Hearings vs. Court Cases
If you head to a tribunal court, your case will be heard before a panel of decision-makers. Unionized employees are the ones who have their cases tried in tribunal courts. Unlike as is the case with regular courts, they don’t need to hire lawyers.
You will attend the hearing of the appeal with the arbitrator (adjustor) Keep in mind that the tribunal’s hearings are informal. You would go through a tribunals court only if you wanted to have your LTD reinstated and you wanted to receive previously denied benefits. If you want to claim damages or have more complex resolutions appealed, you would need to head to a regular court.
If you do go before a formal court, keep in mind that you’ll be pleading your case in front of an actual judge and probably a jury. You’ll also be involved in a complex legal system. You should hire a good lawyer if you want to have a decent shot at winning your case. You’ll gain a few things by filing your case in a formal court system. You can claim damages, including, but not limited to:
• Past benefits owed
• Compensation for mental stress
• Punitive and aggravated damages
The court will require the insurance company to pay your settlement and legal fees if you win your case in court.Since the legal courts have more power than tribunal courts do, you should appeal your case through the legal system if you’re serious about having your denial reversed, as per personal injury lawyer in London.