A Step by Step Guide:
We know that the decision to sue your insurer is not one you have taken lightly. If you are considering legal action, it is likely because you have tried everything in your power to get your long-term disability benefits, but the insurance company continues to deny your claim.
The first step to successfully appealing the insurance company’s decision is to find an experienced disability lawyer with a track record of success fighting against your insurance company. It is critical to do this as soon as you are denied by the insurance company so you do not miss any important deadlines.
At a time where you are under great financial stress, it is also prudent to find a lawyer who offers free consultations and works on a contingency basis, which means no fees are charged up front and you don’t pay unless your case is settled.
Let’s take a look at each step of the legal process you may encounter when suing an insurance company for long-term disability benefits:
1. Retainer Signed
A retainer is a contract that outlines the services your lawyer will provide you, the cost of such services, as well as both parties’ duties and obligations to each other.
Many lawyers who claim to work on a contingency basis may charge a retainer fee. Be clear about this. Ideally, the lawyer you work with will not ask for any financial contribution at the beginning of the case and will only get paid if they recover money for you.
At Share Lawyers, our fees are calculated as a percentage of the total amounts recovered. The percentage that is applicable to each client’s case is discussed fully before we start and is set out in writing in our retainer agreement, which includes an example of how the fee is calculated, so that there are no surprises when we conclude the case.
Once the retainer is duly signed by all parties, your lawyer commences to act on your behalf in all matters regarding your claim.
2. Statement of Claim
This is the document that sets a lawsuit in motion. It is the initial pleading made by your lawyer for you, the plaintiff, in a civil court action. The Statement of Claim outlines the material facts in support of the plaintiff’s claim against the defendant and the amount of monies sought to compensate for damages.
This document is prepared by your lawyer after thoroughly reviewing the details of your case. It is filed in the court and served to the insurance company (the defendant).
It is important to file a statement of claim before the deadlines applicable to your case, known as the statute of limitations. That is why it is critical to consult with a lawyer as soon as you receive a denial.
3. Statement of Defence
This is the insurance company’s response to the Statement of Claim, and addresses every point made in the Statement of Claim. The insurance company typically contests most, if not all of the arguments you have made against them and will file a notice of intent to defend.
4. Examination for Discovery
A discovery is an examination under oath. It is not a trial. Your lawyer will prepare you for the discovery well in advance of the date, and will attend the discovery with you. At the discovery, the insurance company’s lawyers will ask you questions, and a stenographer will take note of everything that is said by both parties. A transcript of the proceeding will be provided.
If either party cannot respond to a question during the Examination for Discovery because they do not have the relevant information at hand, they can request to provide it after the examination. This is called an undertaking.
Mediation is one way for people to settle disputes or lawsuits outside of court. In mediation, a neutral third party – the mediator – helps the disputing parties look for a solution that works for them.
Mediators, unlike judges, do not decide cases or impose settlements. The mediator’s role is to help the people involved in a dispute to communicate and negotiate with each other in a constructive manner, to gain a better understanding of the interests of all parties, and to find a resolution based on common understanding and mutual agreement. The vast majority of cases we handle are settled in mediation and never make it to trial.
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This searchable database contains information about disability, critical illness and life insurance claims, and what you can do if you are denied or cut
off of your benefits. It is a collection of the most common questions we receive from our clients. General answers have been provided by our lawyers.