What to do when a life or disability claim is denied, and it gets “personal”

I know that when your claim was denied, your first reaction was likely a desire to call up the claims adjuster to give him or her a piece of your mind. You likely want to threaten the insurer with litigation if they continue to deny your claim. I know that the denial has been a personal affront to you and that you are likely emotional and upset by what has occurred. You might feel that the claims adjuster does not understand your situation or that he or she has simply ignored everything you said.

The purpose of this post is to share my thoughts and ease your anxiety to help you understand the steps you need to take going forward.

If you call the claims adjuster to vent, he or she will give you the standard response and tell you to send a letter of appeal if you disagree with the decision. From my experience, this will likely be a waste of your time because the insurer usually then hands the file over to another claims adjuster who will “review” the file and likely send you the same response as in the initial declination letter.

Likewise, threatening litigation will also be of little assistance, as litigation is something insurers expect as part of their business. In fact, they set aside millions of dollars per year as a litigation budget to defend legal proceedings filed by claimants. If you do threaten to sue, it is likely the adjuster will cease all communication with you and close the claims file.

Once you sue your insurance company, your file will be turned over to their legal counsel, and that is the last time you will have anything to do with the claims adjuster who denied your claim until the discovery process. 

As part of the litigation process, the parties have a right to discovery. In simple terms, this means that each side must disclose and produce for the other side all relevant documents in their possession. This is called documentary disclosure.

The parties then have a right to conduct an in-person oral examination of the opposing party. This is called an examination for discovery. The lawyer for the insurer will have an opportunity to ask you questions about your case. Likewise, I will have an opportunity to examine a representative of the insurer. In most cases, that will be the person who made the decision to deny your claim. Between the time your claim was denied by the claims adjuster and his or her examination for discovery, you will have had no further conduct with him or her. His or her involvement in your case came to an end when you filed your lawsuit against the insurer. Other than his or her examination for discovery, you will not have anything further to do with him or her until trial, should your claim not be settled before then.

So, what does all this mean?

When you get the declination letter from the insurer, the insurer has already made a decision and there is nothing to be gained by phoning the adjuster and arguing with him or her. You will likely accomplish more by banging your head against the wall! Simply put, do not waste your time by trying to argue with them about a decision they already made and will not change.

You are now at the stage of having to make one of two decisions. Do you forget about the claim and walk away, or do you sue the insurer?

You might be asking yourself: How am I to know if I should walk away or sue? That is where I can be of assistance. I am happy to speak with you, with no initial financial obligation, so that you can tell me about yourself and your claim and ask me any questions you might have. We can do this over the phone, by video conference or in-person. If I think you have a valid claim, I will tell you. If I think you do not have a valid claim or that there is nothing I can do for you, I will tell you. Before we speak, please fill out this short form in order to make our initial conversation more productive. By doing so, you can provide some details and I will be better informed when we speak.

Before we speak, please fill out this short form in order to make our initial conversation more productive. By doing so, you can provide some details and I will be better informed when we speak.

Share This Post

Share on linkedin
Share on email
Share on facebook
Share on twitter
joseph Pollock, Winnipeg Disability Lawyer

About Joseph A. Pollock

Joseph (Joey) Pollock is a Winnipeg-based attorney with over 35 years of legal experience – 25 of those years dealing with disability and life insurance claims.