This article contains general information and is not legal advice. For qualified legal advice, please call 604-876-7000 to get in touch with a BC Disability Insurance Lawyer near you.

*Please note that if you are a union employee and are subject to a collective agreement that references a disability insurance plan, you should immediately discuss your claim with your union representative. Our firm may not be able to assist in these situations. Limitation periods can be very short—sometimes weeks—when a union grievance process is available.

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When your short-term disability (STD) claim gets rejected, you might be thinking: what now? Are there any options other than accepting the insurer’s decision? 

The good news is that yes, you have several avenues to fight back if your disability insurance provider denies your STD claim. Internal appeals, external tribunal reviews, and legal action are all an option post-rejection. 

However, due to the 2-year limitation period you have to fight a denied STD claim, it’s important to understand how these appeal options work and when legal action should be taken.

This article will walk you through your options after a short-term disability denial and outline what options you have to get the benefits you deserve in BC. You’ll learn about critical deadlines, the appeal process, and when professional legal help becomes essential.

Step to Take Right Now If Denied STD Benefits

If your STD claim has been denied, here’s what you should do right now.

Review the Denial Letter

The denial letter should explain why the insurer rejected your claim. Common reasons may include:

• The insurer believes the medical evidence does not support disability
• Insufficient documentation from healthcare providers
• Missing information in the application
• Your disability doesn’t fall under the policy definition of disability

Understanding the reason for denial is important for these next steps…

Request a Copy of Your Claim File

Request a copy of your file from the insurer. This file will typically include medical reports reviewed by the insurer, internal claim notes, assessments or opinions from insurance medical consultants, and other correspondence about your claim.

Reviewing your file can give more insights into why the claim was denied and what additional evidence may be needed.

Get Legal Advice

Even before you’ve made an internal appeal, we strongly advise getting legal advice from a BC lawyer experienced in disability insurance cases. 

Some people assume they must complete the insurer’s internal appeal process before exploring legal options, but that’s not the case. You can speak to a lawyer at any time. 

A lawyer can review your insurance policy, denial letter, and claim file to help you understand why the insurer denied your benefits. They may also identify gaps in the medical evidence or documentation that could affect your ability to challenge the decision.

Getting legal advice early can help you:

• Understand the strength of your claim
• Identify additional medical evidence that may support your case
• Clarify the deadlines that apply to your policy
• Determine whether an appeal or legal action may be the most appropriate step

Your STD Appeal Rights in British Columbia

Internal Appeal

You typically have a limited time from your denial letter to request an internal appeal by your insurance company. 

For an internal appeal, the insurer will re-examine your case with any new evidence you provide. You may be required to provide a written request explaining why the denial was wrong, supported by documentation that addresses the original reason for the rejection.

Depending on your case, you may also need to correct any procedural errors with your original application.

Key Considerations

Before appealing, be aware that:

• Disability insurance providers reject most of the claims they receive.
• You don’t need to wait for an appeal decision before pursuing legal action.
• If the insurer rejected your claim in bad faith, an appeal may not change the outcome. 
• The 2-year limitation period for starting a lawsuit will continue running during an appeal.
• Errors in the original application should be corrected. 
• Additional evidence is likely necessary, avoid simply resending information that the insurer has already reviewed.

Get Legal Advice & File a Lawsuit

Disability insurance lawyers like Dyson Law understand common insurance industry practices and can identify when companies cross legal lines in their claim handling.

Even if you believe the insurance company had the right to reject your claim, it’s still worthwhile to get legal advice to find out whether it’s worth it to pursue further legal action. What may seem like a justified rejection may actually be a tactic to dissuade you from taking legal action. 

When You Need Legal Help with Your Denial

• Appeal is Rejected or Decision is Delayed: You should consider hiring a disability lawyer when you’ve exhausted all internal appeal options without success.
• Violations and Unfair Denial: When insurance companies violate regulations, act unfairly, or purposely delay making a decision to avoid paying legitimate claims, legal counsel is strongly encouraged.

Key Considerations

• Working with a lawyer does not automatically mean a lawsuit will be filed, professional legal help can also secure better settlements through negotiation. 
• Lawyers ensure proper documentation to prevent procedural errors that could damage your claim.
• Delaying getting legal help may put your claim at-risk, as there’s a strict 2-year limitation period in which you can pursue legal action against the company.
• Disability insurance policies contain specific definitions of disability, exclusions, and procedural requirements. A lawyer can review the policy language to determine how it apply to your situation.may 

Dyson Law Firm is Here to Fight For Your Benefits

With over 21 years of experience handling insurance disputes and disability denials in BC, our team understands the tactics insurance companies use to deny legitimate claims. We’ve achieved settlements for many clients who struggled to get STD or LTD benefits from their insurance provider.

Our comprehensive approach uses negotiation, mediation, arbitration, and trial work as needed to secure fair compensation for our clients. Unlike many firms that primarily settle cases, we’re prepared to take your case to court when insurers won’t offer reasonable settlements.

We understand that a lack of income protection puts you in a difficult spot, which is why we work on a contingency fee basis for personal injury and disability cases, meaning no upfront costs for you. We’re determined to fight for the benefits you deserve. 

If you live in BC and are looking for legal advice, book a consultation today or call us at 604-876-7000.

Frequently Asked Questions

Can I work while appealing a short-term disability denial?

Working during appeals can complicate your case and suggest you’re not actually disabled. Surveillance is common in disability insurance cases, and your activity may be used against you to “prove” you’re not truly disabled and entitled to any benefits. 

Some policies may allow trial work periods or part-time employment. Check your specific policy terms and consult with a disability lawyer before returning to work.