Blue Cross Long-Term Disability Claims

Securing long-term disability (LTD) benefits is crucial for individuals who cannot work for extended periods due to injury or illness. However, the process can be complex, especially when facing denials from insurance providers like Blue Cross. In this article, we explore the challenges and strategies surrounding LTD claims with Blue Cross Insurance from the perspective of a Canadian personal injury law firm with experience in LTD claim denials.

Background:

The Blue Cross concept originated in the early 20th century in the United States to provide affordable hospital care to individuals and families. The Blue Cross symbol was adopted by various nonprofit health insurance plans across North America.

Blue Cross Insurance was introduced to Canada in the 1940s, initially as a hospital insurance plan. The Blue Cross symbol and brand became associated with providing coverage for hospital services, including hospital stays, surgeries, and medical treatments. Blue Cross plans in Canada were typically organized as nonprofit associations, owned and operated for the benefit of their members. These plans aimed to provide accessible and affordable health insurance coverage, primarily focusing on hospitalization expenses.

Over time, Blue Cross plans in Canada expanded their coverage beyond hospital services to include various health care benefits. This expansion included coverage for prescription drugs, medical supplies, dental care, vision care, and other health-related services.

Blue Cross plans operate at the regional and provincial level in Canada, with each catering to the specific needs and regulations of its jurisdiction. Different Blue Cross organizations may offer varying levels of coverage and services based on provincial health care frameworks.

Blue Cross Claims Process Overview:

Filing an LTD claim with Blue Cross Insurance entails a multi-step process. Claimants must provide comprehensive medical evidence, treatment records, and relevant documentation to support their disability claim. Clear and consistent communication with Blue Cross representatives is vital throughout the process.

Can Blue Cross Deny My LTD Claim?

Yes, like other insurance providers in Canada, Blue Cross has the authority to deny LTD claims based on various factors. These may include:

• Insufficient medical evidence
• Policy exclusions
• Failure to meet the policy’s definition of “disabled”
• Procedural errors in the claims submission process
• And more

Blue Cross Insurance Case Study:

The Court of Appeal for Ontario recently upheld a decision against Blue Cross Life Insurance in a disability claims case. Originally, a jury awarded substantial punitive damages, retroactive benefits, and aggravated damages to Sara Baker in a disability claims case against Blue Cross. Ms. Baker had experienced a stroke and was insured via her employer’s long-term disability coverage. Blue Cross appealed specifically against the punitive damages award, not disputing the “total disability” declaration or other damages.

The Court of Appeals upheld the original decision, expressing serious concerns about Blue Cross’s handling of Ms. Baker’s claim, indicating potential deliberate strategies to wrongfully deny benefits. In the court’s view, Blue Cross was responsible for deliberate misconduct, which is part of a wider systemic issue that causes a detrimental impact on claimants’ rights and financial well-being.

If a claimant’s LTD benefits have been wrongfully denied by Blue Cross, it is recommended they seek legal advice from a lawyer immediately. Legal professionals can help claimants assess their reasons for denial, compile a comprehensive appeal, and pursue litigation in court, if necessary.

Why Do LTD Insurance Providers Deny Claims?

LTD insurance providers like Blue Cross may deny claims due to discrepancies in medical documentation, conflicting opinions among healthcare providers, failure to comply with policy criteria, or missed deadlines in the claims process. Understanding these reasons is crucial for claimants navigating the LTD claims process.

What Does the LTD Claims Appeal Process Involve?

The appeals process for denied LTD claims with Blue Cross typically includes submitting additional evidence, engaging in dialogue with Blue Cross representatives, and possibly participating in assessments or hearings. Working with a disability lawyer experienced in LTD appeals can greatly assist in navigating this complex process.

Are There Time Limits For Filing Legal Insurance Claims in Canada?

Yes, specific time limits and deadlines apply to filing legal claims related to denied LTD benefits in Canada. It is crucial for claimants to be aware of these timelines and take prompt action, including seeking legal advice if their claim is denied.

How Long Does the Claims Process Take?

The duration of the LTD claims process with Blue Cross varies based on factors such as case complexity, availability of medical evidence, and responsiveness of all involved parties. Claimants should be prepared for potential delays and work diligently to meet all requirements promptly.

What To Do If My LTD Benefits Have Been Denied?

If your LTD benefits claim with Blue Cross has been denied, seeking legal guidance from a reputable personal injury law firm that is knowledgeable in LTD claim denials is crucial. A disability lawyer can review the denial letter, assess appeal grounds, gather additional evidence, and advocate on your behalf during the appeals process.

Contact a Disability Lawyer About Your LTD Denial Today:

Claimants facing LTD claim denials from Blue Cross Insurance can benefit significantly from legal representation. Contacting one of Preszler Injury Lawyers’ disability lawyers can help claimants navigate the appeals process and secure the essential benefits they deserve during periods of disability. To address your denial, schedule a consultation with our long-term disability lawyers today.