Long Term Disability Lawyers

What are the common diseases or injuries that qualify for long-term benefits?

Some of the common conditions for long-term disability benefits are as follows:

• Different types of cancers.
• Respiratory illnesses.
• Neurological conditions.
• Autoimmune diseases.
• Accidents and injuries.
• Cardiovascular disorders.
• Musculoskeletal conditions.
• Mental health illnesses.
• Vision or hearing loss.
• Chronic pain or fatigue syndrome.
• Digestive disorders.

Depending on the severity of the above conditions and how they affect your daily life and ability to work, you may file your claim for long-term disability benefits with the insurance provider.

What is the Qualifying Period or Elimination Period mentioned in the policy document?

The qualifying period refers to the lapsed time between the day of your injury or illness and the day you start receiving your benefits. This varies from policy to policy and could fall anywhere between 3 months to 1 year. The policy document may also refer to this period as the Elimination Period. During this period, the insurance provider will evaluate your claim and decide on your eligibility for receiving the benefits. It is possible for you to apply for short-term disability benefits while you are still in the qualifying period for financial relief.

What is the typical duration of long-term disability benefits?

Typically, the long-term benefits should last until you are fit enough to report back to work or until the insurance coverage period expires, which will be when the employee reaches the age of 65 in most cases. However, there are policies where long-term disability coverage only lasts for 5 or 10 years. Again, there might be exemptions for certain serious illnesses like cancer. Therefore, you should carefully read the policy document to determine your eligibility, understand the duration of these benefits, and make alternative arrangements before the policy expires.

What are some of the common reasons for rejecting a long-term disability benefits claim?

Insurance companies scrutinize every claim and reject any that do not meet their strict requirements. Some of the common reasons cited for rejection are:

• The individual does not meet the criteria for disability as defined in the policy. Read the policy document carefully. For example, in some policies, during the initial period of, say 24 months, you will have to prove that your illness or injuries impair your ability to perform your duties at work. However, after this period, you might be required to prove that your disability now impairs your ability to perform any work that meets your qualifications and experience.
• You didn’t finish the prescribed treatment. If you did not follow the treatment plan recommended by the medical team for any reason, this might be seen as a lack of effort on your part to fully recover from your illness. This might include refusing to undergo the recommended surgery or rehabilitation program or not taking the prescribed medication. You might be worried about the risks or side effects involved, but the insurance company might use this as an excuse to stop your payments.
• Any pre-existing conditions. Here, it’s crucial that you carefully read the policy document. The coverage may exclude any medical condition you may have had before the start of the policy. If the insurance provider can prove that your current disability is a result of your pre-existing condition, then they can reject your claim on these grounds.
• Failure to meet the deadlines. You must strictly adhere to the time limits mentioned in the policy document. Any failure to submit the necessary documents before the deadline might lead to automatic rejection of your claim. The same applies to the filing of your appeal or any other follow-up documents you need to submit as part of your claim. Follow the advice of your Disability lawyer and ensure that all your submissions are done within the time limit.

What are your options when your claim is rejected?

If your claim for long-term disability benefits was rejected by the insurance provider, do not give up. Follow the steps mentioned below and continue the fight for your rights.

• Read the letter of denial carefully. The insurance provider will send you a letter informing you of their reasons for rejecting your claim. Read it and compare it with the criteria mentioned in the policy document.
• Strengthen your case with further documentation. If your application was rejected because of insufficient evidence, you need to strengthen your claim. Gather more documentation from your medical team regarding your medical condition to prove your disability and also from your employer to prove that your current condition does impair you from performing the duties required by your employer.
• Submit your appeal before the deadline. Follow the advice of your lawyer in preparing your letter of appeal. The letter should specifically address the reasons mentioned by the insurance provider in their letter of denial.
• Take legal action against the insurance provider. If you are convinced that your right to long-term disability benefits was unfairly denied by the insurance provider, you may take legal action against them. You can file a lawsuit for damages as well as for additional compensation for the hardships you underwent because of their denial of your claim. You also have the option to approach regulatory bodies like the Financial Services Regulatory Authority of Ontario (FSRA) or the Ombudsman before you take the legal route. Follow the advice of your Disability lawyer in this matter.