Each year, many Ontarians apply for long-term or short-term disability for several reasons. Unfortunately, many of these requests end up getting denied, leaving hard-working and sick individuals feeling hopeless and financially strapped. If you have experienced a catastrophic accident, you may end up with life-long personal injuries that prevent you from returning to work. You may also suffer health issues unrelated to a personal injury that can prevent you from working. Having your disability benefits denied can create an extremely stressful situation, but don’t give up. There are many options out there for people who have been initially denied disability benefits.
If you are unsure about what your disability policy covers, or if your initial claim is denied, proper legal counsel can help guide you on the appropriate next steps to help you access the benefits you need. Personal injury lawyers, like De Rose Lawyers, are here to help you navigate the complicated appeals process and claim benefits that will help improve you and your family’s situation.
What Is Short-Term Disability?
Most employers do not actually provide short-term disability benefits. In many cases, short-term disability is an income replacement that provides you with up to 80% of your gross salary for up to 6 months.
If you do not have short-term disability benefits from your employer, you may be eligible for Government of Canada Employment Insurance (EI) sickness benefits. The government offers up to 26 weeks of benefits, but this will only be applicable to you if you pay into EI.
To be eligible for EI sickness benefits, you must:
- Have used up all your sick leave
- Have worked enough insurable hours
What Is Long-Term Disability?
Long-term disability benefits essentially act as a type of income replacement. You will receive these disability benefits for as long as your long-term disability insurer decides that you are unable to work. Once you have qualified for long-term disability benefits, you will be provided with periodic payments for as long as your benefits are valid for, or as long as you are unable to work, whichever one comes first.
Although many policies are similar, it’s very important to understand what your individual policy covers. That’s why it’s always a good idea to get in touch with a lawyer that specializes in long-term disability, such as De Rose, to go over your policy with you and make sure your coverage is enough.
It is very important that you have a suitable long-term benefits plan in the unfortunate instance that you find yourself suffering from an unexpected illness or injury and cannot work.
Most employers provide some form of long-term benefits disability insurance benefits, but many do not. LTD is an income replacement benefit that provides up to 60% of your gross salary (there is a monthly limit) for the time you cannot work.
It is usually available after exhausting the following benefits:
- Short-term disability insurance
- Sick leave benefits from your employer
- EI benefits
These benefits usually continue until you reach the age of 65.
When Do You Qualify For Long-Term Disability Benefits?
It depends. Long-term disability benefits don’t come into place until you’ve used up your short-term benefits. This includes short-term disability insurance or Employment Insurance (EI). Employment Insurance is something paid out by the government, that you pay into with every paycheque. Many independent contractors or business owners do not have Employment Insurance. After you’ve become disabled or unable to work, there is typically a 90 to 120-day period which is called the elimination, waiting, or qualifying period before your long-term disability benefits come into effect.
There are two different kinds of tests that are common in group policies. Sometimes both tests apply to a single policy. These are “regular or own occupation” and “any occupation” tests.
Not many private policies exist. The percentages vary, and qualification dates vary. There is no standardized formula for this type of benefit. That’s why it’s very important to talk to a lawyer to properly understand your policy and what these different terms mean.
How Do You Apply For Long-Term Disability Benefits?
There is a form you must fill out, which many doctors don’t fully understand. MVA forms on the other hand are standard, and many doctors are familiar with filling those out. However, the first long-term benefits application is incredibly important and the medical report you must attach is critical. It must immediately meet the contractual obligations.
To get this form, you must contact your insurance provider. The form must be filled out by a medical professional and filled out properly. To help ensure a successful report, it’s extremely important that your medical professional understands exactly why you cannot work.
That’s where a lawyer specializing in long-term disability comes into play. We can intervene before you speak with your doctor or medical professional and help you understand exactly what obligations need to be met for your specific contract and how to properly communicate these needs with your doctor. If these forms aren’t filled out correctly the first time, your request may be denied, and you will have to restart the process from the beginning.
Reapplying after a denial takes a long time, and in many cases, people cannot afford to wait. That’s why it’s always advised to speak with a lawyer from the beginning of the process, to prevent delays and to get you the coverage you need as soon as possible.
This evidence will need to be provided from your medical professionals on an ongoing basis to continue receiving your benefits. Whether your claim involves invisible illnesses such as chronic pain or mental illness, the medical evidence is still required to process your claim.
Can You Get Disability Benefits For Depression?
It’s true that all disability benefit providers in Canada recognize depression as a disability. It’s a condition that can qualify for benefits. However, a diagnosis alone won’t qualify you.
Ultimately, proving that depression or a mental health issue is keeping you from work can be difficult. Most providers focus on the severity of your symptoms and will consider previous, present, and future medical treatment plans. They will also scrutinize how your symptoms affect your work and how hard you tried to keep working.
Keeping your documents in order and recording all necessary paperwork to assist your claim can go a long way in recovering long-term disability benefits. Nevertheless, a lot of individuals fear speaking out against their employer because they feel they will get fired – especially for depression. However, Canada’s human rights laws state that employers have a duty to help employees with medical conditions that affect their ability to work.
What Types Of Depression Benefits Are Available?
If you’re unable to work due to depression or disability, there are several types of depression benefits available.
- Employment Insurance (EI) Sickness Benefits
- Short-Term Disability Insurance
- Long-Term Disability Insurance
- Veterans Affairs Canada
- Provincial Disability Benefits
- Disability Tax Credit
- CPP Disability
- Workers’ Compensation
Was Your Disability Claim Denied?
If your benefits have been denied, it’s very important that you get yourself a long-term disability lawyer.
Long-term disability insurance is meant to provide financial assistance to you in your time of need. When an insurance company wrongfully denies your claim, you need to seek competent legal advice as quickly as possible. Your best choice is to hire an experienced long-term disability lawyer to review your rights and remedies.
At De Rose Lawyers, we have 40 years of combined experience working for innocent victims who have been wrongfully denied their benefits. We are here to help you get the long-term disability compensation you deserve and to make sure the maximum benefits owed are paid to you and your family.
Common Reasons Long-Term Disability May Be Denied
As stated above, there are many reasons why your long-term disability claim can be denied, but here are some of the most common reasons:
- Complicated wording of insurance policies detailed in the fine print of your coverage. Oftentimes, important clauses and exemptions are listed in the fine print of insurance policies that could be overlooked. Providers might point to these exemptions as a reason for denying a claim.
- Insufficient medical documentation could result in the denial of a claim as well. Should you be unable to produce requested medical documentation to your insurance provider, it could result in your claim being denied.
- In certain cases, there might only be a short window to file a claim for long-term disability. Should you choose to make a claim several days or weeks after the disability began, that could result in a denial.
- Your insurance provider doesn’t consider you to be experiencing “total disability”.
- There are alternative occupations you can pursue while experiencing a disability.
- The insurance provider is running surveillance on you as they suspect you are partaking in insurance fraud.
- When filing a claim, you provided incorrect or incomplete information in your application, resulting in a denied claim.
- Conflicting information between your doctor’s medical reports and the insurance provider’s medical team reports.
Long-Term Disability Denied – The Appeals Process
You can appeal a long-term disability denial. The process is complicated and best addressed with proper legal counsel.
Here are six steps you should take in the event you are denied long-term disability insurance:
- Take note of the deadline for appeal and reach out to legal counsel.
- Inform your employer that you are preparing to appeal the insurance decision.
- Prepare all necessary documents needed for the appeals process including detailed notes on doctor’s visits.
- Carefully read the fine print of your insurance policy including any exemptions that may impact your policy.
- Study your denial letter and begin drafting your appeal letter.
- Carefully review your appeal letter with your qualified legal counsel and send it to your insurance provider.
Long-Term Disability Denied – Appealing By Lawsuit
In instances when an appeal letter has failed, and long-term disability benefits are withheld by your insurance provider, Ontarians can push their claim with a lawsuit. In fact, most lawsuits are more successful with these kinds of cases as the original denial letter shows that your insurance provider has already made their decision regarding your claim. Insurance providers control their appeals process and do not hire a third party to make a fair decision.
While the process of taking legal action against your insurance provider might seem intimidating, long-term disability lawyers can fight for what you are entitled to. Lawyers can seek out additional information, issue an official statement of claim, and can collect compensation should you experience damages from your insurance provider denying benefits in the first place.
There are many complicated legal steps required for a successful lawsuit against an insurance provider, and Ontarians are encouraged to reach out to specialized legal counsel to ensure they receive the benefits that they are entitled to.
Looking For A Long-Term Disability Lawyer In Toronto?
If you or a loved one has been denied long-term disability, De Rose’s long-term disability lawyers can help. Give us a call today to schedule a consultation with a member of our experienced personal injury team. We will be there with you, and for you, throughout the appeals process.