Insurers often deny claims for long term disability without hesitation. It is in their best interest to deny these claims from a profit standpoint. However, it is not in the best interest of the disabled party who is entitled to receive these benefits.
If your claim for long-term disability benefits has been denied, you have the right to appeal the decision. The appeal process can become quite complicated, and you will need the assistance of a lawyer for the best possible outcome for your appeal.
Proving Your Disability
When proving disability Ontario residents will be required to prove that they have a physical or mental disability. This will include answering questions that are similar to the following:
- What is your disability, and when did you first experience symptoms?
- How is this disorder preventing you from performing your work duties?
- Is the injury or illness work-related?
- Have you suffered from this or a similar condition in the past?
- Are you currently undergoing treatment for the condition?
- What types of treatment have you received, are currently receiving or will receive in the future for this condition?
- Do you feel that you will be able to return to work in the future?
- Are you receiving any other benefits, such as workers’ compensation?
- What are the names of your treating physicians?
When proving disability, you will also be required to provide the insurer with the following:
- Access to all of your medical records concerning your condition
- Information on how to contact your employer (or past employer) regarding your job duties
You may also be asked to attend an independent medical exam by a medical care provider chosen by the insurance company.
In addition to these requirements, to prove disability applicants will also have to show the insurer that they cannot perform their job duties. The first proof must show that the disability prevents the person from performing their specific job. The second test is determining if the disability prevents them from doing any type of gainful employment based on their experience and schooling.
These two qualifications can be a little more difficult for the disabled party to show. What the insurer believes is possible to do with a medical condition and what is reality are often quite different. This is why having legal representation is very necessary during the appeal process.
What a Lawyer Can Do for Your Case
The insurance companies are responsible for making the long-term disability claim process complicated. It is their goal to make the process complicated in hopes that you will become frustrated and drop your claim.
The process should be much simpler. You should only be required to meet the same qualifications as those by the Canada Pension Act, which governs CPP benefits. Under this Act, a person is considered disabled if:
- The person has been diagnosed with a severe or long-term mental or physical disability
- The condition is classified as severe because it prevents the person from having gainful employment
- The condition is anticipated to last for a long period of time or cause the eventual death of the person
Proving disability should not be more complicated than meeting these criteria.
Working with a lawyer will help ensure that the insurance company honors its policies and does not cause you undue harm or stress by willingly prolonging the claims process. A lawyer will make sure that the conditions set forth by the Canada Pension Act are followed, and that excessive testing is not forced upon the applicant.
It does not matter if your long-term disability coverage is a private policy or one provided by your employer, they are all required to honor the terms of the policies that they issue, regardless if it impacts their bottom line.
