COVID-19 and Frontline Healthcare Workers: How Can I Successfully Appeal a Denied LTD Claim?May 23, 2020
Covid-19 and Frontline Healthcare Workers
Frontline healthcare workers are essential to our safety and experience higher levels of fear, worry, and uncertainty. And now along with all the other stressors that go with being a frontline worker, they have Covid-19 to deal with. With Covid-19 Frontline Healthcare workers worry about contracting the virus or spreading the illness to their family just as we do. Those with higher risk and pre-existing conditions may feel distressed about contracting the virus. They can have a chronic disease or medical condition that makes them particularly vulnerable for severe complications if they get COVID-19.
Frontline healthcare workers face increased stress and anxiety and may qualify for disability benefits. It may trigger a pre-existing condition such as anxiety or depression, although COVID-19 is a new disease and can’t be considered a pre-existing condition, other illnesses can be triggered or made worse by COVID-19. Or workers simply may be afraid to go to work with insufficient supplies of personal protective equipment (“PPE”). The shortage of supplies and re-using face masks will increase their risk.
Ontario has developed guidelines and support for frontline workers.
Frontline Workers and Long Term Disability
For those who develop a prolonged disabling condition during the pandemic they may apply for a long term disability (LTD) claim. Should a person’s condition become severe and their doctor believes they will not return to gainful employment, then a disability claim may be appropriate.
Frontline healthcare workers usually have group coverage through their employer for long-term disability benefits. The policy will define “partial” or “total” disability. In most cases, the policy will require continuous rehabilitation efforts by the claimant.
Although the most common type of disability policy wording requires complete or “total” disability from working, some policies allow “partial” disability. In those policies which allow claims for partial disability, a claimant may have a persistent, reduced capacity to work or decreased productivity.
A denial of benefits can occur at any stage of a long term disability claim. You can appeal the insurer’s decision through its internal process. However, in most cases in the absence of new, compelling medical evidence, this will not change the insurer’s decision. Instead, you may need to retain a lawyer and begin legal action.
Note: It is important to initiate the claim within two years of denial of the benefit.
Reasons for Denial
Insurers may deny disability claims due to insufficient medical records. The claimant should see their doctor regularly, at least every two weeks to demonstrate that they are receiving appropriate treatment. In addition, claims are often denied for failure to cooperate with medical practitioners or follow an appropriate treatment plan.
The insurer will expect the claimant to at least see a family doctor. However, further steps are often required. The family doctor should make referrals to specialists. The claimant must follow the advice of his or her doctor and take advantage of all available treatments.
A claimant should also apply to the federal government for CPP Disability Benefits. This is a separate application process. There is a Physician Statement portion of the application. Should you qualify for the CPP benefit, it may be easier to establish your claim for LTD benefits. In addition, CPP disability benefits are usually deductible from the LTD benefit. Therefore, the insurer will expect the claimant to at least make the application to CPP.
Using a disability lawyer with the expertise to guide you through these critical early stages of your disability claim after a denial of long term disability benefits will help you build a strong case to present to the insurance company. Disability lawyers have the experience to recognize what the insurance companies are looking for in distinguishing a winning case.
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