Diabetes and Long-Term Disability Claims: What You Need to KnowDecember 03, 2020
Diabetes and long-term disability are not often terms closely associated with one another. However, diabetes and long-term disability claims are far more common than you think. Long-term disability insurance for diabetics is approved only once the individual has properly submitted their claim supported by credible medical evidence of disability.
Two Main Types of Diabetes
There are two main types of diabetes: Type I and Type II. Type one diabetes manifests when the pancreas releases such a small amount to attack cells that are supposed to process it. Sugar thereafter builds up in the bloodstream as opposed to being used as energy. This type of diabetes is typically seen in the early years of development and is treated with insulin.
The other type of diabetes is known as Type II diabetes, which is much more common and prevalent in adults. Type II diabetes manifests when the body fails to make proper use of insulin or is not producing enough insulin. In a similar fashion to Type I diabetes, sugar builds up in the blood as opposed to being used as energy. Type II diabetes can be treated with exercise and diet if it has not progressed too far.
Finally, Gestational diabetes is a condition that affects pregnant women during the second or third trimester. This form of diabetes manifests because the body is unable to produce enough insulin to handle the impact of rapidly changing hormone levels along with the growth of the baby.
Diabetes is the cause of a variety of different complications. For differing reasons, these complications can make it very difficult to continue working either at a sedentary or physical type of employment.
Some of the most common complications include high blood pressure, depression, anxiety, eating disorders, heart disease, chronic kidney disease, stroke, erectile dysfunction, and foot problems such as infections and ulcers.
These complications lead to functional restrictions and limitations which have a significant impact on a person’s ability to perform their activities of daily living and, by extension, their essential employment responsibilities.
Application for Disability Benefits
You should always consult with a lawyer before making an application for disability benefits. A great starting point is to visit https://www.canada.ca/en/financial-consumer-agency/services/insurance/disability.html to understand if you need disability insurance and, if so, whether you should apply for either long-term or short-term disability benefits.
Short-term disability coverage extends benefits for up to a period of 6 months while you are recovering from sickness or injury. If your employer maintains a short-term disability plan, your disability claim must be filed through that disability plan.
If your employer does not offer short-term disability coverage and you do not maintain coverage on your own, it is possible that you are eligible for Employment Insurance (E.I.) sickness benefits. In order to qualify, you must:
(a) Regularly have made use of all of your sick leave; and
(b) Have worked a sufficient number of hours.
You can find out more about E.I. benefits here: https://www.canada.ca/en/services/benefits/ei/ei-sickness.html
Long-term disability coverage most often commences once the following benefits come to an end:
(a) Short-term disability insurance;
(b) Sick leave benefits received from your employer; and
(c) E.I. benefits
In most cases, long-term disability plans replace approximately 60% to 70% of your normal income.
A lawyer should be consulted before submitting an employee statement since you do not want to say too much or too little. Lawyers have experience with filing such forms and know the exact words to use and how to use them. This is especially important since the employee must outline all of the different ways they are unable to conduct their activities of daily living as well as their essential work functions.
Attending Physician Statement
As for the attending physician statement, the doctor treating the disabled person must explain the nature of the patient’s condition as well as any and all complications that have manifested themselves, specifying the limitations and restrictions of the affected individual.
It is important that on both the attending physician statement and employee statement that clear examples of how the complications caused by diabetes have affected the disabled person’s life, as well as their activities of daily living. Specific, real-world examples go a long way here, and the inability to sit at a computer (such as at a sedentary job) or to engage heavy machinery (in a physical job) on a regular basis help to make the case for the issuance of disability benefits.
Additionally, all relevant medical information and documentation in support of the disabled person’s claim should be submitted in conjunction with the aforementioned statements. These documents and medical proofs may include x-rays, bloodwork, consultation reports from treating physicians and therapists as well as hospital records.
The Claims Stage
Insurance companies who are charged with the duty to review and either approve or deny claims are evaluating to see if disabled individuals are seeking out proper treatment from specialists, medical professionals, therapists, and the like. This treatment should be consistent, regular, and ongoing in order to properly support a person’s claim.
Insurance carriers deny claims for any number of reasons. A few of the most frequent examples are:
(a) Insurance carrier does not feel that the claimant has undergone treatment with enough regularity or is not appropriate for the disability claimed;
(b) An appropriate specialist for the disability has not been selected;
(c) There is not enough objective medical evidence to support the disabled person’s claim of disability;
(d) The limitations and restrictions claimed are not supported by medical evidence;
(e) Claimant has the ability to work in a sedentary position if their former job was physical or if their former job was sedentary they are able to continue working in the same or similar capacity.
If your claim has been denied at any stage of the process, you do have the right to challenge and appeal the decision of the insurance company. You may file a suit against the insurance carrier to compel a more thorough review of your case.
Overall, it is your best bet to consult with a lawyer who is experienced in both long-term and short-term disability matters so that you may be educated as to your rights, responsibilities, remedies, and obligations and to make sure you did not miss any deadlines for filing. The claims process can be a long and arduous one and it is not something that you want to deal with when you are dealing with diabetes and a long-term disability.
Take the time to consult with a reputable and experienced lawyer if you are considering filing a claim for either short-term or long-term disability benefits. In most cases, the consultation is free and there is no obligation. Invest the time to consult with a professional and you will realize far better results than had you filed a claim on your own.
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