‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims

Making a disability claim can be overwhelming for people who find themselves unable to work due to their health. It can be a challenge to know where to start when you need assistance during an extremely difficult time.

That’s where I come in. My primary role as a disability lawyer is dealing directly with insurance companies on my clients’ behalf to get them compensation when their insurance claim is denied or their benefits are cut off.

I also help individuals understand disability claims from start to finish. Having previously worked for the insurance industry, I’ve seen the process from both sides.

Here are some common questions from my clients about disability benefits and the steps I tell them to take.

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Should I apply for short-term or long-term disability benefits?

The first step is to figure out which disability plan or program you qualify for. If you recently stopped working, the first thing to use is whatever sick pay or sick days you can access through your employer.

When your disability prevents you from working for more than a few days, some employers offer short-term disability benefits (STD) or salary continuance benefits. These benefits are intended to provide disability income to people who need to be off work due to sickness or injury for up to six months.

Not every employer offers STD benefits, so you may need to check that they’re available for the initial period of your disability leave.

If you do not have STD benefits, then you may qualify for employment insurance sickness benefits or other government income support programs.

READ MORE: Can’t work? Why long-term disability may be better option than government assistance

Long-term disability (LTD) benefits provide financial assistance when a covered plan member is unable to work long-term due to an accident, illness or injury. Depending on the nature of the disability, the benefit can provide income replacement up to age 65.

To be eligible for LTD benefits, you must be covered under a disability plan or insurance policy. This could be a workplace group policy provided by your employer or union, or it could be an individual disability insurance policy you bought yourself.

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If your disability was caused by a workplace accident, then LTD benefits will coordinate with workers’ compensation benefits. This type of benefit differs from province to province. For instance, Alberta has the Workers’ Compensation Board, B.C. provides WorkSafe, and Ontario has the Workplace Safety and Insurance Board.

How do I know if I qualify for disability benefits?

Disability plans and insurance policies have virtually the same requirements to qualify for disability benefits: it comes down to what your doctor says.

If your doctor declares that you can’t work because of your compromised health, you should qualify for LTD benefits.

Your doctor will need to fill out a medical form and provide you with their clinical notes when you apply for disability benefits. Without this documentation from a medical professional, the insurance company will not approve your application.

How do I apply for disability benefits?

Every insurance company has its own application forms, which should be available through your employer or directly through the insurance company’s website.

Most group disability policies require you to complete three forms: a statement from the employee, a statement from the employee’s doctor and a statement from the employer. These documents must be submitted to the insurance company.

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Each disability plan will set out its own time frame to apply for benefits.

READ MORE: What to know about your long-term disability rights in the age of COVID-19

How do I complete application forms for disability benefits?

Make sure all required forms are filled out properly and completely, and provide any other information or documents that support your claim for STD or LTD benefits. Far too often my colleagues and I see legitimate disability claims being denied because the forms are incomplete or the information provided is unclear.

It’s also a good idea to check that your doctor has filled out their form as comprehensively as possible and that the information they submit is consistent with what you have put in your form.

Your doctor must include all your diagnoses and restrictions, and any limitations to physical, cognitive and emotional functioning. They should also list all treatment providers, such as therapists and specialists, and all treatment, whether under way or planned.

If any of this information is missing from the form, ask your doctor to include it in a brief narrative report. In my experience, a narrative report can be the most effective way to provide the necessary information to the disability insurer about your disabling health issues.

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Does my employer need to provide any information for me to receive disability benefits?

Your employer is required to submit a form directly to the disability insurer that explains your position, how much you were earning, your job and the essential duties you were handling. The insurance company uses this information to assess whether you qualify for the STD or LTD benefit.

This means it’s important to tell your employer in writing that you’ll be on a sick leave. I recommend providing a medical note from your doctor confirming that your illness and disability are the reasons you are not at work.

I have seen situations where the employer has tried to convince the ailing worker to quit their job or even terminated an employee for taking a leave of absence.

But I always tell clients not to resign, retire or accept a severance package without consulting an employment lawyer at Samfiru Tumarkin LLP first. Your employer can’t legally fire you because you are sick or taking a medical leave. They also can’t force you to leave your job. If they fired you or forced you out over medical leave, our firm would likely be able to secure a full severance package, which can be as much as 24 months’ pay, as well as human rights damages.

READ MORE: Most common mistakes people make when they are denied long-term disability

What happens after I’ve finished an application for disability benefits?

Submit your disability application to the insurance company. An adjuster or case manager will be assigned to review your claim and will contact you directly, usually within a week to 10 days.

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They will ask about your disability claim, your health and your treatment. They may also ask a variety of questions about your level of day-to-day functioning to determine whether you qualify for disability benefits. I tell clients that honesty is the best policy, since you have a duty to cooperate with the process of evaluating your claim.

The adjuster may also contact your doctor if they need more information to make a decision about your claim.

When will the insurance company make a decision about my claim?

The whole process of applying for disability benefits should not take more than a few months. You can expect a decision on your disability claim within 30 to 45 days of your application.

If the decision takes longer, you have every right to ask why.

Once a decision is made on your claim, get it in writing and make sure you understand what it says. Your employer will also get a copy of the decision letter, with any references to medical or health information removed.

READ MORE: Long-term disability claim denied? This is why you need a disability lawyer

What if my STD or LTD claim is denied?

If your short- or long-term disability claim is denied or your benefits are cut off for any reason, contact my team at Samfiru Tumarkin LLP immediately. A disability lawyer can review your situation at no cost and help you determine how to get the compensation you are owed.

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Have questions about completing the forms for disability benefits?

Find the answers in this disability claims resource created by Samfiru Tumarkin LLP.

If your long-term disability claim has been denied, contact the firm or call 1-855-821-5900 to secure assistance from a long-term disability lawyer in Ontario, Alberta or British Columbia. Get the advice you need — and the compensation you deserve — from the most positively reviewed long-term disability law firm in the country.

Tamar Agopian is a disability lawyer and partner at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in employment law and long-term disability claims. The firm provides free advice on Canada’s only Disability Law Show on TV and radio.

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