Many employees aren’t aware that they have long-term disability (LTD) insurance coverage as a part of their group benefits plan through their employer.
Whether you recently began suffering from a medical condition that has prevented you from working, or are just curious about what it covers, it’s important to ask your employer if you have short- or long-term disability coverage as a part of the company’s benefits package. This disability coverage can provide you with financial support if your health is compromised and you can’t earn a paycheque.
If you’ve never dealt with LTD insurance before, here are five things to know about disability claims and what to do if you have trouble getting benefits from the insurance company.
1. Don’t give up if your legitimate LTD claim is denied or benefits are cut off
If an injury or illness prevents you from working, your employer’s group benefit plan (or a plan you have purchased as a self-employed individual) should support you as you recuperate.
But insurers often deny claims or cut benefits off. For example, insurers may say you are not “totally disabled” — a term made up by insurance companies — and therefore should be able to continue working. Regardless of the severity of your condition, though, if you are unable to work, and your doctor agrees, you should get LTD payments.
When a claim is denied, it’s important to take action as soon as possible. You only have two years from your first denial for benefits to file a legal claim. If you put off dealing with the denial, you could run out of time to file a claim.
If you are uncertain about your situation, contact a disability lawyer, like the team at Samfiru Tumarkin LLP. We don’t charge for disability consultations, and we can quickly assess your situation and let you know what your options are.
READ MORE: 4 reasons why long-term disability claims are rejected, and how to fight back
2️. Insurance companies can’t ignore information supplied by doctors
If your doctor says that you are not able to work and your disability interferes with your job, it doesn’t matter if the insurance company believes your doctors or not. Our legal system has established through court cases that in these situations, your insurance provider must honour your long-term disability policy and pay your benefits.
Providing thorough documentation from treating doctors that clearly details your medical issues when you apply for benefits can bolster your chances of being approved.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
3. Insurers can’t stop your LTD benefits if you don’t try to go back to work
In my experience, your insurance provider will eventually tell you that it’s time to try to go back to work — usually after you have been receiving benefits for two years or so. They may even ask you to undergo an independent medical assessment, potentially with a doctor on their payroll, that ultimately directs you to go back to work.
But you’re not obligated to return to work if you are not ready, especially if you don’t have clearance from your own doctors to do so.
The insurance company may threaten to end your benefits if you don’t try to go back by a specific deadline. Without the approval of your medical team that you are functionally able to return to work, it is more likely that a court will find that the insurer is obligated to continue to pay your benefits.
READ MORE: Can your LTD insurer force you back to work?
4. LTD appeals are often a waste of time
When your benefits are denied, you will be presented with what looks like a formal opportunity to appeal the insurance company’s decision. It might even look like a neutral third party is extending this second chance.
But the process is anything but neutral. It actually takes place within the insurance company and is likely overseen by the same people that denied your LTD benefits in the first place. That’s why appeals are rarely successful.
Often, the appeals process is so time-consuming that people run out the two-year clock on filing a legal claim. So I tell clients that instead of wasting time on an appeal, it’s better to go through a long-term disability lawyer to get compensation.
5️. Choosing the right LTD lawyer can help you get the compensation you need
An experienced LTD lawyer, like the ones at Samfiru Tumarkin LLP, can help you get the compensation you’re owed, without taking payment until your case is resolved to your benefit.
Once you have a disability lawyer on your side, you can let us take over the paperwork, correspondence with the insurance company and contact with your doctors. That way, you can get back to what matters most: focusing on your health and your recovery.
READ MORE: What to expect when hiring a lawyer to fight your disability claim denial
Has your LTD claim been denied? Not sure how to get the money you need while you can’t work?
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 disability and employment law firm in the country.
Sivan Tumarkin 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. He provides free advice as a host of Canada’s only Disability Law Show on TV and radio.