long-term disability claims denial law
Navigating Denied Long-Term Disability Benefits: How a Lawyer Can Help in Ontario
When individuals face health challenges that prevent them from working, long-term disability benefits serve as a financial safety net, providing much-needed support during difficult times. However, the process of obtaining long-term disability benefits can be complex and daunting, especially when claims are denied by insurance companies. In Ontario, Canada, individuals who have been denied long-term disability benefits often turn to legal professionals for assistance in seeking the benefits they rightfully deserve. In this article, we'll explore the reasons why long-term disability claims may be denied and the valuable role that lawyers play in advocating for individuals in such situations.
Why Long-Term Disability Claims May Be Denied:
1. Insufficient Medical Evidence: Insurance companies often require substantial medical evidence to support disability claims. If the medical documentation provided is deemed inadequate or insufficient to establish the severity and impact of the disability on the individual's ability to work, the claim may be denied.
2. Policy Limitations and Exclusions: Long-term disability policies typically contain specific limitations, exclusions, and eligibility criteria that must be met for benefits to be paid. If the disability falls outside the scope of coverage or if the individual fails to meet the policy's requirements, the claim may be denied.
3. Disputes Over the Severity of Disability: Insurance companies may dispute the severity of the individual's disability or question whether it prevents them from performing their job duties. This often leads to disagreements between the claimant and the insurance company, resulting in denied claims.
4. Failure to Meet Deadlines and Requirements: Long-term disability claims involve strict deadlines and requirements that must be met for the claim to be considered valid. Failure to adhere to these deadlines or provide requested information in a timely manner can result in claim denials.
How a Lawyer Can Help:
1. Reviewing and Assessing the Claim: A lawyer experienced in long-term disability law can review the details of the denied claim, assess the strengths and weaknesses of the case, and determine the best course of action moving forward.
2. Gathering Additional Evidence: Lawyers can work with medical professionals and other experts to gather additional evidence supporting the disability claim, addressing any gaps or deficiencies in the initial documentation provided to the insurance company.
3. Navigating the Appeals Process: If a long-term disability claim is denied, individuals have the right to appeal the decision. A lawyer can guide claimants through the appeals process, ensuring that all necessary documentation and evidence are submitted and advocating for their interests during appeal hearings or proceedings.
4. Negotiating with Insurance Companies: Lawyers can negotiate with insurance companies on behalf of their clients, seeking to resolve disputes and reach favorable settlements that provide the long-term disability benefits owed to the individual.
5. Litigating When Necessary: In cases where appeals are unsuccessful or insurance companies refuse to cooperate, lawyers can initiate legal action by filing lawsuits against the insurance company. Through litigation, lawyers can pursue the full extent of their clients' entitlement to long-term disability benefits in Ontario's courts.
Seeking Legal Assistance:
Denied long-term disability benefits can have devastating financial consequences for individuals and their families. In such challenging circumstances, seeking the assistance of a knowledgeable and experienced lawyer is crucial. By enlisting the help of a lawyer specializing in long-term disability law, individuals can navigate the complexities of the claims process, overcome obstacles, and effectively advocate for their rights to receive the benefits they deserve in Ontario.
When you buy long-term disability insurance, or when you have access to such insurance policies as part of your employment, you would expect that should you ever become disabled, you will be able to tap into your long-term disability (LTD) policy. In an ideal world, it would be as simple as that. Become disabled from work, you apply for benefits, and you get those benefits. Unfortunately, as most people eventually discover when they have to make an insurance claim, it is actually quite complicated. People find out that there are actually many reasons that insurance companies will have to deny long-term or short-term disability benefits.
It is important to note that any disability policies are contractual in nature. That means, the terms of your insurance policy are unique to the policy that you have agreed to with the insurance company.
The basics of most short and long term disability insurance policies are that they provide you with a monthly cash benefit to help you with everyday expenses should you be away from work for an extended period of time. Typically, your disability insurance policy will cover a percentage of your income. Depending on the policy, it's typically between 50 and 75% of your salary. Some policies may pay until age 65. Some policies will also cover you for any occupation or your own occupation. Your own occupation is a better definition, because it just means you cannot work at your current job. With any occupation, it means you cannot perform the duties of any job. That means, if you become disabled, but you could perform a less demanding job, you will not qualify under the any occupation test. Some plans offer own occupation coverage for the first two years and then switch to any occupation after that.
The best thing to do to protect yourself is to ensure that you have sufficient coverage. If your coverage comes from work, you should contact your company's human resources department to see what your benefit entitles you to. You should also find out if there are any caps to your benefits. If you find out your company benefits are insufficient, you may wish to consider purchasing a private disability plan to supplement your group benefits. This is an important insurance policy for you to have, to ensure that if you ever become disabled from working, you have a source of income to survive.
If you have been denied short- or long-term disability by the insurer, you have many options. A lawyer can explain to you what options you have. There are internal methods of appealing an insurer's decision. Typically, you may try to exhaust the internal appeals procedures first. This is especially the case if the insurer just lacks documentation. However, don't take too long to appeal. If you find out your appeal is not going anywhere, speak to a lawyer immediately. Long and short term disability lawyers typically also do personal injury work, and have expertise in fighting short and long term disability denials. If you have any medical evidence, it is best to collect it and keep it in a safe place. If you don't have medical documentation, a lawyer can help you get that documentation and fight any denials that you may get from the insurance company. Do not give up on your claim. A lawyer can proceed with litigation, if necessary, in order to fight for your entitlement to the benefits that you have rightly paid premiums for and should be entitled to.
That being said, there are other avenues for monetary assistance in case you are unable to work one day. If you have contributed to Canada Pension Plan, you may be entitled to Canada Pension Plan (CPP) disability benefits. However, the test to meet is a difficult one. There are also Employment Insurance Sickness Benefits to consider, for the shorter term.
Ready to get started? Key Legal has free of charge Ontario Long-Term Disability Lawyers ready to help you either through Zoom meetings or by telephone. You can either book an appointment or request a lawyer on-demand. Just use our booking page or our chat feature to get started!