When you are on long-term disability (LTD) because of an injury or illness, challenging an insurance company that has rejected your claim for LTD benefits can be a daunting prospect.
Termination of these benefits, or the denial of an insurance claim altogether, happens more often than people realize. What many people don't know is that they have a legal right to dispute an insurer's decision.
Disputing denials can be a complicated process, but you don't have to take on the insurance company by yourself. In fact, it can be in your best interest to seek legal advice when your LTD claim has been denied or your benefits have been terminated.
If you are on disability for whatever reason, your priority should be getting better so that you can return to the life you once enjoyed. However, challenging an LTD claim denial or termination can be extremely stressful, and can take valuable time away from your treatment or therapy.
The team at Gluckstein Lawyers has an extensive understanding of insurance laws and we know how to dispute and litigate long-term disability insurance claims. We are dedicated to ensuring that your needs are met with our full-circle care, and our lawyers will work diligently to get the benefits you deserve.
Understanding LTD Insurance.
There are several ways to obtain LTD coverage. If you finance your home, your financial institution may require you to purchase an LTD policy. Others may either have LTD coverage through a package of group benefits offered by their employer, and depending on the circumstances, they may be responsible for paying for all or part of the premium. For those who do not have LTD insurance already, there is an option to purchase long-term disability insurance plans privately.
Long-term disability policies provide an income replacement benefit for those who are unable to work because of an illness, accident or injury. If your injury or illness prevents you from returning to work for an extended period, LTD may provide coverage, in some serious cases, up until retirement age.
You may also be covered by separate short-term disability (STD) insurance. STD benefits differ from LTD benefits and are for those who are expected to be back on the job within a few months.
LTD policies differ and you must meet the eligibility criteria dictated by the insurer to qualify for benefits.
Insurance Company Challenges.
Long-term disability insurance typically covers a range of illnesses, disabilities or injuries. There are some injuries, however, such as "invisible injuries" (including cognitive, emotional or behavioural conditions), that insurance companies have been known to challenge, which is why seeking legal advice makes sense. Just because your claim for LTD benefits has been denied does not necessarily mean that you are not entitled to benefits. Consulting with a lawyer can help you understand your rights.
With any LTD claim, there is something known as the disability test. Generally, the test is based on your inability to perform the essential functions of your job. However, after two years, the insurer will only consider you to be totally disabled if you are unable to perform the tasks of any job, meaning that you could be expected to return to work in a different capacity.
It is important to know that you cannot be forced to take on just any role, however. The work must be commensurate with your relative position in the workforce, your age and other real-world factors.
Simply stated, if you were middle management when you went on LTD, you wouldn't be expected to dig ditches. It should be noted that the Courts are on your side on this issue and you may have a solid legal reason to refuse work outside your sphere of experience and position within the company.
How a Toronto Long Term Disability Lawyer Can Help.
It is well known that insurance policies contain language that can be confusing. The application process to make a claim for benefits is also complex. A simple mistake, missing a deadline or failing to provide proper medical documentation can lead to a claim denial. If you fail to follow through on the treatment prescribed by your physician or if the insurer disputes your disability based on the definitions of the policy, your claim could be denied or terminated.
The insurance company can also deny your claim on the basis of a pre-existing medical condition. This is commonly defined as any condition that you have previously received treatment for and is related to the issue that led to your LTD claim. However, just because the insurer says a pre-existing condition justifies a claim denial does not mean that you are not entitled to benefits.
Although insurance companies must follow specific stipulations and procedures, they also have a duty to act in good faith to their insureds. An experienced LTD lawyer can ensure they do just that. As a first-time claimant, you may not be familiar with the applicable rules and regulations, but a lawyer who understands disability insurance law can help cut through the jargon to protect your interests.
Being Proactive Can Be Beneficial.
Many people hire a lawyer after their claim has been denied or terminated. It can also make sense to seek advice when you decide to file for benefits, especially if you are concerned that the insurance provider might dispute or deny your claim. You will need to document the reason for your claim, providing such information as physician statements, medical records and treatment options. You will be under a deadline and also will be expected to complete the application forms accurately.
A lawyer who has dealt with insurance companies knows exactly what is needed and when. They also know how to anticipate challenges and can negotiate with the insurer.
It should be noted that if your claim is denied, many insurers will inform you of your right to pursue an internal appeal. It may sound reasonable but it is not always in your best interest. The same people who already denied your claim will consider your appeal and, in many cases, these decisions are not reversed.
Further, the limitation clock to commence a lawsuit may have already started running so you must act immediately. Involving a lawyer at this stage can help you determine the best course of action for your particular situation.
Experience You Can Trust.
When you are unable to work due to an illness or injury, your focus should be on getting better. Dealing with a denial or termination of benefits can add stress and hamper your recovery. If you have questions or concerns about your LTD claim, the team of Ontario long-term disability lawyers at Gluckstein Lawyers is here to help.
Once we take your case, the insurance company can only deal with us so you can concentrate on your health. Our lawyers will explore all available options to find the best solution for you.
Contact us today to set up a free consultation.