Long Term Disability Claims

A pile of blister packs of different medications | Long Term Disability Claims

Long Term Disability Claims | Co-Authors Ian Hurley and Bram Lecker

Long Term Disability Claims.

The Globe and Mail recently reported that one in three Canadians will be disabled for 90 days or more, on at least one occasion, before the age of 65. Some workplaces offer their employees disability benefits as part of their compensation package. These are excellent “peace of mind” contracts. They cover you for part of your income loss in the event of an illness or disability. Generally, Short Term Disability Benefits cover you for 120-180 days. If you are still not well after this period, then more coverage comes from Long Term Disability Claims. In fact, if your condition is severe enough and it is clear from the onset that you will not be able to do your job again, or for an extended period of time, you should file this claim right away.

Filing Long Term Disability Claims.

It is no secret that the worst thing about Long Term Disability Claims is the approval process for qualifying to receive them. Long Term Disability Claims represent large expenses for insurance companies who do not benefit from paying them out. Consequently, they use every means at their disposal to deflect and reject all but the most persistent of applicants.

The process starts out with junior level claims advisors asking for medical reports to evaluate the claim in detail. And it escalates from there. After an interminable period, they will either reject your claim or request further medical evidence. Sometimes, they set unreasonable deadlines for receipt of this evidence knowing fully well that it will take you a while to obtain specialist appointments.

Reasons for Delay or Denials.

In our estimation, these tactics are for delaying or denying the claim based on technicalities.  Examples include pre-existing conditions, being out of the “qualifying period” or the nature of the disability not fitting the definition set by the insurer. This vetting process is very onerous to negotiate for most people while fighting a serious illness. If you are also desperately dependent on this benefit to manage your finances, then this will be one of the most stressful periods of your life.

Eventually, with no resolution of this matter, some employers start agitating their employees. They will demand you return back to work or risk losing it for abandonment. Sadly, this sequence of events is predictable. By design, it is an exercise to frustrate you into giving up.

Denied Disability Claims Statistics.

Of course, the insurance industry does not publish comprehensive statistics on the number of disability claims they deny. However, there are good reasons to believe these numbers are shockingly high. The OmbudService for Life & Health Insurance, a national complaint resolution and information service established and funded by the insurance industry, reports that 40.2% of the complaints they received in 2016 related to disability insurance.  And to support this further, the majority of disability cases we manage are for claims denied illegitimately. Almost always, these denials have nothing to do with the merits of the claim but everything to do with cost-savings for the insurance company.

Employment Contracts | long term disability claimsNotes about Long Term Disability Claims.

Anyone filing for Long Term Disability Claims should be cognisant of the following important points:

  1. Most employees never see the actual insurance policy. When a claim is filed, most only read the employee booklet. If there is a conflict between the two, then the booklet prevails.
  2. There should be no reason whatsoever for the insurance company to discuss your medical details with your employer. Do not feel pressured into signing any consent forms to this affect.
  3. The insurers, not you, carry the burden of proof if your physician has clearly determined you are incapable of carrying out your duties at work. They must prove otherwise to withhold your benefits.
  4. Your employer offered these benefits as part of your compensation package. They are just like your salary. Withholding them for no good reason is a breach of your rights under our employment statutes.

This is why your case must be managed by an experienced employment lawyer who also possesses extensive medical knowledge of your condition. A personal injury lawyer may not understand employment law to effectively manage litigation.

Lecker & Associates has been practicing this specialized area of employment law for over 35 years.

Why Hire a Long Term Disability Claims Lawyer?

Long Term Disability Claims require you to pay attention to the legal fine print. Unlike the service you can expect from your medical team, you must cull all expectations of empathy and kindness from your insurer. Unfortunately, this is now a matter of dollars and cents, not your well being.

You will be pitted against a team of corporate lawyers tasked to protect their employer’s funds. The best thing you can do is to consult with our experienced team of lawyers. It is time for equally qualified legal representation on your side to push this claim through. We know how to fight the insurance companies at their own game. And the law is very clear about harassment. Serious legal consequences await those who put you through unwarranted mental injury and suffering.

Legal Fees.

We can likely alleviate much of your anxiety at the very first meeting and the process will be easy. The initial review of your long term disability claims status is free. Furthermore, for the majority of Long Term Disability cases, our fee is charged as a percentage of the settlement we obtain for you. We take on a vested interest in seeing your case succeed. Legal fees should never deter anyone in this situation and you may read more about our legal fees here.

If any of this describes your situation, we encourage you to contact us as soon as possible. We can likely help you better than anyone else.

Read other similar articles about Disability Claims and the Legal Services we provide to employees of Ontario.

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