If you're unable to work and earn a living due to a debilitating physical or mental health condition, applying for long-term disability benefits may be your only option for financial support.
To increase your chances of success, it's best to consult a long-term disability lawyer to help you file your long-term disability claim, as they are familiar with the insurance company's requirements, the excuses they use to deny legitimate claims and how to fight them to get you the benefits you're entitled to when you need them most. The following guide summarizes the claims process for long-term disability benefits and what you can expect.
Confirming Eligibility for LTD Benefits
Long-term and short-term disability insurance is sometimes provided by employers as part of a benefits package. They can also be purchased by contractors, self-employed individuals and others who are not covered by a workplace policy. Long-term disability (LTD) insurance is designed to provide coverage for a portion of your income if you develop a severe illness or injury that prevents you from performing the primary functions of your work for an extended period. Some policies require you to apply for government disability benefits as well. These are often through programs such as the Canada Pension Plan and the Ontario Disability Support Program.
When applying for LTD benefits, the first step is to check your policy to ensure that your medical condition is covered and to learn about the claims process. Some common disabilities covered by LTD policies include arthritis, fibromyalgia, chronic fatigue syndrome, depression, anxiety disorders, Crohn's disease, and cancer.
Filling Out the Forms
You will need to obtain the necessary forms from your employer or the insurance company, which may be available online. You, your employer and your healthcare provider will be required to complete separate sections of the claim application. It's crucial to speak with your healthcare provider regarding the Physician's Statement, as it must detail how your disability prevents you from completing essential work tasks while providing as much medical proof as possible. Claims are often denied because of the lack of information in this section.
What Happens After You've Submitted Your LTD Claim
After receiving your LTD claim application, the insurance company will assign a case manager to your file. The case manager may conduct a phone interview to gather additional information and may ask you to attend an independent medical examination ("IME"). This IME is performed by a professional chosen by the insurance company, and you must attend for your application to be considered.
If your claim is approved, you will receive information on the amount of benefit payments, payment frequency and instructions on how to maintain eligibility. If your claim is denied, you will be given a reason in the denial letter and advised of your right to appeal. You should speak to an LTD lawyer immediately to determine the best way to proceed with your claim based on the reasons for the denial.
Fighting an LTD Claim Denial
It's important not to give up your claim for benefits if it's denied. Insurance companies often deny legitimate claims, and LTD lawyers can help you fight for your benefits. However, there is a two-year time limit from the date of the denial letter for you to file a lawsuit against the insurance company and sue for your benefits.
Therefore, it's essential to start working with your LTD lawyer early to build the strongest possible case before filing the lawsuit. Keep in mind that the claims process and requirements may vary depending on your insurance policy.