416-460-6823Serving All Of Ontario
Posted by On 26-08-2020
Long term disability (LTD) insurance is intended to provide a stream of income while you are disabled from your employment. Industry statistics suggest most claims are accepted, but many legitimate claims are rejected. Sometimes these denials could have been avoided had the application been completed differently. This blog post will cover 10 tips to increase the chances of having your long term disability claim approved.
Applying for LTD involves a fair amount of paperwork, starting with forms created by the insurance company. These can usually be provided by your employer, but you can also obtain them directly from the LTD insurer upon request. The forms are sometimes collectively referred to as an application package, and typically consist of three separate documents: one for you to complete; one for your employer to complete; and one for your doctor to complete.
Your benefit booklet will describe the various coverages available, which often include extended health benefits (such as prescriptions and dental), life insurance, and short and long term disability. The booklet will give you a general idea of what you are entitled to under the policy, and some basic information such as how the benefit is calculated, the waiting period, and other information.
The benefit booklet is only a summary. The policy will contain much more detail, and can be difficult to understand. In some cases it is important to read the actual policy wording. Provisions that deal with pre-existing exclusions, exceptions to exclusions, all source maximums, direct offsets, and indirect offsets can be quite technical. Consider seeking help from a long term disability lawyer if these or other terms might apply to your claim.
Some LTD claims are denied on the basis of the wrong box being checked, a wrong date, or the wrong description of an illness or injury. Make sure you know what you are being asked before you input any information. Double check it before submitting.
Contracts of insurance, including long term disability contracts, require both sides to act with the utmost good faith. If you get caught in a lie, or if the LTD insurer suspects you are being less than truthful, the claim will very likely be denied. Overturning a denial is much easier when all information is consistent and can be verified.
Functional restrictions and limitations are at the heart of disability claims. While diagnosis is important, LTD insurers are much more concerned with function; that is, why you cannot work. Be specific about what prevents you from performing your job duties. For example, rather than stating “I cannot work due to back pain”, focus on your limited function, such as: “Back pain prevents me from lifting more than 10 pounds, sitting for more than 30 minutes, and standing for more than 15 minutes. In addition, the side effects of medication makes it difficult to focus and concentrate while operating heavy machinery.”
If your primary disability relates to chronic pain that prevents you from heavy lifting, but you also suffer from a secondary condition such as depression and anxiety, list all medical issues. The insurer is required to look at the big picture, not just your primary condition. That said, there is no need to list every medical issue you have ever had, just those that have caused or contributed to your absence from work.
A claim for depression or anxiety that prevents you from completing the essential tasks of your employment is much more likely to be approved than a claim that your workplace caused anxiety requiring a stress leave. This may may seem like a distinction without a difference, but insurers really don’t want to pay disability claims for what is perceived to be workplace issues. Many LTD claims are denied for this reason, so be careful how you describe the workplace. But also remember point 5! If the workplace did cause or contribute to the disability, be honest and candid.
Most group policies contain an effective coverage date, which is not necessarily the date you started employment. Often new workers are not insured for the first several months of employment. If the date of disability is before the effective coverage date, then the claim will be properly denied.
Group policies also include a pre-existing exclusion, meaning if your disability arises from a condition you had been treated for within a defined period of time, the insurer may deny coverage. Usually the pre-existing exclusion only applies for one year from the date of coverage, and there are often exceptions to the exclusion. For example, if you have been insured for less than one year, but have not had treatment for a certain number of days before the date of disability, the exclusion might not apply. Pre-existing exclusions can be very complex. This is an issue where you should consult an LTD lawyer before applying for benefits.
The chances of your claim being approved are higher if you consult a lawyer first. Most long term disability lawyers will agree to do so for a flat fee or an hourly rate. Michael Jordan is an experienced LTD lawyer who will review your application for free. If the claim is approved, you no longer require any legal assistance. If the claim is denied, Michael can guide you through the process of an appeal or lawsuit.
About The Author
Michael Jordan is a long term disability lawyer with more than 17 years experience litigating all types of insurance claims. He is a founding partner of the Bay Street firm Jordan Honickman Barristers. Michael represents clients across all of Ontario, with satellite offices in Ottawa and London.
Email: mjordan@jhbarristers.com
Direct Cell: 416-460-6823
Michael Jordan
Jordan Honickman Barristers
Contact Today
