You were proactive and purchased a long-term disability policy. You have paid the premiums each month to ensure you have it when you need it. Now you need it and the insurer is claiming that you do not. What can you do?
If the time has come for you to use the long-term disability benefits you paid for and the insurance company is denying your claim, our Ajax long term disability lawyers can help. To learn more or discuss your claim consult with an injury lawyer in Ajax today.
Our long-term disability lawyers can meet with you in Ajax for a free initial consultation. Call 1-877-573-3563
Qualification Requirements
Many people are unaware of what exactly “long-term disability” means. A long-term disability must last 12 consecutive months or longer. If a doctor expects a person’s disability to last less time than that, they will not qualify. For example, a broken leg will likely not qualify, but schizophrenia might.
In addition, the disability must keep a person from working at their current job. If an individual is able to work but needs to work less hours, they likely will not be eligible for long-term disability.
When a long term disability claim lawyer in Ajax reviews a claim, they look at a person’s medical records to ensure they include diagnosis information and proof of duration of the condition. The doctor’s notes should also include how the condition limits a person’s function, especially limitations that affect their job.
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Long-Term Disability Coverage
It is important that a person know exactly what to expect from a long-term disability policy. A person will only receive payment for a portion of their lost wages, typically around 66 percent. They will not receive compensation for medical bills or anything else related to the disability.
While every policy has different terms, what a person receives will depend on three things:
- Whether or not a person can work at any other job
- The percentage of wages to which the policy entitles the individual
- Whether a person receives other benefits (e.g., workers’ compensation, pensions, etc.)
Most policies will only pay benefits for two years if a person can work at other jobs. Within this time the individual should attempt to find suitable work. If they believe they cannot work at any other jobs for which they are qualified, or applicable jobs are not available near Ajax, our lawyers can prove a person’s inability to adjust to other work.
An Ajax long term disability lawyer can call upon vocational experts who know the local job market and can testify whether it is likely that the person will find a job with the limitations of their condition.
A person’s policy will also stipulate the percentage of your regular wages that become the amount of your long-term disability benefits. If you were receiving a static amount for pay on a regular basis, your benefit rate should be easy to determine. Issues with these calculations can arise when your income is irregular, or you are self-employed.
You might also face issues calculating your benefits if you receive other types of benefits. Any benefits you receive from other sources will likely offset (i.e., reduce) your long-term disability benefits.
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How a Lawyer Can Help
A knowledgeable long term disability lawyer in Ajax can also pair the statement from the doctor explaining the individual’s limitations with a statement from their employer explaining the job’s duties. With these statements, the lawyer can indicate how a person’s health prevents them from completing job requirements.
If the individual’s medical records and/or the statements from their doctor and employer do not reflect this information and the lawyer cannot prove the first two elements of disability claims, they will seek opinions from specialists in their area of care.
Our lawyers have relationships with experts in the area and can call upon them if an expert opinion is necessary to prove the severity of limitations or length of condition.
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In Case of a Coverage Denial
Denials are very common. The insurance company might deny your claim if you:
- Have errors on your application
- Do not have enough evidence to support the severity or duration of your condition (The insurance company wants to see all of your medical records pertaining to your disability. If you do not supply all records from the time of diagnosis to your most recent appointment, they may claim you are not doing enough to help your condition.)
- Do not have evidence that you cannot work at your job or other jobs
- Found that you are disobeying your doctor’s orders (e.g., your doctor told you that you cannot lift more than 25 pounds, an investigator found a picture of you carrying your spouse on your back)
If the insurer denied your application, we will file a request for reconsideration. We will determine the reason for the denial and provide additional evidence to fill the gaps in your original application or fix the errors that caused the denial. Even if you did not work with us to file the initial claim, we can help you through the appeals process.
Improving the Chances of a Claim
Keeping up with your medical care is perhaps the most important thing you can do to preserve your benefits. If the insurance company notices a lapse in care, they might conclude that your condition is not severe or that you are attempting to make it worse by neglecting treatment.
Honesty is another important part of obtaining and keeping your benefits. Do not lie about the severity of your condition, but do not downplay it, either. When asked about your limitations, it helps to keep a journal of how your condition affects your ability to care for yourself, do household chores, and perform at your job.
Finally, your case can benefit from the help of a lawyer from our Ajax long term disability lawyers.
Call or text 1-877-573-3563 or complete a Free Case Evaluation form
