When you sustain an injury or illness that renders you unable to work for 12 months or more, you may be eligible for monthly cash benefits from your private or employer-sponsored long-term disability (LTD) insurance policy. However, securing benefits can be tough. Insurers have strict eligibility requirements, confusing exclusions, and complicated processes.
Like all insurance companies, the ultimate goal in settling claims is to pay the least amount of benefits for as short of a period as possible. Therefore, it behooves you to know the protections available to you after suffering a disability.
Scarborough long-term disability lawyers will work to protect the rights of those who suffer injuries or illnesses because of another’s negligent or careless actions. To get started on your claim, consult with an experienced injury lawyer today.
Our long-term disability lawyers can meet with you in Scarborough for a free initial consultation. Call (416) 364-2000
Qualification Requirements
Each insurer may vary slightly in policy terms. In general, LTD policies provide coverage for most illnesses and injuries that prevent you from working. Certain policies exclude workplace injuries the Workplace Safety Insurance Board covers.
Some insurance policies stipulate you only have to prove you are unable to perform your current job to qualify for benefits, whereas other policies require you prove you are unable to do any job you may be qualified for in light of your education, experience, and training.
A seasoned long-term disability lawyer in Scarborough can help you understand your policy’s fine print and determine whether or not your condition is eligible for coverage. If your insurer excludes your condition from its coverage, they can also help you explore other avenues of compensation.
Scarborough Long-Term Disability Lawyer Near Me (416) 364-2000
Total Benefits
Most employer-sponsored disability plans calculate benefits at two-thirds of your average pre-injury wages, but the rate can vary between 50 and 80 percent of your salary. Also, most plans limit the number of monthly payments you can collect.
Private policies usually pay a certain pre-determined amount for disability benefits, which you were informed of when you purchased your plan. Your Scarborough long term disability lawyer can check with your broker/insurer if you are unsure of the benefits available to you.
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Length of Wait
Again, insurers vary on their terms. However, in most cases, your disability must be expected to last for a period before you become eligible for long-term disability benefits. This period, referred to as the “elimination” or “qualifying period” can range from three to six months.
In the interim, an LTD lawyer can help you determine your eligibility for short-term disability through your employer, Employment Insurance, or Sickness Benefits through the Government of Canada.
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In Case of a Denial
Collecting disability benefits is not always easy or straightforward. First, a lot is required of you. You will need to submit an application that is accurate and thorough, provide adequate medical evidence to support your disability, cooperate with your doctors, stick to your treatments, and ensure you carefully adhere to the claims process.
But, even when you do everything right, it is not uncommon for insurance companies to unjustly deny LTD benefits or to prematurely terminate them. The common reasons for denials include the following:
- You or your employer did not provide the necessary documentation to support your claim
- The insurer alleges your injury is not covered by the plan
- The insurer argues you are capable of working in some capacity, even when your doctor says you are disabled
- Not revealing past accidents or injuries to your lawyer. Past injuries are almost always uncovered by the insurer during the process. Failing to reveal this information to your lawyer can be extremely damaging to your claim
The upside to receiving a denial of benefits from the insurer is that you have the right to appeal the decision. Note, while most insurance companies provide several levels of internal appeals, sometimes it is better to file a lawsuit to avoid getting stuck in the appeals process and overstepping statutes of limitation. Managing a denial is a complicated and important process, but if handled correctly, you have a much better chance of obtaining the benefits to which you are entitled – in full and for the appropriate duration.
It is critical to discuss your options with your long term disability attorney in Scarborough because your (much needed) disability benefits hinge on how you handle a denial and who is representing you.
Value of a Lawyer
It can be dangerous to accept the insurance company’s settlement offer without a qualified lawyer’s review. Insurance companies can minimize payments by interpreting ambiguous policy language in their favor, prey on claimants’ ignorance of their rights, and exclude certain income when calculating benefits.
Therefore, we strongly urge you to meet with a Scarborough long term disability lawyer who is experienced in handling LTD cases and who can offer an accurate estimate of the value of your claim before signing any agreements.
Call or text (416) 364-2000 or complete a Free Case Evaluation form
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