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Submitting A Long-Term Disability Benefits Claim


Disability can arise out of many different forms including both physical or non-physical injuries. A physical disability or non-physical disability would render a person unable to do their job. If that person submits a claim for disability to the person’s insurance company, the insurer will look at their medical documents impartially in order to arrive at the decision on whether a person is disabled or a person is able to perform the functions of their employment.

If you would like a better understanding of the requirements of long-term disability benefits in Toronto, you should work with a skilled Toronto disability benefits lawyer before you submit your claim.

Application Requirements

An individual has to meet the requirements set out in the policy. For example, an individual has to work for a certain period of time as set out in the policy and if a person is unable to complete the job that an individual is usually capable of performing then that individual could apply for long-term disability benefits.

With that said, an individual may not be accepted. A person may need evidence from their family doctor or specialist to support why that individual is unable to work and/or to meet the definition contained in the policy. Much of that determination is based on the medical documentation that is provided. The insurer may ask for more documents or medical records to get a complete picture of an individual’s medical concern.

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Often the insurance company will keep asking for documents before making a decision. What is unfair about that is that they make people pay their own expenses to cover the associated costs.  The insurer is saying they have to prove their claim and get the medical records necessary, and if a person does not furnish the records, they say they cannot make a decision and issue a denial.

Scenarios to Claim Benefits

Often a person is injured in a car accident or they can have a degenerative disease that renders them incapable of performing the job like they used to. Age is a common cause but most causes revolve around one’s injuries. There could be depression or anxiety that will render an individual incapable of doing their job or doing it like they did before. They could then claim long term disability benefits in Toronto from their employer.

The insurance carrier is responsible for providing long-term disability benefits. Sometimes there are private contracts in place but it is generally contracted between the insurance carrier and the company that a person worked for that outline long-term disability benefits for the employee.

Medical Coverage Included

Each disability policy is a unique arrangement arrived at between the insurance carrier and the employee’s place of business. This is true whether it is a large company or small company. They come to an agreement as to how long an employee needs to work in order to be eligible for benefits. Terms vary. Sometimes a policy can require six months, or a year, or two years, and a person has to finish the probationary period as outlined within the policy. Typically medical coverage included in disability benefits is dental, pharmaceutical, massage, chiropractic care, and similar benefits.

A person would be eligible for coverage up to a certain percentage of medical costs. Sometimes it is 60%, 70%, 80%, or sometimes even 100% depending on a person’s position in the company. If a person has coverage for disability, the next question is whether they have both Short Term and Long Term Disability Coverage.  Short-term benefits generally provide up to 120 days of coverage but if the disability lasts longer then that a person can obtain long-term disability provided they have such coverage. In such a case, a person really needs to be mindful of the definitions that are within the long-term disability benefits policies.

Occupation Test

The first requirement for finding long-term disability in Toronto is the person being unable to complete the tasks of a person’s own employment.  This is called the “own occupation test.” Whether a person is a hairdresser, a policy analyst, a customer service representative or a truck driver, and they are unable to do those specific jobs is determinative as to whether or not they qualify. After two years the “test ” usually changes. It becomes any occupation based on a person’s experience, training, or education.

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That means that an individual’s disability could be determined with regard to any occupation. Where a person was a truck driver and that person has the experience to be a call center representative, that person can sit at a desk instead of sitting in a truck. That person would be sitting at the desk making phone calls to people, and whether it is physical or non-physical then that person may be deemed to be able to do a certain job. After two years, the definition becomes more beneficial to the insurance company that issues the policy.

Role of a Lawyer

A long-term disability injury lawyer will obtain the policy, first and foremost. It is very black and white in terms of what the policy states and what coverage a person is eligible for and what the coverage is. The lawyer will initially review that policy and see if that person is eligible based on the medical documentation and a person’s medical condition.

The personal injury lawyer may send that person potentially to a specialist to assess their condition and to see what their abilities are.  The person may be referred to a functional ability assessor or a vocational assessor to see what type of jobs a person has the ability to do and they are going to rely on those reports to fight the insurance companies that are denying the claim against their necessary requirements in Toronto.

 

Areas We Serve

Practice Areas

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151 Eglinton Ave W,
Toronto, ON
M4R 1A6
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
4145 N Service Rd
Burlington, ON
L7L 4X6
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
2 County Ct Blvd #400,
Brampton, ON
L6W 3W8
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
105 Consumers Drive
Whitby, ON
L1N 1C4
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
92 Caplan Ave #121,
Barrie, ON
L4N 0Z7
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
380 Wellington St Tower B, 6th Floor,
London, ON
N6A 5B5
Toll Free: 1-888-608-2111
2233 Argentia Rd Suite 302,
East Tower Mississauga, ON
L5N 6A6
Toll Free: 1-888-608-2111
1 Hunter St E,
Hamilton, ON
L8N 3W1
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
459 George St N,
Peterborough, ON
K9H 3R9
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
22 Frederick Street,
Suite 700
Kitchener, ON N2H 6M6
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
352 Elgin Street,
Ottawa ON
K2P 1M8
Toll Free: 1-888-608-2111
10 Milner Business Ct #300,
Scarborough, ON
M1B 3C6
Toll Free: 1-888-608-2111
*consultation offices

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