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What Factors are Considered When Processing my Disability Claim in Ontario?

Disability benefits, such as those offered by long-term disability insurance, can be a valuable resource for a disabled worker. Long-term disability benefits are designed to address the economic ramifications of a claimant’s inability to work because of serious illness or injury.

There are many factors to consider when applying for long-term disability benefits or appealing a denial of benefits. Below is an overview of important factors taken into consideration when processing a long-term disability claim in Ontario. Ask about more specific requirements depending on the program through which you’re applying for benefits, like the Ontario Disability Support Program or private LTD insurance.

Do you qualify as disabled?

One of the most important factors the insurance company will consider when processing your claim is, “Does the claimant meet the definition of disabled?”

A disability is a mental or physical condition that makes it impossible for you to:

  • engage in normal daily activities (such as grooming, dressing, housework, running errands, etc.); and
  • continue working and earning an income.

A disability may arise as the result of an accident, such as a slip and fall or automotive crash. Or, impairment may by the result of a progressive disease or other unexpected illness, such as cancer or Parkinson’s disease.

A medical condition is not a disabling condition unless it significantly affects your ability to work or otherwise function in normal daily activities. For example, asthma or a broken leg may not be a disabling condition if you are able to continue working at your normal capacity despite the condition.

Have you presented compelling evidence to support claims of disability?

The disability benefits process relies heavily on the presentation of compelling evidence, including objective medical documentation.

Your claim for long-term disability insurance benefits should be supported by evidence including:

  • official diagnosis;
  • treatment records;
  • test results (blood tests, x-rays, MRIs, CT scans, bone density calculations);
  • physician statements (including those from specialists, such as neurologists, cardiologists, oncologists);
  • employer statements (including details about your work and necessary functions of your role, like whether your job requires you to stand for eight or more hours a day, or sit for prolonged periods of time); and
  • personal statements (may include details about your ability to engage in daily activities, such as whether your disability has made it impossible for you to get dressed in the morning).

The insurance company will assess your evidence to verify the existence of your medical condition and its impact on your ability to work. A poorly evidenced claim may result in a denial of benefits. In these cases, you may choose to request a reconsideration of your claim or appeal the decision.

Have you met the time requirements?

The insurance company will examine the timeline of events when processing your disability claim. Long-term disability benefits are available only to those who will be unable to work for a prolonged period of time or will be permanently unable to work.

You must first meet the waiting period—or elimination period—before you will qualify for benefits. This means you may have to wait as much as several months after the onset of disability before you qualify for benefits.

Take advantage of a free case consultation to learn more about what to expect during the disability benefits process. Call the Preszler Injury Lawyers at 1-800-JUSTICE® today.

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