Kitchener Long-Term Disability Lawyers

Life can be unpredictable. No one imagines that, one day, they might need to rely on their insurance provider to help them through a tumultuous and challenging chapter of their lives. But even the most cautious, health-conscious, stable person can have their life suddenly turned upside down by a severe injury or a disabling physical or mental illness.

People who have received a diagnosis for a serious, debilitating medical issue often find it impossible to continue going about their day-to-day activities. As a result of their condition, they may no longer be able to continue carrying out the duties of their jobs. And when this happens, through no fault of their own, people suffering from disabling medical conditions could face monumental physical, emotional, and financial difficulties.

For workers in Kitchener and throughout Waterloo Region, a denied or delayed long-term disability claim can create immediate stress. Mortgage payments, rent, groceries, medication, rehabilitation costs, and family responsibilities do not stop simply because an injury or illness makes working impossible. Our Kitchener long-term disability lawyers may be able to help if your insurer has denied your claim, delayed payment, terminated your benefits, or treated your disability unfairly. Contact us today for a free consultation.

Long-Term Disability Benefits In Kitchener

Insurance policies exist for this very reason. Certain people have access to insurance coverage through their employer’s group plan; others might pay monthly premiums privately to a policy they have purchased independently of their employer. If their insurance policy provides coverage for long-term disability benefits, people who have been waylaid by an unexpected illness or injury might be able to access crucial financial support.

If an insurance policyholder’s newly acquired medical condition makes it impossible for them to carry out the tasks associated with their job, provided their insurance plan includes an adequate level of coverage, they might be entitled to apply for LTD benefits. These monthly income replacement payments do not reflect the entirety of a recipient’s regular earnings. Instead, LTD benefits often provide recipients with between 60% and 70% of their normal income. Certain policies might also impose payment caps on the amount of benefits qualified policyholders are entitled to receive, which might limit the amount of their monthly benefits payments even further.

That said, for people who cannot continue earning their regular salaries or hourly wages because of circumstances outside of their control, LTD benefits are often a crucial source of stable income. In fact, for many eligible claimants, LTD benefits might be the only source of regular income available to help them make ends meet during a frightening and uncertain time.

A long-term disability policy may be provided through an employer, union, professional association, or private insurance plan. These policies are contracts, and the wording of the contract matters. A Kitchener long-term disability lawyer may be able to review the policy language, medical evidence, and insurer correspondence to help determine why a claim was denied and what steps may be available.

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Who May Qualify For Long-Term Disability Benefits?

The eligibility requirements for LTD benefits differ between insurance policies. Even policies sponsored by the same insurance provider might have different definitions of disability or other variable terms and conditions. That is why, before submitting an application for LTD benefits to your insurance company, it is prudent to review the details of your plan and make sure your medical condition entitles you to receive them.

Many long-term disability policies use an “own occupation” test at first. This generally considers whether the claimant is unable to perform the essential duties of their own job. After a certain period, many policies shift to an “any occupation” test, which may consider whether the claimant can perform another suitable occupation based on their education, training, and experience. Because these definitions can vary from one policy to another, it may be helpful to speak with a long-term disability lawyer before responding to an insurer’s request for more information or appealing a denial.

Certain medical conditions that might entitle a policyholder to receive LTD benefits include, but are not limited to:

• Heart disease
• Back problems
• Chronic pain or complex regional pain syndrome
• Lupus or Lyme disease
• Psoriatic arthritis
• Fibromyalgia
• Paralysis
• Depression
• Bipolar mood disorder
• Post-traumatic stress disorder
• Cancer
• Multiple sclerosis
• Severe migraines
• Chronic fatigue syndrome
• Long COVID
• Anxiety disorders
• And possibly more

Some disabling conditions are visible. Others are not. People living with chronic pain, mental health conditions, neurological symptoms, autoimmune disorders, or fatigue-related illnesses may face additional challenges because their symptoms are not always obvious to others. Insurance companies may still be required to assess these claims fairly and in accordance with the policy terms.

Long-Term Disability And Mental Health Claims

Mental health conditions can be just as disabling as physical injuries. Depression, anxiety, post-traumatic stress disorder, bipolar mood disorder, and other psychiatric conditions may prevent a person from working, maintaining concentration, interacting with others, or completing job tasks reliably.

Despite this, people with mental health-related disability claims may face skepticism from insurance companies. An insurer may suggest that the condition is not severe enough or that the medical records do not prove total disability. These assumptions can be harmful and unfair.

If your mental health-related LTD claim was denied, our Kitchener personal injury lawyers may be able to help you understand your options. Preszler Injury Lawyers has experience assisting people whose disabilities are not always visible but are still very real.

Why Long-Term Disability Claims Are Denied in Kitchener

Unfortunately, even though eligible claimants might have compelling medical evidence proving that they suffer from a severe medical condition for which they have been receiving ongoing treatment, insurers might find reasons to deny their claims for LTD benefits. For people living with a disability who cannot work because of their medical conditions, being denied LTD benefits can be more than perplexing; it can be disheartening, upsetting, and legitimately frightening.

Long-term disability claims in Kitchener may be denied for many reasons. An insurer might argue that there is not enough objective medical evidence, that the claimant can still perform their job duties, that treatment has not been pursued aggressively enough, or that the medical condition does not meet the policy’s definition of disability. In some cases, insurers rely on surveillance, independent medical examinations, paper reviews, or selective interpretations of medical records to justify a denial.

Common reasons LTD claims may be denied include:

• The insurer says the medical evidence is insufficient
• The insurer disagrees with the treating doctor’s opinion
• The insurer says the claimant can return to work
• The insurer alleges non-compliance with treatment
• The insurer says the condition is excluded under the policy
• The insurer says the claimant missed a deadline
• The insurer terminates benefits after the policy definition changes
• The insurer relies on a medical review by a doctor who has not treated the claimant
• The insurer says the claimant can perform another occupation
• And more

A denial does not necessarily mean the insurance company is right. It may mean the claim needs stronger medical support, clearer evidence about functional limitations, or legal action to challenge the insurer’s position.

What To Do If Your LTD Claim Was Denied In Kitchener

If your claim for LTD benefits was denied even though you should be entitled to receive them, our long-term disability lawyers serving Kitchener may be able to help you pursue legal action to overturn your insurance provider’s unfair decision and recover the payments you are rightfully owed. To learn more, contact us today and schedule a free initial consultation on your case.

After receiving a denial letter, it is important to read the letter carefully and keep a copy. The letter may explain the insurer’s reasons for denial, reference appeal deadlines, identify the medical evidence reviewed, and outline the policy provisions the insurer is relying on. However, an internal appeal is not always the best or only option. In some cases, filing a legal claim may be more appropriate than repeatedly appealing to the same insurer that denied the benefits.

The Importance of Medical Evidence In A Long-Term Disability Claim

Medical evidence is often central to a long-term disability claim. This evidence may include records from family doctors, specialists, psychologists, psychiatrists, physiotherapists, occupational therapists, pain clinics, rehabilitation providers, and other treatment professionals.

However, a diagnosis alone may not be enough. Insurers often focus on functional limitations. In other words, they may ask how the condition affects your ability to sit, stand, walk, lift, concentrate, communicate, attend work reliably, manage stress, or complete the core tasks of your job.

For example, a person working in an office in downtown Kitchener may be unable to perform their role because of chronic migraines, cognitive symptoms, depression, or severe back pain. A person working in manufacturing, construction, healthcare, retail, transportation, or education may be unable to meet the physical or psychological demands of their occupation because of a serious injury or illness.

Our Kitchener long-term disability lawyers may be able to help identify gaps in the insurer’s assessment and explain what types of evidence may assist with a denied LTD claim.

How Our Kitchener Long-Term Disability Lawyers May Be Able To Help

Our long-term disability lawyers serving Kitchener are familiar with the unfair tactics often used by insurance providers to withhold crucial funding from policyholders who, by all accounts, should be entitled to receive it. We fight on behalf of our clients’ best interests and have a history of helping mistreated members of the local community recover the payments they deserve.

A Kitchener long-term disability lawyer may be able to help by communicating with the insurance company, reviewing the policy, gathering evidence, identifying the insurer’s weaknesses, and pursuing compensation for denied or terminated benefits. If appropriate, a lawyer may also pursue damages connected to the insurer’s conduct.

In addition, if your disability or illness was the result of an accident caused by another person’s negligence, you may be eligible to explore additional compensation through a personal injury claim. Our Kitchener car accident lawyers and our Kitchener slip and fall lawyers frequently help clients evaluate LTD claim disputes and personal injury lawsuits simultaneously.

Do Not Wait Too Long To Get Legal Help

Long-term disability disputes can involve strict deadlines. Your policy may include time limits for submitting proof of claim, appealing a denial, or taking legal action. Ontario’s Limitations Act, 2002, may also affect the time available to start a lawsuit. In most cases, claimants have 2 years from the date of receiving their denial to file a claim.

Missing a deadline could affect your ability to pursue the benefits you need. If your insurer denied your claim, terminated your LTD benefits, or asked you to return to work before you are medically ready, consider speaking with a Kitchener long-term disability lawyer as soon as possible.

Book Your Free Initial Consultation With Our Kitchener Long-Term Disability Lawyers

To learn more about how our Kitchener long-term disability lawyers may be able to assist you, call Preszler Injury Lawyers today at 1-888-608-2111 and take advantage of your free initial consultation.

If your LTD benefits were denied, delayed, or terminated, you do not have to face the insurance company alone. Our long-term disability lawyers serving Kitchener may be able to review your situation, explain your options, and help you pursue the benefits you may be rightfully owed.

Contact Preszler Injury Lawyers today to schedule your free initial consultation.

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LONG-TERM DISABILITY BENEFITS DENIED OR CUT-OFF IN KITCHENER?