Long-term disability (LTD) benefits may be hard to get in Ontario, Canada. Even if you have a policy in good standing, either as a part of an employer-provided group policy or as an individual, a LTD insurance carrier may deny benefits.
If this happens to you, you may qualify to appeal the decision. Some people have been able to get the benefits they may be entitled to by challenging their insurance carrier’s denial, and you may be able to recover compensation or receive your LTD benefits if you qualify. The Financial Consumer Agency of Canada provides additional information on things to consider when purchasing a disability insurance plan.
Proving a Long-Term Disability Claim May Be Difficult
While each LTD insurance carrier may have its own claims process, policy details, and specific forms, many require the same types of supporting evidence to prove your claim. There are several steps you may need to take to gather evidence, file your claim, and ensure the insurance company receives the necessary information. These steps may include:
Reviewing Your Policy
You may need to review your policy closely so you understand the claims process and what may be required before you attempt to file a claim. Alternatively, you may work with the human resources representative at your work for an employer-sponsored group plan, or contact your insurance carrier to learn more about navigating the process of preparing and filing your claim.
Seeking the Necessary Medical Evidence
Your LTD insurance carrier may require proof of your diagnosis, any limitations, and your prognosis. This proof may come from medical records, documents completed by your health care providers, and other documentation of your condition and its severity.
You may not need to submit this documentation when you file your claim. You may only be asked for contact information so the insurance carrier may request documentation from members of your health care team. However, you may want to talk to your doctors about your claim so they know the insurance carrier may contact them.
Gather Collateral Evidence
In addition to medical evidence, you may also have collateral evidence to support your claim. This is information about your injury, illness, or related disability that may not be in your medical records, but that friends or family may be able to confirm. This may include information about the emotional toll of your condition, the impact of your medical condition on your ability to provide self-care, and other similar information they may witness.
Some people may also consider keeping a journal to document their injury or illness and the effect it has on their everyday life. This may also be collateral evidence of your qualifying condition.
Identify Other Necessary Information and File Your Claim
Lastly, your insurance carrier may want information about the last day you worked or other information about your job. Your employer may even need to complete forms to go into your LTD claim file with the insurance carrier.
Once you understand what documents you may need, you may be able to file your claim with your LTD insurance carrier according to their process.
Long-Term Disability Insurance Carriers May Deny Claims
It is not uncommon for long-term disability to be hard to get because LTD insurance carriers often deny claims. Some policyholders who file claims may have to take additional action to fight a denial and pursue benefits through the appeals process. In some cases, it may be relatively easy to explain concerns with your claim and file, such as:
- You missed a doctor appointment
- You missed treatment
- There was an inaccuracy or missing item in your file
- There was another relatively minor concern with your file
In other cases, the reason the insurance carrier lists for your denial may be more convoluted. This may be difficult to overturn, but it may still be possible if you qualify to challenge it.
A lawyer may be able to review your denial notice and help you understand if you qualify to file an internal appeal or seek compensation through an external appeal. They may also be able to help you navigate the external appeals process and recover compensation or get your benefits started, if you qualify.
In some cases, however, you may need to file a lawsuit to pursue the money you may be entitled to. The Limitations Act of 2002 puts a two-year time limit on taking legal action in an Ontario LTD benefits appeal, so you should consider contacting a lawyer as soon as possible.
Reach Out to Preszler Injury Lawyers About Your LTD Denial
You may be able to speak to a member of the Preszler Injury Lawyers team today about your LTD benefits denial. We serve clients in Ontario, Canada, and offer free initial consultations. Call 1-800-JUSTICE to learn more about how we may be able to help.