Maximizing your chances of successfully filing a disability claim hinges upon your ability to prove that your symptoms or impairments are serious enough to qualify. While there is no sure-fire path to approval, you may be able to help the process by following a few simple guidelines that go into filing a long-term disability claim successfully.
Ensure That Your Application Conforms with Guidelines
Receiving long-term disability begins by completing one or more forms. If the insurer pays both short- and long-term disability benefits, then you might need to complete a separate application for both. Generally, you will also be required to complete an attending physician’s form.
Determine if Your Illness or Injury Is Coverable Under the Policy
Whether your long-term disability is covered by your insurance company relies primarily on how disability is defined by the terms of your policy. The decision to offer you long-term disability hinges upon the severity of your illness or injury, regardless of the diagnosis. Insurers emphasize their focus on the symptoms that rendered you unable to work in the first place.
However, your medical diagnosis is still vital to understand the duration of the benefits you may qualify for. In matters involving an unknown medical issue, it is a challenge for your doctors to establish your diagnosis and prognosis. Efforts may focus on testing and diagnostics to rule out possible illnesses.
It is vital to understand that you should provide your insurer with details about any potential conditions that you may have. You have a duty to ensure that you are making every reasonable effort to determine a diagnosis to receive benefits.
While there is not a guarantee that you may receive long-term disability benefits, some of the following medical conditions may qualify someone:
- Back Pain and Injuries
- Complex Regional Pain Syndrome (CRPS)
- Anxiety and other mental health disorders
- Heart Disease
- Lyme Disease
- Multiple Sclerosis
If your insurance company denies your claim, but you believe that your illness or injury qualifies you to receive benefits, then you may find that it is helpful to discuss your claim with an Ontario long term disability claims lawyer. He or she may help you comprehend your next steps toward obtaining the benefits you feel you deserve.
Play by the Rules Throughout the Long-Term Disability Claims Process
There are numerous rules associated with long-term disability claims. They are there to protect you, your employer, and the insurance company. Your policy is subject to the language in your disability policy or plan, the insurance regulations of Ontario, and the common law of Canada.
As you see, there are many governing laws that may determine the treatment of your claim. Plus, each insurance policy is unique, which means obtaining and reading a copy of your policy to determine the terms and rules of your plan.
Attend Your Doctors’ Appointments and Follow His or Her Medical Advice
It is vital to follow the orders of your physician, including attending follow-up appointments, making lifestyle changes, and taking medications as prescribed. Failure to engage in this aspect may result in a denial of coverage since it is your responsibility to do your part in mitigating further illness or injury.
What to Do if Your Long-Term Disability Insurance Company Denies Your Claim
If your long-term disability insurance company denies your claim, they may send you a denial of benefits letter. The denial is only justified if you do not qualify to receive benefits. While the insurance provider is offering their opinion, it is still just an opinion generally devoid of any medical support.
Fortunately, insurance companies offer some form of dispute resolution process to appeal your denial. Typically, the appeals process involves you proving that you are unable to work with supporting documentation and medical evidence.
From there, the internal appeals process begins, and the insurance company issues a new decision on your claim (which is almost always the same as the original determination). It is vital that you contact a long-term disability lawyer to help you with this aspect since he or she has the legal knowledge and experience to present your case.
Contact an Ontario Long-Term Disability Lawyer for Assistance
If you believe that your long-term disability claim was wrongfully denied, you do not have to accept your insurer’s first opinion as to its final offer. Contact Preszler Injury Lawyers today for your initial free consultation by calling (416) 364-2000.