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What Rules Apply to My Long-Term Disability Plan?


Determining what rules apply to your long-term disability plan depends on the specific verbiage used in your policy. Your policy may outline all the terms, exclusions, and other important frameworks about how to file a claim, prove you have a ‘total disability’ as it relates to your long-term illness or disability, and more. It should also outline information about how long you may need to wait for benefits and how long your benefits may last.

The language used in the ‘small print’ of your policy may be difficult to understand, but it is a good place to learn about the coverage that may be available to you, and what rules may apply. If you believe your insurance carrier unfairly denied your claim, a lawyer may be able to review your policy to help you understand the benefits to which you may be entitled.

Common Rules That May Apply to Your Long-Term Disability Plan

While every carrier handles its policies in a slightly different way, and there may even be differences in the details from policy to policy, there are some common rules you may expect to find in your policy. These rules may play a key role in defining when you may receive benefits, what you need to do to claim them, and how long you may receive them.

These include:

Qualifying Disabilities

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Long-term disability plans are for injuries or medical diseases and conditions that prevent the policyholder from working. They are sometimes called ‘total disability’ policies. In general, the standards that usually apply include not being able to work your own job for the first two years, and not being able to work any job for any number of years after that.

Elimination Period

Every long-term disability policy includes an elimination period, but the length of this period may vary widely. This is the period you must wait between when your injury or illness occurred, and when your long-term disability benefits become payable. You may be able to use paid leave or short-term disability to continue receiving income during the elimination period.

Duration of Benefits

Some policies cap how long you may continue to receive long-term disability benefits. This is sometimes known as the ‘maximum duration.’ The maximum duration of these benefits may vary greatly in length based on the specific language used in your policy.

Off-Sets

Off-set clauses ensure the insurance company may reduce your benefits based on the amount you receive from other programs. This is generally a dollar-for-dollar deduction.

Filing a Complaint

Insurance carriers must give policyholders the option of appealing a denial of benefits. As a result, they each developed their own reconsideration process. While you may think of this as filing an appeal, the insurance carriers commonly refer to it as filing a complaint.

Your Insurance Carrier May Look for Reasons to Deny Your Claim

If you file a disability claim, your insurance carrier may look at all the rules in your policy and weigh them against your claim and supporting information. If you do receive a denial notice, do not panic. Policyholders who initially receive denials may later get the denial overturned or otherwise recover compensation.

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If you believe your carrier denied your claim unfairly, a lawyer may review your policy and determine if you may qualify for disability. We may be able to help you fight the denial and recover the money you need while you undergo treatment and heal.

Here are some of the options a lawyer may use if your carrier denied your claim:

  • File a lawsuit against the insurance carrier
  • Collect evidence to prove you qualify and attempt to negotiate a settlement
  • Take your case to trial and present a strong case for compensation

The most appropriate approach may depend greatly on the facts of your case, including determining what rules apply to your long-term disability plan. It is also important to know that there is a strict deadline for filing a lawsuit against your insurance carrier.

If you do not take legal action in the two years following the date on your initial denial notice, you may lose the right to do so under the Limitations Act of 2002, S.O. 2002, Chapter 24.

Talk to an Ontario Long-Term Disability Lawyer Today

If you need help understanding which rules apply to your long-term disability plan, or if you received a questionable denial, Preszler Injury Lawyers may be able to help. We may review and explain your policy, exclusions, and other important factors. If we believe the insurer wrongly denied your claim, we may also be able to help you challenge their decision and pursue compensation.

In Toronto or elsewhere in Ontario, you may reach Preszler Injury Lawyers by calling 1-800-JUSTICE today.

 
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