Blogs

Facing a disability can turn your world upside down. Whether it’s due to an unexpected injury, a chronic illness, or a mental health condition, the inability to work adds significant financial strain to an already stressful situation. When you file a disability claim, you expect the support you need. Unfortunately, many valid claims are denied, leaving people feeling lost and overwhelmed.

At Kotak Law, we understand the challenges you face. Our team of experienced disability lawyers is dedicated to helping Edmonton residents navigate the complex insurance landscape. We fight for your rights and work tirelessly to secure the benefits you deserve. This guide will explain the types of disability claims, why they are often denied, and how we can help.

Understanding Disability Claims in Edmonton

Disability benefits are designed to provide financial support when you are unable to work due to a medical condition. In Alberta, there are several types of claims you may be eligible for.

Short-Term Disability (STD) Benefits

Short-term disability benefits are typically provided through your employer’s group insurance plan. They offer income replacement for a limited period, usually ranging from 15 to 52 weeks, immediately after you become unable to work. STD benefits are intended to cover temporary disabilities while you recover from an illness or injury.

Long-Term Disability (LTD) Benefits

If your disability prevents you from returning to work after your short-term benefits expire, you may be eligible for long-term disability. LTD benefits are also usually part of an employer-sponsored group plan, but can also be purchased through a private policy. These benefits can provide income replacement for a set number of years or until you reach the age of 65, depending on your policy.

Canada Pension Plan (CPP) Disability Benefits

The Canada Pension Plan (CPP) provides disability benefits to individuals who have made sufficient contributions to the plan and have a “severe and prolonged” mental or physical disability that regularly stops them from doing any type of substantially gainful work. A key difference is that LTD policies often define disability as being unable to perform your own occupation, whereas CPP requires you to be unable to perform any occupation.

Common Reasons for Applying for Disability Benefits

People in Edmonton apply for disability benefits for a wide range of medical reasons. The critical factor is how the condition impacts your ability to perform your job duties.

Common conditions include:

• Chronic Illness: Conditions like fibromyalgia, Crohn’s disease, chronic fatigue syndrome, and multiple sclerosis can make it impossible to maintain a regular work schedule.
• Mental Health Conditions: Depression, anxiety, bipolar disorder, and PTSD are among the leading causes of disability. These invisible illnesses can be just as debilitating as physical ones.
• Musculoskeletal Injuries: Back injuries, carpal tunnel syndrome, and severe arthritis can prevent you from performing physical tasks required by your job.
• Serious Accidents: Injuries from car accidents or slips and falls can lead to long-term physical limitations.
• Cancer: The diagnosis and treatment of cancer often require significant time away from work for recovery.

Why Are Disability Claims Denied?

Receiving a denial letter from your insurance company can be devastating. Insurers often deny claims for various reasons, some of which may seem unfair. Understanding these reasons is the first step toward building a successful appeal.

Insufficient Medical Evidence

One of the most common reasons for denial is a lack of sufficient medical evidence. Your application must include comprehensive documentation from your doctors that clearly outlines your diagnosis, symptoms, and functional limitations. A simple doctor’s note stating you are “unfit to work” is not enough.

Missed Deadlines

Disability policies have strict deadlines for filing claims and appealing denials. Missing one of these deadlines can result in an automatic denial, even if your claim is otherwise valid. It is crucial to read your policy carefully and act quickly.

Policy Exclusions and Definitions

Your insurance policy is a legal contract with specific terms, definitions, and exclusions. For example, some policies may not cover pre-existing conditions. An insurer might also argue that while you cannot perform your own job, you are capable of doing any job, a common shift in definition after two years of receiving benefits.

Discrepancies in Information

Insurance companies will scrutinize your application for any inconsistencies. This includes comparing your reported limitations to your daily activities, often through surveillance or social media monitoring. Any activity that seems to contradict your claim can be used against you.

How Kotak Law Helps Edmonton Clients Fight Denials

If your disability claim has been denied, do not lose hope. At Kotak Law, we represent clients by taking direct legal action against insurance companies. Our team is committed to pursuing lawsuits and negotiating settlements to ensure you receive the compensation you rightfully deserve.

• Legal Expertise: We thoroughly review your denial letter and insurance policy to identify the insurer’s reasoning and develop a strong legal strategy to challenge it in court.
• Gathering Strong Evidence: We work with you and your medical team to collect comprehensive evidence, such as specialist reports, functional capacity evaluations, and vocational assessments, to build a solid case.
• Managing Communications: We handle all communication with the insurance company, protecting your interests and allowing you to focus on your health and recovery.
• Litigation and Settlement Negotiation: We file lawsuits against insurers who wrongly deny valid claims and negotiate aggressively to achieve fair settlements for our clients. If necessary, we are prepared to take your case to trial to secure the benefits you are owed.

Frequently Asked Questions (FAQ)

1. Do I have to pay upfront to hire a disability lawyer?

No. At Kotak Law, we work on a contingency fee basis. This means you do not pay any legal fees unless we win your case. We offer a free consultation to discuss your situation and explain your options.

2. The insurance company wants me to see their doctor. Do I have to go?

Yes, you generally must cooperate with your insurer’s request for an independent medical examination (IME). However, it is wise to speak with a lawyer before attending. We can help you prepare for the assessment and ensure your rights are protected throughout the process.

3. How long do I have to appeal a denial in Alberta?

The time limit for appealing a disability denial can be complex. Your policy may outline an internal appeal process with short deadlines. For filing a lawsuit, there is typically a two-year limitation period from the date of the first denial. It is critical to act quickly and seek legal advice immediately.

4. Can my employer fire me for being on disability?

No, Alberta’s human rights legislation protects employees from being fired because of a disability. Your employer has a duty to accommodate your needs to the point of undue hardship. If you believe you have been wrongfully terminated, we can also advise you on your legal options.

Take the Next Step with a Free Consultation

You do not have to fight the insurance company alone. The team at Kotak Law is here to support you every step of the way. We are committed to helping Edmonton residents get the justice and financial security they deserve.

If your disability claim has been denied, contact us today to schedule your free consultation. Let us handle the legal battle so you can focus on what matters most—your health and well-being.