When a serious illness or injury prevents you from working, the last thing you need is a battle with your insurance company. The disability benefits you’ve paid for are meant to provide a safety net during these difficult times. Yet, many people in Calgary find their legitimate claims unjustly denied, adding immense financial pressure to an already challenging situation.
At Kotak Law, we see the impact these denials have on individuals and their families. Our dedicated team of disability lawyers is committed to helping Calgary residents secure the compensation they are entitled to. We understand the tactics insurance companies use, and we are prepared to fight for your rights. This guide explains the disability claim process, the common hurdles applicants face, and how we can help you challenge a denial.
Navigating Disability Claims in Calgary
In Alberta, disability benefits provide crucial income replacement when you cannot work due to a medical condition. It is important to understand the different types of support available.
Short-Term Disability (STD)
Most often provided through an employer’s group benefits plan, short-term disability offers financial support for a specific period, typically up to six months. It is designed to cover your income loss while you recover from an immediate illness or injury. Your STD claim is the first step in the disability process.
Long-Term Disability (LTD)
If your condition persists and you are unable to return to work once your STD benefits end, you may be eligible for long-term disability. LTD benefits can be accessed through group insurance or a private policy. They are intended to provide income replacement for several years or until you reach retirement age, depending on the specifics of your plan.
Canada Pension Plan (CPP) Disability
The federal government offers CPP disability benefits to individuals who have made sufficient contributions to the plan. To qualify, you must have a “severe and prolonged” disability that prevents you from engaging in any type of substantially gainful employment. The eligibility criteria for CPP are often stricter than for private LTD policies, which may only require you to be unable to perform your own occupation.
Common Conditions Leading to Disability Claims
A wide variety of medical conditions can make it impossible to continue working. The key factor is not the diagnosis itself, but how its symptoms and limitations affect your ability to perform the essential duties of your job.
Many claims are based on conditions such as:
- Mental Health Issues: Conditions like major depression, anxiety disorders, PTSD, and burnout are leading causes of disability. Though invisible, their impact on cognitive function, energy, and focus can be completely debilitating.
- Chronic Pain and Illness: Fibromyalgia, chronic fatigue syndrome, Crohn’s disease, and multiple sclerosis involve unpredictable and often severe symptoms that disrupt one’s ability to maintain a consistent work schedule.
- Musculoskeletal Disorders: Debilitating back pain, severe arthritis, and repetitive strain injuries like carpal tunnel syndrome can make physical work impossible and even affect sedentary jobs.
- Serious Medical Events: The recovery period following a heart attack, stroke, or cancer treatment often requires extended time away from work, leading to the need for disability support.
- Accident-Related Injuries: Long-term impairments resulting from motor vehicle accidents or other serious incidents are a common basis for disability claims.
Why Do Insurance Companies Deny Claims?
Receiving a denial letter can be shocking and disheartening. Insurance companies are for-profit businesses, and they often look for reasons to deny claims to protect their bottom line. Understanding these reasons is the first step in building a powerful legal case against them.
Lack of Objective Medical Evidence
Insurers frequently argue that there is not enough medical proof to support your claim. A simple note from your family doctor is often deemed insufficient. They want to see comprehensive records, specialist reports, and test results that clearly document your diagnosis and how it limits your functional abilities.
Policy Loopholes and Definitions
Every insurance policy is a complex legal document filled with specific definitions, limitations, and exclusions. An insurer might deny your claim based on a pre-existing condition clause or by arguing that your condition doesn’t meet their definition of “total disability.” A common tactic is to change the definition of disability after two years, stating that while you can’t do your own job, you could do any job.
Surveillance and Social Media
Insurance companies may conduct surveillance, including hiring private investigators or monitoring your social media profiles. They look for any activity they can interpret as being inconsistent with your reported limitations. A single photo or video taken out of context can be used to justify a denial.
How Kotak Law Fights for Calgary Clients
If your disability claim was denied, you do not have to accept the insurer’s decision. You have the right to take legal action. The team at Kotak Law is prepared to sue the insurance company on your behalf and fight for the full compensation you deserve.
We level the playing field and hold insurers accountable.
- Strategic Legal Action: We bypass the internal appeal process, which is often designed to frustrate you into giving up. Instead, we initiate a lawsuit against the insurance company to demonstrate that you are serious about pursuing your rights.
- Building an Ironclad Case: We work closely with you and your medical providers to gather all the necessary evidence. This can include obtaining detailed reports from medical specialists, arranging for functional capacity evaluations, and securing expert opinions to prove the extent of your disability.
- Aggressive Negotiation: Once we file a lawsuit, insurance companies are often more willing to negotiate a fair settlement. Our lawyers are skilled negotiators who will fight to secure a lump-sum payment or the reinstatement of your monthly benefits.
- No Upfront Fees: We handle all communication and legal work, so you can focus on your health. You pay no fees unless we successfully resolve your case.
Frequently Asked Questions (FAQ)
- Is a lawyer necessary if my disability claim is denied?
While you can try to handle it alone, your chances of success are significantly higher with an experienced disability lawyer. Insurance companies have teams of lawyers working for them; you should too. We know the law and the procedures required to force them to pay.
- What if my employer terminates my employment while I am on disability leave?
In Alberta, it is illegal for an employer to fire you because you have a disability. They have a duty to accommodate you. If you have been wrongfully terminated, our firm can also advise you on filing a human rights complaint or a wrongful dismissal lawsuit.
- How long do I have to sue after a denial in Calgary?
You typically have two years from the date your claim was first denied to file a lawsuit against the insurance company. It is vital to contact a lawyer as soon as you receive a denial letter to ensure you do not miss this critical deadline.
- The insurer is sending me for an “Independent Medical Exam” (IME). What should I do?
You are generally required to attend an IME. However, these doctors are paid by the insurance company and are often looking for reasons to support a denial. It is highly recommended that you speak with a lawyer before the assessment. We can help you understand what to expect and how to protect your rights.
Schedule Your Free Consultation Today
You don’t have to face this fight alone. The lawyers at Kotak Law are here to be your advocates and champions. We are committed to helping Calgary residents get the justice and financial support they need to move forward with their lives.
If your short-term or long-term disability claim has been denied, contact us now to schedule your free consultation. Let us take on the legal burden so you can focus on what is most important: your health.
