Disability Lawyers Calgary
Meet Our Long-Term And Short-Term Disability Lawyer In Calgary
It can come as a surprise for disability claimants to face an initial denial of their long-term disability claim by the insurance company after applying for benefits. One of the worst things that can happen to a claimant is when the insurance company will not let them know the reason for the refusal and/or deny their claim despite the support of their treating doctor(s). Further, the insurers try their best to prove that a person’s claim is exaggerated or not disabling.
In light of these hardships by insurers, this is where Kotak Law will use its immense experience to assist their clients in helping them gather the evidence to prove they are disabled as per the terms of the insurance policy and help those who are unfairly denied by insurers get the benefits they deserve.
How Does A Long-Term Disability Lawyer Help You During Chronic Pain In Calgary, AB?
Chronic Pain is expected to be a long-term condition with the lowest quality of life. It can adversely affect a particular body part or many at the same time as a result of a previous wound or injury. The cause of chronic pain includes an extensive list, such as nerve damage, cancer, psychogenic pain, fibromyalgia, or injuries caused by accidents and falls, amongst others.
The complication in chronic pain usually extends far beyond severe physical pain with time. Yet, insurance companies do not always recognize chronic pain as a disabling condition. They typically argue that if someone was able to manage working with their chronic pain then they question what caused that person to stop working, and they deny the claim on the basis that the individual was capable of working despite the chronic pain. If this sounds familiar to you, you do not need to panic; our Disability Claim Lawyers assist claimants in disputing an insurer’s decision to deny LTD benefits in such circumstances.
Our LTD benefit lawyers help individuals gather objective medical evidence for their chronic injury or illness (for example, clinical notes and records, X-rays or test results) to help prove that their chronic medical condition does prevent them from being able to work. Our lawyers help their disabled clients obtain medical evidence from their treating medical practitioners supporting that their disabling condition meets the test of being totally disabled as defined in the insurance policy, and our lawyers will use that to fight to get individuals the benefits they deserve.
What is the role of Short-Term Disability Lawyers in Calgary?
Short-Term Disability (“STD”) provides compensation or income replacement for illness or injuries to those who are not able to earn their livelihood. When you are in the crucial stage of short-term disability, which is typically the first step in a disability claim, it is sometimes difficult to prove your disability given you are still in the earlier stages of seeking medical advice and/or treatment for your condition. This can be a complex situation as insurers often use the lack of medical evidence as a reason for denying legitimate claims.
This is where an experienced disability lawyer at Kotak Law can help you. We represent people who have been denied disability benefits, whether it is short-term or long-term, even if the denial is based on an alleged lack of medical evidence.
In addition to our years of strong and compassionate advocacy, we have successfully sued insurance companies like Manulife, Sun Life, Desjardins, Blue Cross, Great West Life, AIG, Empire Life, SSQ, Industrial Alliance, RBC, Canada Life, Equitable Life, and more.
Being denied disability benefits is frustrating and stressful, especially when you have no income, and this is why we at Kotak Law are always committed to helping people access the benefits that they need and are entitled to.
Kotak Law offers free consultations to guide you with the best approaches to making a wise decision. Furthermore, we work on a contingency fee basis, meaning that we only get paid if we are able to successfully help you recovery money on your behalf.
How Do You Proceed With A Disability Benefits Claim?
In order to proceed with a disability benefits claim, whether for Short-Term Disability (“STD”) or Long-Term Disability (“LTD”) benefits, you should always refer to the claims process given to you by the insurer or your employer (if it is a group plan offered through your employment), as each plan and policy differs. For example, some plans do not contain STD benefits at all and instead you must go on Unemployment Insurance or sick leave or something of that nature for a specified waiting period before being able to make a claim for LTD benefits. You should still submit your claim for LTD benefits as soon as you are able to do so.
For those plans that do contain STD benefits, typically you must apply for STD benefits before being able to apply for LTD benefits. In cases where it is the same insurer for both STD and LTD benefits, if you are approved for the entire STD benefit period then usually your claim will automatically transition to LTD benefits so long as you continue to meet the test of being “totally disabled” as defined in the insurer’s policy. However, when the STD and LTD insurer are different, in that scenario you typically have to complete a separate LTD benefit application which you submit directly to the LTD insurer, and this should be done prior to the end of the STD benefit period to avoid any delays for your LTD claim.
Whether you are applying for STD or LTD benefits, most plans require you to complete an application, which is often referred to as an “Employee Statement” or “Claimant’s Statement.” You must also have a doctor complete an “Attending Physician’s Statement” that gets submitted to the insurer. Lastly, for group plans offered through your employment, your employer is usually required to complete an “Employer’s Statement”. Once these items are submitted to the disability insurer, this may be enough to allow the insurer to make a decision on your claim. Typically, however, insurers like to see more medical records so they will request the clinical notes and records of your doctor(s). If you have any medical notes supporting that you need to be off of work, you should consider sending this to the insurer as well.
The Employee Statement or Claimant’s Statement usually consists of basic and essential information, such as a series of questions related to your disability, its nature, and its adverse effects on your ability to work. It usually asks you to list the condition, diagnosis and symptoms that prevent you from working and it may ask about what treatment you are receiving. The statement will ask which doctors you are seeing and ask for detailed information about the treatment you are receiving for your condition.
The Attending Physician’s Statement must be completed by your doctor. The form asks for numerous details about your diagnosis, treatment, your symptoms, the severity of your condition, how it impacts your ability to work, and what your prognosis is. You should consider requesting your doctor to complete the form thoroughly; otherwise, the insurer may allege there is insufficient medical information to support your claim and this may be a reason for your claim to be denied. As noted, it is helpful if your doctor attaches their medical records when submitting this form, as supportive medical records can serve as confirmation you suffer from a totally disabling condition.
The Employer Statement is completed by your employer and usually consists of your employment details such as your job title, job duties, how long you have worked for the employer and the date you ceased work.
After the insurer has received your submitted application (Employee or Claimant’s Statement) and Attending Physician’s Statement, a representative of the insurance company will contact you to discuss your claim. This is usually in the form of a telephone call during which the insurer will ask about your disability, symptoms, restrictions and limitations, treatment, and your ability to participate in household tasks as well as social and recreational activities. They can even ask you for more details and medical records, such as details about any upcoming appointments or treatment that is scheduled.
The eligibility test for whether you will be deemed “Totally Disabled” is defined under your respective policy and it can differ between different plans/policies. Generally speaking, under most disability policies, the test for STD benefits and usually for the first two years of LTD benefits surrounds whether or not you are capable of performing the essential duties of your own occupation. After that, the test usually changes to whether you are capable of performing the duties of any occupation based on your education, training and experience.
What to do if your STD or LTD claim is denied?
The reasons for the denial can be vary from case to case. Often, insurance companies claim that your condition doesn’t prevent you from performing your essential job duties and will deny your claim on this basis.
Insurance companies often offer an internal appeals process to dispute the denial of your claim. These have strict deadlines so if you are going to pursue an internal appeal you should ensure to meet those deadlines. The downside of an internal appeal is that you are usually responsible for collecting the evidence to support your appeal and this includes paying out of pocket for medical records. Another downside is that your appeal is typically decided by either the same person who made the initial decision to deny your claim or a colleague of theirs, so it is usually rare that an insurer will reverse their decision. Further, as part of your appeal you may prepare a letter detailing why you cannot work and their decision was wrong, but the insurer may use this against you to argue if you are capable of preparing such a letter this shows you have a capability of working.
An alternative and often more beneficial option for most people is to contact a disability lawyer. At Kotak Law, if you retain our firm to represent you for the denial of your claim we will pay to obtain any medical records that are needed to support your claim so that you are not out of pocket, and these expenses become assessable disbursements which we ask the insurer to reimburse us for. We also do not pursue an internal appeal and instead we start a lawsuit; that way, instead of your claim being decided by either the same person who made the initial decision or their colleague, instead it now goes to their litigation department where the insurer assigns a litigation specialist and a lawyer who are higher up in the insurance company and will review your claim objectively.
