A denial of your long-term disability claim can prompt sudden chaos for you and your family. You may be forced into draining away life savings or going into debt. The situation can be frightening, frustrating, and unjust.
At Kotak Law, our experienced lawyers will be able to help you understand the merit of your disability claim, and can help you reclaim your life – whether your claim has been unfairly denied, your benefits have been terminated, or you would like to make a disability claim.
Our priority is helping our Hamilton clients receive the settlement that they deserve, while supporting them every step of the way. That means fiercely advocating for you, while staying in touch, keeping you informed of your case, and guiding you throughout the process.
If you think you may have a long term disability claim in the Hamilton area, call Kotak Law Firm. We will meet with you at a convenient location and fight for your rights every step of the way.
I’m applying for long term disability benefits – what do I need to know?
First, it’s important to remember that your disability may be immediately apparent to you, but your insurer has a vested interest in disbelieving your assertion. As a result, disability claims demand real effort to proving and documenting evidence of your ailment.
Because of this, it vital that you strictly follow your treatment doctor’s treatment recommendation. A failure to do so is a common pratfall that hinders a disability claim. Surprisingly, insurance companies can even deny a claim on the basis that the claimant acted correctly, but the claimant’s doctor recommended inappropriate treatment.
Be completely honest with your doctor. Good medical evidence begins with your personal doctor. They should document how your condition affects your ability to perform daily tasks including your past and present employment. Your doctor should record your recommended treatment and medications and record how the medication affects you. Please tell your doctor about your symptoms and its severity. Make sure that your doctor understands that you expect thorough documentation.
Naturally, your insurer has a vested interest in denying your claim. Two common methods that insurers use to hinder a disability claim:
1) Seeking out medical evidence that contradicts or refutes the evidence that you provide.
When litigating against your insurance company, you have more rights in regards to the evidence that you do – and do not – provide for your claim. In contrast, when going through your insurer’s internal appeals process, they may demand you undergo certain tests or complete medical questionnaires.
Before completing the insurance company’s questionnaire about your physical and mental activity level over the past year, you need to consider an interview with a lawyer leading your answer. These forms are important parts of application forms and claims, so it is important understand the legal machinations behind each question.
Also, remember that if you obey your insurer’s requests for medical information, this information can be used by your insurer if you choose to litigate. In other words, going through an insurer’s internal appeals process before suing makes your case more difficult.
2) Delayed responses and decisions
Many disability claimants are surprised and frustrated at how long it takes their insurer to give them an answer on their claim, and how opaque the disability claim process is.
If you feel that your insurer is taking advantage of your patience, it may be time to litigate.
Call us today at 1-888-GOKOTAK or fill out our free online assessment. You only stand to gain from taking charge of your disability claim.
Disclaimer: This article is intended to supply general information to the public. We make every effort to ensure the accuracy of this information. However, as laws change quickly, the reader should always ensure the accuracy and applicability of such information with respect to their particular case. The information contained in this article cannot replace a thorough and complete review of the reader’s situation by competent legal counsel who has had an opportunity to review all of the facts.
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Phone: (416) 816-1500
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Fax: (905) 755-8901
Email: info@kotaklaw.com
Hamilton Disability Cases in the News
HAMILTON ELIGIBILITY FOR CPP DISABILITY BENEFITS AT RISK?
The Canada Pension Plan (CPP) disability benefit provides a monthly income for Canadians who are no longer able to work due to a disability. To be eligible to receive the CPP disability benefit, a person must meet the legal definition of a ‘prolonged’ and ‘severe’ disability and also be under the age of 65. Eligibility is also conditional on having been employed and making CPP contributions for a minimum amount of time.
- A severe disability is defined as a mental or physical condition that renders a person incapable of regularly pursuing any substantially gainful occupation. However, in determining your eligibility, medical adjudicators do not consider whether suitable employment is available in your area.
To qualify for these benefits, a Hamilton claimant must have contributed to CPP for a minimum qualifying period of:
- at least 4 of the past 6 years, or
- at least 25 years, where at least 3 of these years were within the past 6 years
The CPP disability benefits application process considers more than a claimant’s medical diagnosis of a particular condition or disease. Medical adjudicators who determine a claimant’s eligibility for benefits also consider the following factors.
- The type and severity of your medical condition
- How the condition and its treatment impacts your ability to work
- Your prognosis
- Your personal characteristics, including age, work history and education
- Work performance, income and productivity
The eligible CPP disability benefit is determined by adding 75% of a person’s maximum CPP retirement pension amount to a flat-rate amount (which is $471.43 in 2016). CPP disability benefit is a taxable benefit. The benefit will cease if the claimant becomes able to regularly work at any job, or when a person turns 65 and is eligible to receive the CPP retirement pension and Old Age Security pension.
Delays in paying out CPP disability claims
Unfortunately, just because you qualify for CPP disability benefits, both medically and in terms of having made sufficient CPP contributions, doesn’t mean that you can simply fill out a form and automatically receive benefits.
In February 2016, Canada’s Auditor General revealed that there is a huge backlog in CPP disability claim applications which has forced many Canadians who are owed CPP disability benefits to wait years for payment. In a CBC News report on CPP disability delays, it was announced that the annual 2015 fall report discovered an average delay of 884 days for processing claims. This means that many Canadians with severe and prolonged disabilities are waiting to receive a vital source of their income.
The former Conservative government established the Social Security Tribunal of Canada to process CPP disability claims, but the backlog of cases awaiting an appeal has almost doubled since the tribunal was created. The wait time to hear an appeal decision has also more than doubled since then. These waits are shockingly long when one considers that the Department of Employment and Social Development’s service standard is a maximum of 120 days to receive a decision on a disability case.
The Auditor General also determined that an incredibly large number of claims are rejected in their initial application but later overturned. In 2014-2015 for example, 35% of cases initially rejected were later accepted when it was determined that the applicant was actually eligible for benefits. One of the difficulties and sources of delay in the application process is that the application kit, including 42 pages and 5 forms, is extremely complex and lengthy, and may take as much as a few months to complete.
In terms of real-life impact, these significant delays are putting many Hamilton residents with disabilities at real financial hardship, wondering how they can pay for their mortgages or rent, food and other necessities. What makes this situation even more egregious is that individuals with a serious disability are already struggling and often overwhelmed by a significant illness or disabling condition, such a spinal injuries, cancer and mental illness.
With respect to applying for and/or appealing CPP disability claims, it is always in the claimant’s best interests to ‘get it right the first time’ in terms of including the required medical, employment and other relevant documentation with your application. A lawyer experienced in expediting disability claims can ensure that you have all the necessary documents to substantiate your claim and can also help file a successful appeal to the Social Security Tribunal.
Our team at Kotak Personal Injury Law has represented many Hamilton residents with disabilities in resolving their disputed CPP disability benefits claims. Call Kotak Law today for expert help in completing your application or appeal.
