A serious illness or injury can change your life, making it impossible to continue working and earning a living. When your condition persists beyond a few months, long-term disability (LTD) benefits are designed to offer financial stability. These benefits provide income replacement when you are unable to work for an extended period, allowing you to focus on managing your health.
For many in Toronto, navigating the complexities of an LTD claim can be overwhelming. This guide explains how to apply for long-term disability, common reasons claims are denied, and how a disability lawyer can protect your rights.
Applying for Long-Term Disability in Toronto
Long-term disability benefits are typically part of a group benefits package offered by your employer. The application process is detailed and requires careful attention to ensure you meet all the policy requirements.
Determining Your Eligibility
Before you can receive LTD benefits, you must first complete a “qualifying period,” which is the duration your short-term disability benefits last (often 17 to 52 weeks). Once that period ends, you can apply for LTD if your disability continues.
Eligibility for LTD hinges on the definition of “disability” in your specific insurance policy. Initially, most policies define disability as being unable to perform the essential duties of your own occupation. After a set period, usually 24 months, this definition often changes to being unable to perform any occupation for which you are reasonably suited by education, training, or experience.
The Application Package
Applying for LTD involves a comprehensive package of forms that must be completed thoroughly.
- Employee’s Statement: You will need to provide detailed information about your medical condition, your symptoms, and how they prevent you from performing your job duties. Honesty and detail are critical.
- Employer’s Statement: This form is completed by your employer and provides the insurer with details about your job title, duties, salary, and work history. It is wise to communicate with your HR department to ensure this is done correctly and on time.
- Attending Physician’s Statement (APS): This is a crucial medical document. Your family doctor and any specialists must provide objective medical evidence of your disability. This includes your diagnosis, treatment plan, prognosis, and a clear description of your functional limitations and restrictions.
All completed forms must be submitted to the insurance company before the deadline specified in your policy.
Why Long-Term Disability Claims Are Denied
Receiving a denial for your long-term disability claim can be incredibly stressful. Insurance companies deny claims for a number of reasons, and understanding them can help you prepare a stronger appeal.
Lack of Sufficient Medical Evidence
This is the most frequent reason for denial. The insurer may argue that the medical documentation provided does not objectively prove that your condition prevents you from working. This can occur if your doctor’s notes are not detailed enough, if you have not pursued all recommended treatments, or if the insurer’s medical consultants disagree with your doctor’s assessment.
Change in Definition of Disability
Many LTD claims are terminated after 24 months. This is typically when the definition of disability in the policy changes from being unable to do your own occupation to being unable to do any occupation. The insurer may argue that you are capable of working in a different, less demanding job, even if such a job is not readily available.
Insurer’s Surveillance
Insurance companies sometimes conduct surveillance to verify the extent of a claimant’s disability. They may monitor your daily activities or review your social media profiles. If they find evidence that seems to contradict your reported limitations, they may use it to deny or terminate your benefits.
How a Disability Lawyer Helps with a Denied Claim
If your long-term disability claim is denied, you have the right to appeal. However, the internal appeal process is often complex and challenging to win. An experienced disability lawyer in Toronto can level the playing field.
When you partner with Kotak Law, we take control of the process to fight for your benefits. Here’s how we help:
- Comprehensive Case Review: We start by thoroughly analyzing your denial letter, your insurance policy, and all medical documentation to understand the insurer’s reasoning and build a counter-strategy.
- Strengthening Your Medical File: We work with your medical team to gather stronger, more persuasive evidence. This may involve seeking reports from specialists or arranging for functional capacity evaluations to provide objective proof of your limitations.
- Handling All Communications: We become the point of contact with the insurance company and their lawyer. You will no longer have to deal with the stress of communicating with adjusters. We manage all correspondence and deadlines.
- Litigating for Your Rights: We will initiate a lawsuit against the insurance company to fight for the benefits you are owed. Our team is skilled in negotiating fair lump-sum settlements or, if necessary, taking your case to court to secure your financial future.
Engaging a lawyer shows the insurance company that you will not back down. It significantly improves your chances of having your claim denial overturned.
Contact Kotak Law for a Free Consultation
Living with a long-term disability is difficult enough. You should not have to fight an insurance company for the financial support you need and deserve.
At Kotak Law, our team has helped countless people in Toronto successfully challenge LTD denials. We work on a contingency fee basis, meaning you do not pay us anything unless we win your case. Contact us today for a free, no-obligation consultation to learn how we can help you.
