How to Make a Short-Term Disability Claim in Calgary, Alberta
If you are dealing with a medical condition that makes it difficult or impossible for you to work, you may be eligible for short-term disability (STD) benefits. Short-term disability insurance is designed to provide financial assistance to individuals who cannot work for a specified period due to an illness, injury, or a medical condition.
Pursuing a short-term disability claim in Calgary, Alberta can be a complex and overwhelming process, especially if you have been denied benefits. In the following content, we will outline the steps involved in making a short-term disability claim and what to do if your STD claim is denied. We will also explain how our STD lawyers in Calgary and throughout Alberta can help you.
Submitting an Application for Short-Term Disability Benefits
There are typically three primary forms that need to be submitted in order to apply for STD benefits: 1) Employer’s/Plan Sponsor’s Statement; 2) Claimant/Employee/Plan Member’s Statement; and 3) Attending Physician’s Statement.
1. Employer’s/Plan Sponsor’s Statement
In order to submit a claim for STD benefits, one form that typically needs to be completed is what is commonly referred to as an Employer’s Statement or Plan Sponsor’s Statement. This document is completed by your employer and contains details of your short-term disability coverage as well as details about your employment and absence from work, amongst other vital information.
Contact your human resources department or benefits administrator to ensure that they have received the Employer’s Statement or Plan Sponsor’s Statement from the disability insurer, and to further ensure that it is completed and submitted to the insurer in a timely manner so that there are no delays in processing your claim.
2. Claimant/Employee/Plan Member’s Statement
Another document that is required to be submitted in order to process your claim for STD benefits is what is commonly referred to as a Claimant’s Statement, Employee Statement or Plan Member Statement. This document serves as your application for short-term disability benefits and provides details about your medical condition and work history.
Some of the information you may need to provide on the Claimant/Employee/Plan Member’s Statement consists of:
- Personal information: This includes your name, address, phone number, and employee ID number.
- Medical information: You need to provide details about your medical condition, including the date of onset, diagnosis, your symptoms and treatment plan.
- Work history: You will need to provide information about your job, including your job title, duties, and the date you stopped working due to your medical condition.
- Other benefits: If you are receiving benefits from other sources, such as workers’ compensation or a private insurance plan, you usually need to provide this information on the form.
You should also attach any medical documentation that supports your claim, such as doctor’s notes, test results, or hospital records. Once you have completed this document, you should submit it to your insurance provider as soon as possible as there are often deadlines for when you must apply by.
3. Attending Physician’s Statement (Healthcare Provider Statement)
Your healthcare provider must also complete a statement confirming your medical condition and inability to work. This statement is commonly known as an Attending Physician’s Statement and it provides critical information about your medical situation and its impact on your ability to perform your job.
Your medical practitioner may need to complete different forms depending on the insurance provider’s requirements. Some of the information they may need to provide includes:
- Diagnosis and treatment: Your healthcare provider needs to provide details about your diagnosis and the treatment you are receiving.
- Prognosis: They may also need to provide information about your expected recovery time and any ongoing treatment or care you may need.
- Work limitations: Your healthcare provider needs to indicate any restrictions and/or limitations on your ability to work, such as physical, psychological or cognitive limitations.
- Clinical notes and records: The insurer will usually ask for you or your doctor(s) to provide copies of their clinical notes and records in order to substantiate that you have a disabling condition, and that you have been regularly seeking medical care and treatment for your condition. This includes the records of your family doctor as well as any other doctors or specialists you are seeing with respect to your disabling condition.
It is important to regularly seek medical care and appropriate treatment for your illness or injury, and to ensure you provide details to your healthcare providers about all of your symptoms and how these impact your life both at work and at home. That way your doctor(s) will have all of the necessary information to complete their statement thoroughly. Once your healthcare provider has completed the Attending Physician’s Statement, they should submit it directly to your insurance provider and/or provide you with a copy of it so that you can submit a copy directly to the insurer.
My Short-Term Disability Claim Was Denied
If your short-term disability claim has been denied, you may feel frustrated and uncertain about your financial future. However, it is essential to understand that a claim denial does not necessarily mean that you are not entitled to benefits.
If your claim has been denied, the first step is to review the reasons provided by the insurance company carefully. In many cases, claim denials are based on incomplete, inaccurate or insufficient information, or a lack of medical evidence to support your claim.
If you believe your claim has been wrongfully denied, you have the right to appeal the decision. However, the appeals process can be complex and time-consuming, and the majority of insurers state that you are responsible to pay out of your own pocket to support your appeal, including paying for any medical records or evidence you need to obtain to support your claim. This can be a significant financial strain as you are already not working and therefore not receiving an income. It is even more financially draining because insurers will ask you to submit clinical notes and records of all medical practitioners you are seeing, and doctors’ records are often expensive, especially if they are voluminous. As such, it is often in your best interest to seek the assistance of an experienced STD lawyer.
How Our Lawyers Can Help You
At our law firm, we have extensive experience helping individuals in Calgary and throughout Alberta navigate the short-term disability claims process. We understand that dealing with a medical condition can be stressful and overwhelming, and we are here to provide compassionate and effective legal support.
Our STD lawyers in Calgary will work closely with you to understand the intricacies of your claim and help build a strong case for why the insurer has wrongfully denied you benefits. We will gather additional medical evidence, review the insurance company’s decision, and provide you with clear guidance on your options.
If necessary, we can represent you in a lawsuit to ensure that you receive the benefits you are entitled to. Our lawyers have a track record of success in handling STD claims, and we are committed to fighting for our client’s rights.
If you are dealing with a short-term disability claim in Calgary, Alberta, or surrounding areas, our lawyers are here to help. Contact us today to schedule a meeting or call to learn more about how we can assist you.