By Nainesh Kotak
After more than 25 years in legal practice advocating on behalf of employees who are unable to work as a result of illness or injury, you develop a sense of the most pressing questions people will have about long-term disability (LTD).
Few people give their LTD insurance policy even a moment’s thought before the time comes to make a claim. Sadly, the sense of emotional and financial security the coverage is supposed to bring to policyholders quickly falls away as soon as they start interacting with insurers who do not always have their best interests at heart.
To help get you started on your LTD journey, here are my answers to some of the most asked questions I get from claimants. If I haven’t addressed yours or you need further guidance, our lawyers are only a phone call away.
1. How do I appeal an LTD denial?
Disability insurance companies typically offer an internal appeal process to challenge denials or terminations of benefits. However, the whole procedure tends to be a waste of time — just like students grading their own tests, LTD providers rarely find fault with their original decisions and usually stick with their denials, leaving claimants in the same place they started weeks or even months down the line.
At Kotak Law, we see a lawsuit against the insurance company as a more effective solution, moving promptly to commence claims on behalf of clients and then moving the case quickly towards a possible settlement.
2. How long does LTD last?
LTD policies come in all shapes and sizes, depending on several factors, including the identity of the provider, and whether they are group policies offered by employers or private individual plans. The length of time you may be entitled to receive long-term disability benefits will depend on the precise wording of your policy.
However, most provide for payments up to age 65, as long as you meet the definition of total disability. Some policies specify shorter benefit periods, while others may provide for payments beyond the age of 65. You should also expect a qualifying period before benefits kick in — usually lasting between 60 and 120 days — although some workplaces will have short-term disability programs to cover this time.
3. Can I make an LTD claim for stress?
Workplace stress is on the rise, and employees who are unable to work as a result can apply for short- or long-term disability benefits through their insurance company. As part of the application process, they will need their doctor to fill out a form known as the “attending physician’s statement,” which must include specific medical information about the claimant’s condition, as well as their expected time to recover.
Make sure your doctor understands the nature of your job and any adverse impact it may have on your mental health, as this could be key to conveying why you are unable to perform your occupational duties.
4. Do I have to return to work?
Under the terms of the typical LTD insurance policy, workers are entitled to receive benefits for up to two years if they are totally disabled from performing the essential tasks of their “own occupation.” If a person feels — and their doctors agree — that they are ready, then they can return to work at any stage.
However, after two years in receipt of benefits, the policy wording usually changes, requiring a claimant to be totally disabled from employment in “any occupation” for which they are “qualified or may reasonably become qualified by training, education or experience.” Many insurers seize on this tougher test to terminate benefits, but before then, claimants are often invited to an insurer-approved “transferable skills analysis,” with a view to matching their abilities and education with potential alternative work.
At Kotak Law, we help clients fight back against unfair benefit terminations and inappropriate work options that bear no relation to their skill sets.
5. Is long COVID covered by my LTD policy?
LTD coverage is not tied to any particular diagnosis, but is meant to kick in once any health issue — including long COVID — prevents you from being able to perform the essential duties of your job.
As the pandemic has progressed, the medical community has become more aware of the enduring — and potentially debilitating — effects of COVID-19 infections on a small subset of patients.
Unfortunately, LTD insurers are moving a little more slowly when it comes to recognition of this emerging condition, raising questions about if or when policyholders contracted their original infections and casting doubt on the strength of the medical evidence backing up their claims.
In the absence of formal long COVID diagnoses, our firm focuses cases on the symptoms suffered by injured employees, encouraging clients to seek treatment and follow the advice of health professionals.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.
Call your trusted long-term disability lawyers at 1-888-GOKOTAK or (416) 816-1500. Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St. Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Fort Erie, Keswick, Kingston, Ottawa, Barrie, Timmins and other locations.