Disability benefits provide much-needed financial support when you are unable to work due to severe illness or injury. You are required to file a claim with your insurance provider if you want to receive disability benefits. No problem - just a bit of paperwork, right?
If only it were so easy. Many legitimate disability claims are denied due to mistakes in the application forms, missed deadlines, or insufficient medical evidence. The outcome of your disability claim depends on the strength of what you file with the insurance company. With the right knowledge and advice, you can increase your chances of getting approved. Here is what you need to know before you file a disability claim.
Look to the policy
You may have disability insurance through your employer, or you may have purchased coverage privately through an insurance company or insurance broker. In either case, the first step to any disability claim is to review the language of the policy itself.
Think of the policy as your guidebook. It sets out your legal rights and the ground rules to follow when making your disability claim. Understanding essential information such as the definition of disability, how eligibility is determined, how much you can expect to receive (e.g., a percentage of your pre-disability income), and how long you’ll have to wait until you start receiving payments (known as the elimination period) is critical to the success of your claim.
Determine the elimination period
All long-term disability (LTD) policies are subject to an elimination period or “qualifying period.” This is the period of time you must wait between the start of your disability and the date you start to receive LTD benefits.
The waiting period varies from policy to policy, but typically ranges from 90 to 120 days. Some, but not all, policies permit you to apply during the elimination period, so that if you are approved, you will begin receiving LTD benefits as soon as the elimination period expires. It’s important to check the terms of your specific policy so you understand the timelines you must meet when filing your disability claim.
You will not receive long term disability benefits during the elimination period, but you may qualify for other types of income replacement during that period, such as benefits under a short-term disability plan or Employment Insurance (EI) Sickness Benefits.
Understand your diagnosis and your doctor’s view of your medical condition
Proper diagnosis of your medical condition and support from your doctor are two key pieces to a successful disability claim. Talk to your doctor about your medical condition and whether they support your disability claim. If your doctor does not agree that you are disabled from work, you should consider getting a second opinion from a different medical professional. It’s unlikely that your disability claim will be approved if you don’t have a doctor’s support.
Gather medical records
Evidence is essential to a successful disability claim. You will need to obtain medical records from your doctor, hospital(s), specialists, and other healthcare providers to support your claim. The records should detail your diagnosis, symptoms, prognosis, treatments you’ve received, and how your medical condition is impairing your ability to work.
It takes time to collect these documents, so you should start requesting medical records as early in the process as possible. A long term disability lawyer can help you compile and submit the documents and supporting evidence needed to boost the strength of your claim.
Prepare your application package
When you notify the insurance company or the HR department that you intend to file a disability claim, they should provide you with the application forms and instructions on how to apply. There are usually three main forms that need to be completed: a benefit application for you to fill out, a report from your employer, and a medical report from your doctor.
Read the application materials carefully and take your time completing the forms. Mistakes, missing information, and lack of sufficient detail are top reasons for LTD denials. Talk to your employer and your doctor about the level of detail they should provide in their reports. Information such as when you stopped working, attempts to return to work/return to modified duties, your specific symptoms and how they limit you or leave you unable to work must be included.
Submit your disability claim
Once the application package is ready, submit it to your LTD insurance provider, along with all necessary supporting documentation. You will then have to wait for the insurer to review and notify you of its decision to approve or deny your LTD claim. It typically takes 30 to 60 days to get their decision, assuming there are no delays caused by missing information, mistakes, etc.
While you wait, its OK to contact the insurance company to check on the status of your application. You should also be prepared to submit additional information if the insurer asks for it.
If your disability claim is approved, review the insurance company’s approval decision carefully so you know the terms and conditions that apply (e.g., amount and duration of benefits; reasons the insurer can terminate benefit coverage; steps you’ll need to take to reapply for LTD benefits at the two-year mark when the policy definition changes from own occupation to any occupation).
If your disability claim is denied, you have the right to know the reasons for the denial. You also have the right to appeal, which means asking the insurer to reconsider its decision. You also have the right to file a legal claim to get the compensation you deserve. It’s strongly recommended that you reach out to a long term disability lawyer ASAP to discuss your legal rights, options, and the applicable deadlines for appealing or starting a lawsuit.
Guidance and Advice from A Long Term Disability Lawyer
Oshawa and Lindsay lawyers at Kelly Greenway Bruce know all the tricks and tactics insurance companies use to delay and deny disability claims. Once you hire Kelly Greenway Bruce, we deal with the insurance company on your behalf. No more struggling to figure out paperwork or deadlines, and no more dealing with insurance company gaslighting. You can focus on your health and taking care of yourself, knowing that you have a trustworthy advocate on your side. We encourage you to connect with our long term disability lawyers in Oshawa or Lindsay today for a free case evaluation.