Tips for Making a successful Disability Claim

If you suffer from an illness or injury that prevents you from performing the essential tasks of your job, you are eligible to claim long-term disability benefits under your disability insurance plan.   Even if you can perform some of your work requirements, you are still eligible to claim benefits if you can’t effectively perform the essential activities of your current job.   Then, after you’ve been disabled for two years, you may continue to receive disability benefits if you're unable to perform any job for which you’re suited by way of your training, experience or education.

An eligible claimant won’t receive long term disability benefits until after the waiting period specified on their LTD plan has passed, which is typically 120 days after becoming disabled.  However, during the waiting period, you may have enough sick days accumulated to provide you with an income for several weeks; and/or you may be eligible for short-term disability benefits from your employer or your employment insurance (EI) sickness benefits.  Short-term disability benefits can run for 1 to 3 months, while EI sickness benefits are paid up to a period of 15 weeks.  Check with your employer to see if you can claim either of these benefits.  

After the LTD waiting period has expired, you should receive benefits if you meet the eligibility criteria and if you were consistently unable to work during this period.  LTD benefits provide income replacement as long as you remain disabled and continue to meet the criteria, up to the age of 65.  Also, be aware that you may be eligible for long-term disability benefits despite having your short-term disability claim denied. 

Whether you’re claiming LTD benefits through your employer plan or from another disability coverage provider, you may not be approved for benefits even when you are genuinely unable to do your job.  Disability insurers require detailed and specific information to prove your disability and you risk having your LTD application denied if you don’t meet any of the insurer’s requirements.

Here are key steps to take when applying for disability benefits.

1. Don’t miss the notification and application deadlines.  LTD plans specify a deadline (often, 30 days) for notifying your insurance company of your disability. Your LTD insurance plan will also indicate a deadline for submitting your application, including the medical proof for your disability, which is typically a specified number of days before the waiting period when payment of LTD benefits can commence.  If the waiting period is 120 days, then you may need to submit your application 3 months before that date.  Be sure to check your plan to find out about these notification and application deadlines.
2. Undergo medical treatment for your disability and follow your doctor’s advice. In order to qualify for LTD benefits, you must be under the regular care of a physician who is qualified to assess and treat your specific condition.  For example, if you are suffering from a psychological condition, such as depression or post-traumatic stress disorder (PTSD), your disability insurer will view the opinion of a psychiatrist as more credible than that of your family doctor.  Further, when you can provide evidence that you sought care from the appropriate medical professional and followed your physician’s recommendations, you are proving that you genuinely want to get well, which is another aspect of care that your LTD insurer will assess.
3. Submit all required medical information with your application.  This includes any medical tests, such as a CT scan or X-ray, that can verify your disability.  A failure to provide all supporting documents on your LTD application is one of the most common reasons why LTD benefits are denied.
4. Ensure that your doctor’s explanation of your medical condition specifically describes how your disability prevents you from performing the required aspects of your job.  For example, if a person is suffering from serious rheumatoid arthritis in their hands, then the pain, stiffness and weakness in their hands may make it impossible to work on a computer for any length of time and to perform any moderate to heavy lifting.
5. Avoid making harmful social media posts.  Don’t post updates to Facebook or other social media sites which show you being physically active or having fun in activities that might conflict with your claim of being disabled.
6. Be forthright and honest on your application.

It typically takes about a month for insurers to approve or deny an LTD application, so if you don’t receive an answer for two or more months, contact your insurer to find out why there has been a delay.  If your disability claim is denied, it’s important to read and understand the insurance company’s stated reason for their denial.  If the reason is unclear, speak to your insurance representative to gain a certain understanding from them. 

When an application was denied for an easily correctable reason, such as failure to include a medical test substantiating your claim, you may be able to correct the situation on your own by submitting to a further medical test or by obtaining the required medical information and re-submitting your application. 

In some cases of a denied claim, the insurance company becomes convinced that a particular claimant doesn’t have valid grounds to make a claim, despite being genuinely unable to work, and it’s extremely difficult for claimants to reverse their insurer’s decision.  In such a case, a knowledgeable and experienced Kitchener-Waterloo disability claims lawyer offers the best chance for a positive outcome. At Dietrich Law, our experienced disability lawyers have successfully represented many clients in disability claim disputes and we welcome you to speak with our staff to find out how we can help.