Ottawa Long-Term Disability Denial Lawyers
Disability Lawyer Near You
Wondering where to find “the best disability lawyers near me”? You’ve come to the right place! We’ll come to your home or to the hospital to meet with you without any obligation. We can accommodate you by telephone as well. If you prefer to meet us in person, we have 4 locations in the Ottawa area. Let us know what office is near you and we’ll do our best to accommodate. With Auger Hollingsworth, help after a disability denial is always nearby!
Have you been denied disability insurance benefits?
A disability is a physical or mental handicap that can limit your ability to perform everyday tasks, and in some cases, make it impossible to work. When you or a loved one suffers an injury or an illness that inhibits or prevents you from working, it can feel like your whole world has been turned upside down. You may worry about how you’re going to provide for your family, and this adds psychological and emotional stress to an already difficult situation.
Fortunately, in Canada, people who are disabled and unable to work are eligible for Long Term Disability Benefits (LTD), which can help them pay for expenses and maintain their quality of life. At Auger Hollingsworth, our disability lawyers have helped many clients in Ottawa complete the complicated paperwork involved in an LTD claim. And because we understand how important LTD benefits can be for you and your family, we’re not afraid to fight for your rights every step of the way.
How to appeal an insurance claim denial
Having your disability insurance claim denied can be frustrating and stressful. Fortunately, if your first insurance claim is denied, there are other options available. But first, it’s important to speak with a disability lawyer in Ottawa to help with your appeal.
Whether you’ve been denied an insurance claim for private disability insurance or as part of a group disability policy, an experienced disability lawyer in Ottawa can help you by:
- Reviewing your insurance policy to determine if you qualify for disability benefits.
- Determining if it’s sensible to conduct an internal appeal of the denial of your benefits.
- Helping you file a lawsuit if that is your best option.
There is really no replacement for having an experienced lawyer on your team. If you believe you should qualify for LTD benefits and have been denied, then contact a disability lawyer today for assistance.
How do I prove that I’m disabled?
It is not always easy to prove your disability and begin receiving the benefits you deserve. Sadly, insurance companies are no strangers to making things complicated and doing everything they can to save money, so it’s not uncommon for people to have difficulties obtaining their benefits or even to be denied the benefits they deserve.
To prove that you are eligible to collect benefits through a Long Term Disability insurance policy, you must show that your injury or illness meets the definition of “total disability.” Although definitions can vary slightly between insurance companies, “total disability” means that a person cannot complete the duties of their job for the first two years of their disability. After twenty-four months, the definition of “total disability” changes to mean that you are no longer able to perform the tasks or duties of any job that you were previously suited for.
To prove that your injury or illness is a qualifying disability, you must submit a written statement from a doctor or physician that details the cause and extent of your injury. You must also present objective proof, which could mean X-rays, MRIs, surgical documents, or other medical records that prove your injury.
Am I entitled to Long Term Disability benefits?
Determining whether you qualify for Long Term Disability Benefits can be complicated. To do so, you must meet the test of “disability” for your situation, which can be found in your insurance policy contract. While most insurance companies have similar tests to qualify, you must look at your own specific policy.
Once you determine which disability test is applicable, you must present or gather medical documents that prove you meet the requirements. Unfortunately, doctors and health care providers don’t always complete disability certificates for insurance companies that are sufficient. So, once you have the documents from your doctor, inspect them to check the following:
- Do you think what is written will be sufficient to meet the disability test?
- Have all your disabilities been properly identified in the document? This can include mental, physical, and psychological problems.
- Does the document from your health care provider describe why you are disabled and incapable of working?
Sometimes you will have to go to a specialist in your field of disability to get the proper documentation for LTD Benefits. It can also be useful to provide your doctor or the specialist with a description of your occupation. This can help them determine which tasks you’re incapable of completing because of your disability.
Finally, it’s important that you meet all deadlines for your insurance company. Having a knowledgeable disability attorney on your side to help you determine eligibility and guide you through the process can be extremely helpful.
In this second part of a 3-part interview personal injury lawyer Brenda Hollingsworth describes what steps to take after an Ontario motor vehicle accident.
Get a FREE assessment from us here https://www.personalinjuryottawa.ca
Are you looking for expert advice after an accident? The smartest step you can take after any accident is to connect with a personal injury lawyer for a FREE consultation.
In Ontario, Canada, Personal injury lawyers Brenda Hollingsworth and Richard Auger with their team of experienced lawyers offer FREE, no-pressure, advice about your rights and entitlements when you have been hurt.
For more information on whether you have a claim for car accidents, motorcycle accidents, bicycle accidents, any other road accidents, accidents at work, slips and falls, etc, go to https://www.personalinjuryottawa.ca
The interview also discusses what information you should collect at the accident scene before you leave. Get the other driver’s name, address and driver’s license. Wait for the police if they have been called.
It is also important to get medical attention as quickly as possible. It is easier to prove your injury was caused by the accident if you see a medical doctor as soon as possible after the accident.
Requirements for receiving LTD benefits
Proving that your injuries or illness led to “total disability” is the most important factor for receiving benefits. However, there are some other steps you may need to take to receive LTD benefits from your insurance policy. They include:
- Not letting your insurance lapse while you are trying to receive disability benefits. Make sure you keep paying premiums to keep your insurance.
- In some instances, proving that the injury or illness was not a pre-existing condition.
- Proving that you were a full-time employee at the time your injury or illness occurred.
- Making sure that your injury or illness is not excluded from your insurance policy.
Since each insurance company has its own requirements for being eligible for Long Term Disability benefits, it’s best to have an attorney help you through the process.
Common reasons for denial of LTD claims
Any insured person who qualifies as having a “total disability” and who meets policy requirements for filing should be eligible to receive LTD benefits. Unfortunately, many valid claims are denied by insurance companies. Listed below are some of the most common reasons claims are denied in Ottawa:
- The claimant does not meet the eligibility requirements as outlined by their insurance policy.
- The claimant missed important deadlines when filing their claim.
- Not all documents were completed correctly.
- The claimant failed to provide the required medical proof to their insurance company.
- Other procedural or clerical errors were made.
You can avoid making mistakes on your claim by hiring an experienced disability insurance attorney to represent you. Attorneys know how insurance companies try to deny claims and will do everything in their power to make sure your claim is approved and you receive the benefits that you and your family need.
What Our Clients Say
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Contact our Disability Lawyers in Ottawa, ON today
The disability attorneys at Auger Hollingsworth understand how important disability benefits can be for you and your family. That’s why when you work with us, helping you receive your benefits is our number one priority.
We offer case evaluations for Long Term Disability Benefits, Short Term Disability Benefits, and Canadian Pension Plan Disability benefits. For a free consultation and assessment of your case, call us today at 1-888-574-4529 or contact us online.
For more information, visit one of our blog posts:
- De-Mystifying Long-Term Disability
- What’s the Difference Between Short-Term and Long-Term Disability?
- Do I Need Individual Disability Insurance If I’m Covered By My Group Plan?
- Want to Know More About How To Apply for LTD Benefits?
- What to Keep in Mind When Making an LTD Claim
- Want to Know What to Expect When You Hire a Disability Insurance Lawyer?
- Can an Insurance Company Follow and Videotape Me if I Made a Long-Term Disability Claim?
- I’m Receiving Long-Term Disability Benefits; Can I Still Work?
- I Suffer from Chronic Pain and Was Denied Long-Term Disability Benefits
- Is My Depression Considered a Disability?
- See lawyers Richard Auger and Brenda Hollingsworth talk to Jeff Hopper about your right to disability insurance in this video.
Long-Term Disabilities Denials FAQs
Long-term disability (LTD) occurs when a person is injured or sick to the point that he or she is unable to return to work.
LTDs can result from car accidents, slip and fall injuries, workplace injuries or any other type of serious accident.
It is at such times that people rely on insurance – but claiming rightful compensation and benefits for LTDs can be complex.
By their nature, long-term disability claims involve significant sums of money and, as such, many are denied. Denials of long-term disability claims can cause serious distress to families.
Whether you are facing difficulties in proving that you qualify for benefits or benefits have been stopped after a period, you may find some answers to your questions below.
If your application for long-term disability is denied or your benefits are stopped, you will be informed in writing by the insurer.
As part of your notification, you should be informed about how to “appeal” the decision. The key thing to bear in mind is that this appeal is not like a standard legal appeal held in front of a panel of arbitrators or judges. The decision will be made by the same insurance company (and maybe even the same group of people) that denied your claim in the first place.
This means that the success rate of such appeals is very disappointing.
Disability insurance is not all geared around long-term disabilities. It is important to know what type of policy you have and what you are covered for.
The main four types of disability insurance in Ontario are the following:
- Long-term disability insurance (LTD)
This is like income protection insurance. If illness or disability renders you unable to return to work, you will be paid a portion of your income. This can help with living expenses, medical treatment, rehabilitation, and so on.
Coverage is normally provided for two years, after which time you are expected to take up any occupation for which you are reasonably qualified (or could become qualified for). Failure to do so can see the withdrawal of long-term disability benefits.
- Short-term disability insurance
This is also a form of income insurance protection, providing income replacement if you are unable to work due to a medical condition or injury.
It is usually purchased by employers on behalf of employees but applies regardless of where an injury occurs – it does not have to be in the workplace. Payments are generally made only for the first 120 days of a medical issue.
- Critical illness insurance
Critical illness insurance covers you if you are diagnosed with a serious illness such as cancer, stroke, heart disease, heart attack and generally around 10-15 other serious medical conditions.
This cover is paid in one lump sum and is not dependent on whether you return to work or not.
- Disability mortgage insurance
If you become disabled and unable to earn an income, disability mortgage insurance ensures that you have the financial support to pay your mortgage.
It generally includes up to a certain amount every two weeks or month and limits on the duration of payments may apply.
With long-term disability denials, you can be informed that you do not qualify for benefits from the beginning or that you no longer qualify for benefits after a certain period.
Some of the most common reasons for denying claims include:
- Injury or condition not considered restrictive enough
You may be informed that your medical condition or injury is not considered serious enough to prevent you from going to work or is excluded from coverage as per the terms of the insurance policy.
Before accepting your claim, the insurance company will assess the limitations and restrictions caused specifically by your injury. The loss adjuster will decide whether your injuries are serious enough to prevent you from doing your job and this will largely depend on medical reports and the opinion of medical professionals.
- Lack of medical evidence
Some conditions (and their symptoms) such as psychological conditions, brain injuries or chronic medical conditions like fibromyalgia or chronic fatigue syndrome, have few visible symptoms.
Standard types of imaging diagnostics or blood tests do not identify such conditions and so evidence of symptoms must be documented in medical reports. Otherwise, the insurance company can deny your claim based on a lack of medical evidence.
- Material misrepresentation or non-disclosure
Insurance companies frequently attempt to void policies for material misrepresentation (providing incorrect information) or non-disclosure (not telling them key information), thereby invalidating a policy.
A good example might be a pre-existing health condition that should have been declared before the policy was set up.
- Failure to pay premiums
If your policy has lapsed due to non-payment of premiums, you may be ineligible for long-term disability coverage.
- A review of your case after surveillance
Some insurance companies hire private investigators to conduct photograph, video, and social media surveillance without the claimant’s knowledge. Within limits, this is legal and is done to try to catch claimants doing things that they say they can’t do (and therefore undermine their credibility and their claim).
As long as your claim is genuine and you have reported the truth, there is nothing to worry about. Surveillance will not help the insurance company.
However, if the evidence gathered contradicts your version of events, the insurer may deem you able to work and deny your claim or discontinue benefits.
- Breach of a rehabilitation clause
Most long-term disability policies have a rehabilitation clause.
This means that LTD benefits are paid as long as you get appropriate treatment for your condition from a qualified physician. Failure to do so may be deemed a breach of the clause and provide an excuse for the insurance company to terminate benefits.
If your long-term disability claim is denied, you can appeal but, for reasons covered in the question above, appeals rarely work.
Alternatively, you can hire a lawyer and make a legal claim against the insurance company.
Once we start the legal process, the insurer is forced to defend the legal claim, which incurs significant costs.
Often, the insurance company wants to avoid the extra costs associated with a court case (including legal fees and punitive damages) and will negotiate a settlement with the claimant out of court.
Taking legal action is, therefore, often a preferable course of action to lodging an appeal.
If an injury or medical condition prevents you from working or performing the tasks required by your current job, your long-term disability insurance policy should cover you regardless of the type of injury or condition.
Check your policy to see if it excludes certain illnesses or injuries compensable under a Workplace Safety Insurance Board claim through your employer.
Long-term disability policies vary in their terms but most last until 65 years of age and some have maximum periods for payment of LTD benefits, such as five or 10 years.
Most policies will pay up to two years if you are unable to return to your place of work (the own occupation test), after which you are expected to take up any employment in any occupation for which you are able.
If you can show that you are unable to work anywhere, benefits may continue according to the terms of your policy.
You have certain responsibilities during an LTD claim and these should be made clear to you in the approval letter you receive from the insurance company.
You must follow the responsibilities outlined or the insurance company may repudiate your policy and deny or discontinue coverage.
Generally speaking, these responsibilities include:
- Making best efforts to recover from your injury or condition – including following all medical advice
- Meeting with a rehabilitation consultant to prepare you for return to work and making best efforts to do so
- Making best efforts to abide by a return-to-work plan with modified duties
- Making best efforts to pursue benefits from other sources, e.g., Canada Pension Plan (CPP) Disability Benefits and to keep the insurer advised of progress
- Advising the insurer of any reportable income, e.g., CPP Disability Benefits, WSIB payments, severance payment, self-employment income, etc.
- Advising the insurance company of any overpayments made to you
- Advising the insurance company of changes to your health condition
If you have sustained injuries requiring long-term disability benefits and have been denied coverage in Ontario, start by discussing your case during a free case evaluation with a personal injury lawyer at Auger Hollingsworth.