If you are suffering from a serious medical condition or injury and are unable to work, you may be eligible to collect long-term disability benefits. These benefits act as an income replacement to help protect you from financial uncertainty. Your employer may provide disability benefits through a group insurance plan, or you may privately purchase disability insurance. Depending on your policy, you may be entitled to receive 60% to 70% of your income if you meet the eligibility criteria of your insurance company.
You should familiarize yourself with your provider’s long-term disability policy to see if your condition is covered. Usually, any medical issue or injury that prevents you from working should be included. Specific plans will outline which types of disabilities are covered and which are not. There are plans that only cover accidents, and there are often exclusions placed on the kind of accidents or injuries covered.
Another essential factor to consider when determining eligibility will be if you have suffered a workplace accident or have a pre-existing condition. Workplace accidents can also be subject to workplace compensation, which can impact the coverage you receive.
Pre-existing conditions can often be excluded from disability insurance. These exclusions will vary depending on the type of coverage and plan you have, but it is typical for plans to exclude conditions you recently received treatment for before enrolling in your plan.
The difference between short-term and long-term disability is the length of time they are available. Short-term disability is for those unable to work for a short period, usually 6 months or less. In these cases, 70% of your income is generally replaced. These benefits will kick in after a waiting period, which is usually when your sick days have been used up.
Long-term disability is for individuals who cannot work for extended periods. Plans are highly variable on how long these benefits will be paid. Plans may provide coverage for several years or until you reach a specific age. The waiting period is also usually longer with long-term disability and can be anywhere from 3-6 months.
It’s not just physical conditions that are covered under many LTD policies. Mental health issues are covered by many policies as well, accounting for nearly 30% of disability claims in Canada. Consult your insurance company’s policy to see if your condition is covered, but some issues frequently covered are:
Your claim often depends on your ability to demonstrate that your condition prevents you from working. Consider reaching out to our Medicine Hat long-term disability lawyers to arrange a free initial consultation.
While you should consult your insurance plan to see what your long-term disability benefits application will entail, some steps are common across different providers.
After determining your eligibility, you should consult a doctor regarding your impairment. Medical attention is one of the most critical steps in a long-term disability claim. Your doctor or treatment provider will work with you to determine the severity of your impairment and the impact on your ability to work. Gathering medical documents is an essential step in determining the success of your claim.
Long-term disability claims generally have three key components. An application form, reports from your doctor, and reports from your employer. These completed forms will have to be submitted to your insurance company and will explain your disability, your employment, and the details of your claim. A representative from your insurance company may conduct a phone interview and possibly an in-person assessment as well. Make sure to participate in every step of the evaluation. The sooner these steps are completed, the sooner your insurer can begin the decision-making process.
After going through a lengthy application process and providing adequate proof of your injury or medical condition, you may be waiting 8 weeks for a decision from your insurer. You may be struggling to keep your finances under control while you wait and in the end your claim could be denied. Receiving a denial can be unnerving and dispiriting. It’s important that you read your denial letter carefully to understand the reason for the decision. Some recurrent reasons that long-term disability benefits claims are denied are:
When you cannot work due to an illness or injury, it can feel like your life has been turned upside down. Long-term disability benefits should be here to help you, and being rejected from a claim can only add more stress to your recovery. For many Medicine Hat locals, these benefits may be their only option for income replacement. If your claim is denied, you may want to dispute the decision.
Our legal team may be able to assist. We have significant experience with claims like yours and we are familiar with the tactics often used by insurance companies. If you are eligible to file a dispute, we may be able to help recover denied benefits plus additional costs such as interest on loans. To learn more, book a free initial consultation today.
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