Being injured and unable to work is itself overwhelming enough. You may be in pain, trying to stay on top of medical treatments, and may be worried about how you’ll pay the bills. Having long-term or short-term disability benefits through a group plan or your workplace can offer some peace of mind, but these benefits do require you to apply, and the application process can be complex and overwhelming.
It’s no surprise that many hard-working Ontarians with legitimate claims make mistakes when applying for disability. The policies and application paperwork for short-term and long-term benefits are complicated, and there are many potential pitfalls.
Read on to find out the common disability mistakes that could get your claim denied—and how you can avoid these challenges. Should you find your claim denied or if you find your insurer or employer is trying to insist you return to work, even while you’re too injured, contact Derek Wilson Injury and Disability Lawyer for a free consultation?
Missing Deadlines
It’s easy to lose track of time when you’re injured or dealing with a serious diagnosis such as cancer. Nevertheless, one of the common disability mistakes employees make is to miss crucial deadlines when applying for short-term disability or long-term disability benefits.
To make matters more complicated, there are multiple deadlines to contend with. There are deadlines the insurer sets for applying for benefits, for taking legal action, and for providing more information for your claim.
Always ask for clarification if you’re not sure about deadlines. Both the insurer and your employer should have clear instructions for you to follow. Write down deadlines in a calendar and even set notifications on your phone so you’re alerted of upcoming deadlines related to your claim.
Not Gathering Evidence
One of your biggest allies when you file a disability claim is your doctor. A doctor will provide an Attending Physician Statement, which tells the insurance company details about your condition and why you can’t work. Your application may also include additional medical documentation, including lab results and imaging tests, to prove your disability.
However, when seeking to prove your disability, keep in mind that your doctor may not have much time to spare for your claim. Most doctors in Ontario work overtime, and almost three-quarters of medical professionals who are polled report experiencing burnout. Your doctor may be overwhelmed and overworked and may not be able to devote extensive time to visits with you or to your paperwork.
In addition, you might be one of the more than 6.5 million Canadians without regular access to a nurse practitioner or family doctor, you may be facing delays in even getting medical care for your disability. You may need to rely on walk-in clinics or may work with medical professionals who aren’t familiar with your medical history.
In either situation, it can be useful to start gathering evidence yourself. You might want to:
- Take photos of your injuries and date them, being sure to take photos from different angles and over time.
- Keep a dated journal of your symptoms and how they have affected your daily life and ability to work.
- In your journal, keep detailed notes about doctor’s appointments, including any treatments you’re trying, the dates and times of your appointments, any diagnoses you’ve received, and any information your doctor shares with you.
- In your journal, keep track of the instances, times, and severity of your symptoms.
- Write down anything that seems significant about your disability or injury.
- Keep receipts of any medication or medical devices you need to use.
While this information can’t be submitted to insurance companies directly and used as evidence in your claim, it can help you communicate with your doctor. You can bring in your journal, outlining your symptoms and what you talked about at your last appointment, so your doctor can quickly see at a glance what your history with your disability is like.
Your doctor may use the information you bring to accurately diagnose you. He or she may even use it to create the Attending Physician Statement sent to the insurance company. Since doctors are so busy, it’s possible that your description of your symptoms will end up being the one used for the Attending Physician Statement.
Gathering your own evidence of your disability is also useful for you when it’s time to file a claim for benefits. When you apply, you can refer back to your notes to make sure you present an accurate picture of your disability — one that corresponds to the details your doctor shares with the insurer.
In addition to gathering your own evidence, you may also need to gather additional hard evidence of your disability. The insurer may request additional evidence when reviewing your claim, for example, or you may choose to submit additional evidence when seeking benefits to build a stronger case. Here are some of the types of evidence which insurers may accept:
- Lab test results
- Imaging tests, including MRIs and X-rays
- Medical records of hospital visits and visits to doctors and specialists
- Treatment records, which outline the treatment recommended for your condition, your compliance with the treatment, and the outcomes of any treatment
Your doctor will need to refer you for tests or agree to give you copies or records (or send the records to insurance companies directly). But keep in mind that groups like the Canadian Health Coalition recommend that Canadian patients remain persistent and follow up to make sure they’re heard in an overwhelmed system.
To navigate the healthcare system, start by asking your doctor and medical team if they think you will need to miss work because of your medical condition. If they don’t think you’ll need to lose work, it will be hard to prove eligibility for disability benefits.
In addition, keep following up. If you’re waiting for a referral for a test or a specialist, call the doctor’s office after a few weeks to follow up. If your condition isn’t getting better or your symptoms are getting worse, visit the doctor again. Feel free to ask whether a specific treatment or test might help you. You should feel able to speak up and make sure you get quality medical treatment.
Not Being Persuasive with Your Disability Story
You probably don’t think of your disability as a “story,” but in a way, that’s what insurers are looking for. They’re looking for a consistent and very persuasive narrative that basically leaves them with no choice but to say “yes” to giving you short-term or long-term disability benefits.
If you’re keeping your own evidence of your disability and working with healthcare professionals, you’ve taken the first steps to create your claim. You’re building a description of your disability and symptoms, including how they impact your ability to do daily tasks and your job.
You will want to review the description of your symptoms and make sure they make sense. For example, if you couldn’t walk initially but then could walk a bit but then faced complications that affected your mobility, make sure it’s clear why your condition got worse.
Medical conditions and disabilities can change over time, and this can create unfortunate situations where an insurer may try to pressure you to return to work. With a long-term disability, for example, insurers usually have a provision in their policy that allows them to change the definition of disability from “own occupation” to “any occupation.”
What this means is that during an initial period—usually two years—you will qualify for disability benefits as long as you can’t perform your own occupation. After the period set out in the policy, however, you only qualify for benefits if your disability prevents you from doing “any occupation,” which includes jobs outside your current role.
This change in narrative can pressure you to return to work before it’s safe to do so—and before your doctor clears you for work. In addition, while some employers may be able to offer you desk duties or another position, some may not be able to accommodate your injury. In a situation where your benefits may be terminated, or you may need to return to work before you’re cleared, you may want to talk to a disability lawyer who can explain your rights and help you fight back if the employer or insurer is acting in bad faith.
Exaggerating Your Disability
Most people intend to be honest when filing a disability claim, but it’s easy to make a simple mistake. You could indicate that you can’t pick up any heavy item, but what you mean to say is that on most days, you can’t pick up an item that is over 30 pounds.
Insurance companies will carefully look at your version of your injury and compare it to any medical documentation you submit. Most insurers will even check your social media accounts and will hire private investigators to make sure you haven’t exaggerated your disability.
For these reasons, you want to be accurate and completely honest when describing your disability to insurers. You might also want to avoid taking part in any activities or social media chats that make you seem less injured. Remember that even if you post an older photo of yourself on vacation or at a party, an insurance company may use that to deny a claim or try to claim that you’re well enough to return to work.
Not Receiving Treatment
One of the commonly made mistakes when applying for disability has to do with not getting adequate treatment. Unfortunately, some individuals try to “tough it out” and avoid prescribed treatment. Some patients disagree with a prescribed treatment or suffer serious side effects and don’t want to comply with the treatment. Any of these decisions could be costly mistakes.
Getting medical treatment is important for two reasons. First, it addresses your medical condition and increases the odds you will recover or be able to manage your symptoms effectively. Secondly, it gives insurers one less reason to deny your claim or stop your benefits.
Most disability policies require you to get “ongoing care” to qualify for benefits, but not all policies define what kind of care you need. If your insurer feels you haven’t been receiving appropriate care, if you don’t comply with your treatment plan, or if there are gaps in your care, these can all be reasons for an insurer to deny you your rightful benefits.
Contact Us for a Free Consultation
Anyone can make mistakes when applying for benefits, but a simple error shouldn’t cost you the benefits you may rely on. If you’ve received a denial letter or if your insurer or employer is trying to persuade you to return to work when you know you’re not healed, talk to a disability lawyer about the process of appealing and about any options you might have.
In Hamilton, Niagara, Welland, and surrounding areas, you can always call Derek Wilson Injury and Disability Lawyer for a free consultation. At my firm, you always speak with me, Derek Wilson, never a junior lawyer. I’m always honest and transparent about what’s possible in your case and what you may be able to do. Bring in your denial letter when you come in to talk to me, and we can review it together. I have more than 25 years of experience helping countless people in Hamilton and the surrounding areas. I have helped reinstate people’s benefits and have ensured hard-working employees get the benefits they’re entitled to. Disability insurance and personal injury is my law firm’s sole focus, so when you work with me and my team, you’re working with a legal team who understands how to get you your benefits. Contact me today and let’s talk about how I might be able to help.