Long Term-Disability Lawyer Guelph

A disabling illness or injury can strike at any time, and if it does then hopefully you have disability benefits available to you, either as offered through your employer-sponsored LTD policy or a private policy you purchased. Your expectations are that the insurance company will fulfil its contract with you and provide financial assistance (disability benefits) to cover your lost income when you can no longer work due to disability.

However, this doesn’t always happen which is why long-term disability claim denials are common. If you plan to file a disability claim, schedule a free consultation with Derek Wilson. He is a reputable disability lawyer who understands disability law and the subtleties of contract law. Derek and his experienced team are your best chance at getting fair compensation from your insurance company.

Disability Insurance in Guelph, Ontario

Also known as disability income insurance, disability insurance covers Canadians for loss of income due to disabilities. A disability may be caused by but not limited to a number of illnesses such as psychological disorders, physical injuries, and even chronic pain. This insurance coverage may be available under government plans, group employer programs or private plans.

For instance, Workplace Safety Insurance, Employment Insurance, and Canada Pension Plan are some of the insurance plans under federal or provincial governments. Whereas, private disability plans may include private individual insurance coverage and employer-provided group disability coverage. The latter provides the following policies:

Short-Term Disability Insurance

This policy covers the loss of wages or income for a limited period (up to six months) after your sick leave benefits run out. The disability benefits available under this policy are often paid for by your employer and included in your policy. If your employer doesn’t provide short-term disability insurance, you (the employee) can look to employment insurance (EI) for sickness benefits.

Long-Term Disability Coverage

Your long-term disability insurance will kick in after your short-term policy or EI sick benefits run out. These benefits often replace 60% to 70% of your income and are paid for an extended period, usually up to two years, if you cannot work at your regular job (your own occupation).

After two years, your insurance provider will require another assessment of your health condition to determine if you can work at any job for which you are reasonably suited by your education and experience. If you cannot handle substantial duties at any job that you are suited to through training, experience, or education, you will be considered totally disabled. That means you could potentially continue to receive long-term disability benefits until you reach retirement age, generally speaking, this is to age 65 but it would be defined in your policy.

Skilled and knowledgeable disability lawyers like Derek Wilson can help you understand your insurance policy. We will notify you of all relevant deadlines, guide you through the claim application process, and represent you during settlement negotiations with an insurance company. With our legal support, you can get the compensation you are entitled to.

Can Disability Claims be denied?  

Companies that provide long-term insurance have a legal duty to the policyholders to always act in good faith and honour all legitimate disability claims. However, this is not always the case. An insurer may make the entire process of getting compensation challenging by constantly requesting records, forms, or additional medical evidence.

Other insurance companies often raise concerns about claimants’ medical conditions and assert that they may be exaggerated. Unless you seek help from experienced Guelph disability lawyers, there’s a good chance you will get a denial letter stating the reasons that your claim has been denied or terminated. Here are the reasons insurance companies deny LTD claims.

Claim Application Errors

Errors, incompleteness, or delays in filing long-term disability claims can lead to denial. It’s essential to double-check all the information provided, ensure that no sections are left blank, and adhere to all deadlines. An application that is accurate and complete lays a strong foundation for your claim. Also, ensure you submit it on time.

Missing or Insufficient Medical Evidence

Medical documentation is the cornerstone of a long-term disability claim. Claims often get denied if there is no sufficient medical evidence to substantiate your disability. It’s not enough to simply state that you are unable to work. This statement must be backed by comprehensive medical records, diagnostic test results, and detailed statements from healthcare providers.

These documents should demonstrate how the condition impacts your ability to perform your job duties. This underscores the importance of seeking immediate medical attention after an injury or onset of your disabling condition. You must adhere to the recommended treatment, attend all therapy sessions, and take all the prescribed medication. Failure to follow a physician’s treatment recommendations could give an insurance company a reason to deny your claim.

Not Meeting the Insurance Policy’s Definition of Disability

Insurance policies have specific criteria for what constitutes a “disability.” You must understand these definitions as outlined in their insurance plan. Some policies may define disability as the inability to perform the duties of one’s ‘own occupation.’ Others may refer to ‘any occupation’ for which you are qualified. If your medical does not align with these definitions, the claim is likely to be denied.

Video Surveillance that Contradicts Your Disability State

Insurance companies sometimes employ investigators to conduct video surveillance of claimants. If the footage shows the claimant engaging in activities that contradict their state of disability, this can lead to a denial.

Similarly, insurance companies may monitor the claimant’s social media activity. Posts that show the claimant performing physical activities or discussing aspects of their life that are inconsistent with their claim can be used against them.

Seek a Lawyer’s Help

Securing long-term disability benefits can be a complex and demanding process. Sure, there are legitimate reasons insurance companies deny disability benefits. However, it’s important to know that claim administrators and company lawyers work for the insurance company and often present an inherent conflict of interest if they tell you that they can help you.

That’s why a claim may be denied even when you are suffering from a disabling health condition and qualify for LTD benefits. Because the Ontario disability law is complex, our law firm – led by Derek Wilson – can help avoid the mistakes that could lead to claim denial. Over the years, we have worked diligently to help our clients access the money (compensation) they deserve. This way, they can ensure financial security even when they cannot work due to illness.

Fighting an LTD Claim Denial

Suppose you have been receiving long-term disability benefits, and your payments have been terminated, or your claim for LTD benefits has been denied. In that case, your insurance provider will notify you through a claim denial letter that details the reason for the denial. If you don’t receive this letter, ask your insurer to provide you with one.

Facing a long-term disability claim denial can be disheartening, but it’s not the end. You have the right to appeal the decision. This process allows you to address the issues that led to the initial denial. Here are your options:

First, You Need a Lawyer

Navigating the complexities of a long-term disability claim denial can be overwhelming. In such challenging times, enlisting the competence of long-term disability lawyers can be a game-changer. Disability lawyers have the knowledge and experience necessary to challenge the denial effectively and advocate for your rightful benefits.

Therefore, contact Derek Wilson – a reputable Guelph disability lawyer. His law firm can carefully review your claim, scrutinize the insurer’s reasons for denial, and identify any potential oversights or errors. With our deep understanding of disability law, regulations, and the nuances of the insurance industry, we can craft a plan on your behalf to get you the compensation you need.

Our negotiation skills are invaluable, especially when dealing with insurance companies that may use complex tactics to minimize payouts. A disability lawyer not only elevates your chance of overturning the denial but also ensures that your rights are protected throughout the process. Remember, the competence of long-term disability lawyers directly affects your case outcome. Let our firm help you get the compensation money you are entitled to under your long-term disability coverage.

Understand the Reason for your Claim Denial

After receiving a denial letter from your insurance company, it’s crucial to delve into the specifics of the denial. This initial step involves a thorough review of the denial letter and any associated documents provided by the insurer. The letter should detail the reasons for the denial, which could range from insufficient medical evidence to policy exclusions or even procedural discrepancies.

If the denial is communicated verbally, insist on obtaining this information in writing. Written documentation serves as a record that can be carefully analyzed and referenced throughout your appeals process. It provides an unambiguous explanation of the insurer’s decision, which is essential for challenging the denial effectively.

Gather Credible Evidence to Support your Case

Your first application for disability benefits has been denied, and you need detailed and credible evidence to challenge that decision. That’s why you need a lawyer, especially when it comes to gathering and presenting strong supporting evidence. A disability lawyer can guide you in collecting essential documents and statements that bolster your case. They understand the type of evidence that resonates with insurance companies and appeals boards.

For instance, a detailed statement from your physician can be a game-changer. Lawyers know how to collaborate with medical professionals to ensure that such statements not only detail your condition but also show how it impairs your work capabilities. This way, you can directly counter your insurer’s reasons for denial.

Further, if you’re consulting multiple healthcare providers, our law firm can coordinate a coherent collection of medical opinions, ensuring that each contributes a unique perspective to comprehensive information about your disability. Also, we will identify and rectify any gaps or weaknesses in your medical documentation. This can enhance the persuasiveness of your case.

File a Legal Claim

Your insurer will indicate in the denial letter that you can appeal their decision within a certain period (usually 30 days). In our experience, such appeals take time and will likely send you on a wild goose chase. Essentially, you are appealing to the same insurance company that decided not to approve your application for disability benefits. While you are preparing your internal appeal paperwork, the clock is ticking on your 2-year limitation which starts from the date on your first denial letter!

This is the main reason we advise our clients to skip the internal appeal process and take legal action (lawsuit) against your insurer. This will prompt the insurer to either offer you the benefits you deserve or commit resources to fighting your claim in court. The latter comes with a significant cost because experienced lawyers are never cheap.

Derek Wilson Personal Injury Lawyer and his experienced team will provide the legal representation and competence you need to file an LTD benefits claim in court. We will tell your story and present credible evidence on your behalf to ensure you get a fair settlement.

Schedule a Free Consultation

If you suffer from a condition or injury that makes you unable to continue working, you may be entitled to LTD insurance benefits. Contact us today. Derek Wilson is an experienced Guelph disability lawyer who offers assistance to clients pursuing long-term disability benefits. Remember, we provide our services on a contingency fee basis. That means you don’t need to pay upfront.