Long-Term Disability Lawyer Niagara Falls

If you suffer severe injuries in an accident, develop a serious illness or any other medical condition, you may feel it’s like your life has been turned upside down. Sure, medical treatment will offer relief from muscle pain, ensure proper healing of broken bones, or alleviate symptoms of mental health disorders. However, you need financial compensation to cover your lost income and medical treatment.

After assessing your medical situation, your doctor may conclude that you’re totally disabled. The aftermath of such a diagnosis can significantly affect different aspects of your life. For instance, you may be unable to return to a job you once cherished or engage in activities you enjoyed before your disability.

Derek Wilson focuses on helping clients get the short-term or long-term disability benefits they deserve. We have a track record of helping resolve disability claims successfully. Therefore, if your ability to work has been negatively impacted by disease or injury, you can get ongoing disability benefits from your insurer as long as you are eligible.

Consulting skilled long-term disability lawyers allows you to understand your claim better and how various aspects of disability can affect it. Our law firm can also help you determine whether your condition meets your policy’s definition of disability. In addition to helping you build a strong claim, we will provide legal representation, handle negotiations with your insurer, and fight for your right to fair compensation.

What’s Long-Term Disability Insurance?

Long-term disability insurance is a crucial safety net for individuals who suffer from injuries or illnesses that prevent them from working. This insurance benefit provides financial support and stability by replacing a significant portion of your income when you are unable to perform your job duties over an extended period.

When an injury or illness initially occurs, your short-term disability insurance may kick in. This policy offers financial support for up to six months. However, if your condition does not improve, long-term disability insurance becomes essential. It typically replaces between 60% and 85% of your pre-injury income. This ensures a steady flow of income until you can return to work or, in some cases, until retirement age (65 years) if the disability is permanent.

Difference between Short-Term and Long-Term Disability Insurance

The main difference between short-term and long-term disability insurance options is the coverage period. Short-term disability benefits cover you for up to six months from the time of the incident that caused your injuries or the onset of your disabling condition. Note that specifics can vary depending on the insurance company and their LTD insurance plans.

Long-term disability insurance policies also vary widely depending on the insurance company. Disability benefits under these policies often begin after a waiting period of 3-6 months, and the monthly payments may last for years (depending on the nature of your disability). Note that the process of obtaining this compensation under long-term disability insurance is complex and takes time.

Insurance companies often try to reduce or deny disability benefits. That’s why you need dedicated long-term disability lawyers by your side. Our law firm is ready to help. All you need to do is schedule a free consultation with Derek Wilson.

Disability insurance, whether short-term or long-term, may be available through your employer’s group policy. Alternatively, you can acquire the same policies privately and still build a safety net that could replace your lost income if a serious injury or illness makes you unable to continue working.

 Can Long-Term Disability Benefits be denied?

Ideally, if you suffer from a disability and are unable to continue working, you should get the amount of compensation you are legally entitled to. However, your employer or insurance company may go out of their way to terminate benefits payments prematurely or deny your disability claim. In many instances, your insurance company may argue that the nature or severity of your injuries has been misrepresented or you provided insufficient medical evidence.

Here are the reasons insurance companies give for claim denials.

You are not “Totally Disabled”

The term “total disability” is often a point of contention in the assessment of long-term disability claims. Contrary to what the term might imply, one does not need to be in an extremely incapacitated state, like being paralyzed or in a coma, to be considered “totally disabled.” Even chronic pain and mental health issues could cause long-term inability to work.

Note that the total disability term is meant to indicate that an individual is unable to perform substantial duties of their occupation (own occupation) or any other job for which they are qualified through education, training, or experience (any occupation). If the insurer’s doctor issues a medical opinion that contradicts your doctor’s disability assessment, this could lead to claim denial.

Insurance companies may use the complex definition of “total disability” to deny long-term disability benefits. They may argue that if you can perform any tasks related to your previous work or any other job for which you are qualified, you do not meet the criteria for being “totally disabled.” This perspective can lead to the denial of benefits, even when you are genuinely unable to sustain regular employment due to your condition.

Insufficient Medical Documentation

To build a strong long-term disability claim, it’s essential to have comprehensive and supportive medical records. Without comprehensive medical evidence, your claim will be denied. Here’s how to ensure you have sufficient medical evidence to support your claim.

Adhere to the Recommended Medical Treatment

Consistent visits to your healthcare providers are fundamental. For psychiatric conditions like depression or anxiety, monthly consultations with a psychiatrist or psychologist are advisable. For physical impairments, doctor visits should occur according to your doctor’s recommendations. They should be accompanied by objective evidence such as tests, X-rays, MRIs, or CT scans. These documents are tangible evidence that could prove the severity of your health condition.

Detailed and Complete Medical Records

Ensure your LTD insurer has all your relevant medical records associated with your injury or illness. In some cases, long-term claims are denied simply because the insurance company doesn’t have all the necessary medical documentation.

Therefore, it’s in your best interest to work with Niagara Falls LTD lawyers to proactively verify with your insurer which records have been received and which are missing. This will help ensure any gaps in your medical information are filled promptly.

Get Supportive Doctor’s Statement

A detailed statement from your treating physician can be a decisive factor in your disability claim. This statement should elaborate on how your condition impairs your ability to work in your ‘own occupation’ and ‘any occupation.’ It must establish a direct link between your limitations and the medical information provided.

Instead of using standard forms provided by insurance companies, which may be designed to undermine your disability claim, request a comprehensive letter from your doctor. Work with skilled and dedicated long-term disability lawyers like Derek Wilson to gather all forms of medical evidence required to get your long-term disability benefits approved.

Video Surveillance Inconsistent with Your Disability State

Video surveillance is a tactic that insurance companies may use to verify the validity of long-term disability claims. When you file a claim for LTD benefits or are already receiving these benefits, be mindful that insurers might conduct surveillance to ensure that the level of disability you claim aligns with your daily activities. If video evidence shows you engaging in activities that contradict your stated limitations, it could lead to the denial of your claim or the termination of your benefits.

Seek Legal Counsel

Long-term disability benefits claimants need to seek legal help to handle everything related to their disability claim. Sure, an insurance company will make you believe that claiming benefits under long-term disability policies is a straightforward process. However, the same insurance company will scrutinize your claim to find reasons to deny it.

Your best chance to protect your right to fair compensation is to consult the leading Niagara Falls disability lawyers. Derek Wilson is a dedicated lawyer who relentlessly fights for his client’s right to disability benefits.

Fighting an LTD Claim Denial

When you purchase an insurance policy and pay the expected premiums, you are paying for ‘peace of mind.’ The reality is that your insurer may sell you ‘peace of mind,’ but their objective is to make money like all other companies. They make profits by selling insurance policies and make more profits by reducing or not paying disability claims. That means many eligible claimants find themselves having their applications ‘investigated’ for extended periods or wrongfully denied.

Instead of getting the financial protection and peace of mind they have been paying for, they get stress, anxiety, sleepless nights, and conflicts. Derek Wilson can help if your long-term disability claim is denied. He is a highly experienced long-term disability lawyer who knows how insurance companies work. Therefore, if your insurance company terminates your benefits or your claim has been under investigation for a long time, schedule a free consultation with Derek.

What to do After LTD Benefits Have Been Denied?

If an insurance company has denied disability benefits, here’s what you should do.

First, Hire a Long-Term Disability Lawyer

Thousands of Canadians get claim denial letters each year, so these denials are common. This is why disability lawyers come in to support the claimants and facilitate the claim appeal process. The lawyers have a long history of providing legal representation for people pursuing long-term disability claims.

As such, they’re familiar with the industry jargon, any exception to the Limitations Act, how the disability law works, and the common reasons insurers deny LTD claims. This level of experience offers resource-rich support for people whose claims have been denied or who intend to file disability benefits claims.

Remember, it’s never too early to hire a long-term disability lawyer. Therefore, schedule a free consultation with Derek Wilson, and you will get the support you need to navigate the complex legal system and process of getting long-term disability benefits.

Strengthen your Long-term Disability Claim with Credible Evidence

Before you start the appeals process, our law firm will assess the reasons your claim was denied and determine whether your disability case meets the eligibility criteria. Our long-term disability lawyer will also assess the information provided in your initial claim application and identify gaps that may have led to improper assessment of your claim.

Comprehensive Medical Evidence

Note that your lawyer may hire independent experts to compile the necessary functional capacity report, medical expert report, and vocational expert report to prove your total disability. Furthermore, these expert assessments can help fill gaps in your medical records. Keep in mind that disability lawyers can order further medical assessments, get written opinions from your physician, and acquire testimonies from non-medical professionals. These non-medical experts may include a family member, vocational expert, co-worker, or even a friend.

Vocational experts can be helpful if your long-term disability insurance cover is an ‘any occupation’ policy. Under such a policy, ‘disability’ is usually defined as being unable to work or handle any job tasks for which you may be qualified through training, education, or experience. Derek Wilson can help prove your total disability and ensure you get the benefits you are legally entitled to.

Skip the Internal Appeal

Sometimes, engaging your insurer’s internal appeal system may be a waste of time. While all insurance policy providers are legally required to offer a claim appeal process, no formal guidelines are in place for these appeals. If the process takes an extended period, it can mean that you will miss other deadlines for possible external appeals like a lawsuit.

Derek Wilson is one of the dedicated disability lawyers who can provide reliable advice on whether to skip the internal appeal or not. We will assess the reasons for the initial benefits denial and determine the chances of getting favourable outcomes through an internal appeal.

When do Internal Appeals Make Sense?

Perhaps it sounds like a no-brainer to ignore internal appeals and file a lawsuit against your insurer. However, there are times when an internal appeal makes sense. If your claim was denied because you missed a physician’s appointment, you can attend the appointment and appeal your insurer’s decision to deny you benefits.

Sometimes, a claim may be denied because the insurance provider needs clarification from your doctor. Once the necessary information is provided, you can successfully appeal your claim. Note that Derek Wilson and his team will assess the information provided in your claim denial letter and advise accordingly.

Commencing an Action in the Courts

To start an external appeal simply means ‘start an action.’ Essentially, you will be taking your claim denial appeal outside the domain of your insurance company and involve a neutral third party. This may be necessary if the reason for claim denial cannot be fixed through your insurer’s internal appeal process. Keep in mind that you need an experienced and knowledgeable long-term disability lawyer if you intend to file a lawsuit against your insurer.

Just think about it; your physician has examined you and provided a detailed medical report. Then your insurer orders another medical exam through their doctors. If the insurer’s medical report contradicts the one your physician provided, there’s no turning back. Your claim will be denied.

Further, there’s no getting around technicalities with insurance providers. For instance, if your insurer argues that your total disability is a result of a pre-existing condition, you need more than just medical records to successfully appeal your claim denial. Therefore, work with your long-term disability lawyer to file a lawsuit against your insurer.

The Role of Derek Wilson – LTD Lawyer

You are probably not fluent in disability insurance lingo, and you will have a hard time deciphering your LTD insurance policy. Further, it’s easy to misunderstand your rights in such circumstances. Derek Wilson is an experienced disability lawyer who can help you understand the full extent of your responsibilities and rights.

With Derek and his team on your side, you can acquire the credible evidence you need to prove the existence of a disabling health condition. We will acquire and compile your medical records, employer statements, physician statements, and other forms of evidence that can support your claim or successfully appeal your insurer’s denial. Indeed, Derek is an LTD lawyer who prioritizes clients’ well-being and has handled many disability cases successfully.

If you have been looking for a dedicated Niagara Falls lawyer to help you take court action against your insurer, schedule a free consultation. Derek and his team offer free consultations to prospective clients. Furthermore, we implement a contingency fee policy. That means you don’t need to pay money upfront like most LTD lawyers require. Therefore, don’t worry about the hefty legal bill associated with LTD claims. You will pay legal fees after we win your case.