Long-Term Disability Lawyer St. Catharines

If an illness or injury has made you unable to handle substantial duties related to your work, you may be eligible for disability benefits under your long-term disability insurance contract. To access these benefits, it’s recommended to consult a skilled disability lawyer in St. Catharines.

Under normal circumstances, you can work and care for your loved ones, however, this ability can be significantly compromised by serious illness, permanent injury, chronic pain, or any other disabling health condition. Ideally, your LTD insurance policy should cover 60% to 85% of your pre-disability income and ensure financial security.

However, there are times when insurance companies can deny applications for these benefits. That’s why you need to work with an experienced St. Catharines disability lawyers like Derek Wilson.

Eligibility for LTD Benefits

Long-term disability coverage is available either through a group policy provided by your employer or a private policy you purchased. If you have such insurance coverage, there are important aspects you must review to understand your eligibility for disability insurance benefits when a disabling illness or injury strikes. That means your long-term disability policy has requirements that you must meet to be eligible for disability benefits.

Own Occupation

To be eligible for LTD benefits, you must be unable to handle substantial duties associated with your pre-illness job. If your condition meets this requirement, you may start getting disability benefits for the first six months (short-term disability insurance benefits). Afterwards, your LTD policy will kick in.

Any Occupation

Most LTD insurance policies have a change of ‘disability’ definition after a certain period (usually two years). The insurance company will be more concerned about whether you can perform responsibilities under your ‘own occupation’ or ‘any occupation’ for which you are suited through experience, education, or training.

This is the strictest eligibility requirement for long-term disability benefits. You must have suffered a serious injury, illness, or total disability that prevents you from working in any profession you may be qualified for. If your medical condition meets this requirement for total disability, you will be considered totally disabled. You will generally continue to receive benefits payments until you are 65 years old.

At Derek Wilson Personal Injury Law, we know how insurance providers work and the nuances with disability contract law. We will focus on acquiring the information needed to prove your total disability and receive the maximum possible benefits payouts. We will leverage our disability law knowledge, extensive experience, and network of professionals to build a disability claim backed by factual evidence rather than assumptions.

Can a Disability Claim be denied?

We have seen LTD claims wrongfully denied by insurance companies because of technicalities. Here are the reasons your long-term disability claim may be denied.

Insufficient Medical Evidence

Insufficient medical information or evidence can significantly impact the outcome of a disability claim, often leading to denial. When your case manager mention a lack of objective evidence, they refer to the absence of concrete, reliable evidence—like x-rays, laboratory results, and MRIs—that can substantiate a diagnosis of physical or mental health conditions. Such cases become challenging when an insurance company demands such evidence, even if the policy doesn’t explicitly require it.

Two types of medical evidence can back your LTD claim. These include objective and subjective. Objective evidence includes tangible, measurable data such as scans and test results, while subjective evidence covers a patient’s reported symptoms like pain or fatigue. Insurance providers often give more weight to claims backed by objective evidence, even though subjective symptoms are real experiences for disability claimants.

We can help you build your case by working with your health care team and ensure all the appropriate documentation is submitted to your disability benefits carrier. Remember, our knowledge, thorough documentation, and reliable legal advice are key to navigating the complexities of insurance claims. We will provide the support you need to overcome the hurdles posed by your insurer’s strict requirements.

You Failed to Disclose a Pre-Existing Condition

A pre-existing condition means a health issue or symptoms that were present at a certain period before the insurance policy took effect. Insurance companies carefully review medical histories to identify treatments or diagnoses that occurred during a specified exclusion period (often 12 months). Then they use it as grounds for claim denial.

Long-term disability policies usually have specific clauses that limit or exclude coverage for conditions that existed within a defined period before the policy began. This period is known as the “pre-existing period.” This period ranges from six months to two years. If no treatment was sought or received for the health condition during this period, the insurer may not have a valid basis for claim denial.

For policyholders, it’s crucial to understand the specifics of these pre-existing condition clauses and how they apply to their situation. It’s also crucial to engage a disability lawyer who can clarify such clauses and determine whether it could be a legitimate reason to terminate benefits payments or claim denial.

If a claim is unjustly denied based on a pre-existing condition, our law firm can help you in appealing the decision and advocate for the disability insurance benefits you deserve. Remember, we have a dedicated lawyer and a team that will restlessly advocate for your right to fair compensation.

Improper Medical Treatment

Proper medical treatment is the cornerstone of securing and maintaining long-term disability benefits payments. Disability insurance policies universally require beneficiaries to undergo the appropriate and ongoing medical treatment to continue receiving benefits. However, the definitions of “appropriate” and “ongoing” care can be ambiguous and leave room for interpretation, often to the disadvantage of the policyholder.

Insurance companies may scrutinize the type of medical care you receive. Sometimes they may challenge the legitimacy of certain medical experts or the treatment methods they use. If an insurer deems the medical care inappropriate or inadequate, it may use it as a basis to deny a disability claim.

Therefore, it’s crucial to follow your healthcare provider’s recommended treatment plans. Ignoring medical advice or failing to engage in a prescribed treatment regimen can lead to the termination of benefits. Your insurer may argue that non-compliance with treatment indicates that the condition is not as disabling as claimed or you are not making sufficient effort to improve your health condition.

Evidence that Contradicts Your Disability Limitations

Insurance companies are vigilant in their efforts to verify the authenticity of claims. They often employ private investigators to gather additional information about claimants. These investigators might observe, follow, and record your daily activities, aiming to find any discrepancies between your reported limitations and your actual physical abilities.

In addition to physical surveillance, digital investigations are becoming increasingly common. Insurers can use such specialists to analyze your social media activities and online presence to assess your lifestyle and capabilities. Social media posts, pictures, or videos that depict physical activities or engagements that conflict with the limitations you have claimed can be used against. This can harm your claim.

Remember, you still need the help of highly experienced long-term disability lawyers to improve your chances of getting the compensation amount you deserve. Our law firm prioritizes the interests of our clients and protects their rights. Therefore, schedule a free consultation. Our long-term disability lawyer will assess your disability case and guide you through the legal journey of obtaining the benefits you deserve.

Fight for your Denied Disability Insurance Benefits

Cases of denied disability benefits are quite common in Ontario. Therefore, if your disability insurance benefits were wrongfully denied, consult Derek Wilson. He is a knowledgeable St. Catharines disability lawyers who can successfully challenge a disability claim denial. Here’s what you should do.

Get your Claim Denial Letter

This document contains essential details about the claim denial, including the definition of “disability” according to your long-term disability policy, the reasons for denial, and key dates. In Ontario, for example, the denial date starts the clock on a 2-year limitation period for legal action against an LTD insurance company.

It’s also important to be aware of any deadlines for submitting additional information or for legal actions. Missing these deadlines can jeopardize your chances of overturning the denial. That’s why it pays to have dedicated long-term disability lawyers who can help you navigate the legal process of filing long-term disability claims in court.

Skip the Internal Appeal Process

Internal appeals often don’t result in a different outcome. After all, your appeal will be reviewed by the same insurance company that issued the denial. Unless you have new, significant information, it may be more strategic to seek legal advice from reputable disability lawyers in St. Catharines.

We understand the claims process and can offer legal representation so that the entire journey of obtaining insurance benefits doesn’t feel overwhelming.

Keep Seeing your Doctor

St. Catharines disability claimants are advised to keep up with their medical appointments and treatments. Ongoing medical records serve as critical evidence in supporting your long-term disability claim. It also demonstrates the continuity and severity of your condition.

Document Everything

Maintain detailed records of all interactions related to your claim, including conversations with healthcare providers and the insurance company. This documentation can be invaluable in building a strong case for your appeal or lawsuit against the insurance company.

Why Hire a Long-Term Disability Lawyer St. Catharines?

Most claimants ask our St. Catharines disability lawyer whether it is possible to obtain disability insurance benefits or appeal a claim denial successfully. While the latter can be challenging, we have a track record of handling the disability claims process effectively. We have helped disabled clients in St. Catharines and the Niagara Region in Southern Ontario, and the surrounding area to get compensation.

At Derek Wilson Personal Injury Law, we are different from other long-term disability lawyers in St. Catharines. Led by Derek, our law firm takes a personalized approach when handling each case. That means your cases will not be handled by a junior disability lawyer. This is why Derek and his team have managed to win so many disability-related cases.

Furthermore, we implement a contingency fee model. That means you don’t have to pay money upfront to get help from our St. Catharines lawyer. Schedule a free initial consultation, and we will provide you with the legal services you need.