Ontario Disability Lawyer

About half of Canadians live paycheck to paycheck, according to Equifax Canada. This means that any disruption to income, such as an illness, can leave individuals and families struggling to pay their bills and cover the basics.

Fortunately, many Ontarians have short-term and long-term disability through their workplace or through an individual or group insurance plan. In the case of a covered illness, this insurance pays you a percentage of your pre-injury income so you can pay your living expenses while you recover.

The trouble is that while you may be faithfully paying premiums for this insurance every month and have every reason to expect that your insurance company will be there for you if you’re injured, the fact of the matter is there are no guarantees. Many injured Ontarians find that their legitimate claims are denied.

If you’re having a hard time getting your rightful benefits after an injury or illness and you’re worried about paying the bills, reach out to Derek Wilson Injury and Disability Law. My name is Derek Wilson, and I founded Derek Wilson Injury and Disability Law specifically to help hard-working Ontarians like you when they’re denied their rightful disability. If you receive a denial letter, just contact me for a free consultation.

Disability Insurance Denials Lawyer in Ontario

I founded Derek Wilson Injury and Disability Law because I saw a real need. In fact, before I founded my firm, I worked for a boutique Toronto defense firm that focused entirely on insurance defense. I saw how insurance companies fought to deny claims and what strategies they used to deny disability.

I used that early experience to start my own law firm — Derek Wilson Injury and Disability Law — to exclusively represent hard-working Canadians who are in the fight of their lives to get the benefits and compensation they need. I use my 30 years of experience and my early experience representing insurers to make sure Canadians get a fair shot.

In my career, I’ve seen firsthand what you’re up against when you file a claim and get denied. Insurers will sometimes go so far as to recommend that you don’t hire a disability lawyer. When you don’t work with an Ontario disability lawyer, you simply don’t have someone looking out for your best interests. Insurance companies aren’t required to look out for you. In fact, the only obligation they have is to their shareholders, and their shareholders benefit when insurers pay out less and bring in more profits.

Working with an experienced Ontario disability lawyer can be a game-changer for you. An experienced lawyer understands the law and will look out for the strategies insurance companies use to deny claims. A lawyer can also secure evidence you may have a hard time accessing — such as medical reports and records — to build a strong case that proves you’re eligible for disability.

Insurance companies have entire departments of lawyers representing their best interests. You deserve an experienced Ontario disability lawyer working for you so you can focus on recovering from your injury or illness. When you work with my team at Derek Wilson Injury and Disability Law, I can assure you that I’ll be the one you’ll be talking to and I’ll be the one working on your case. I won’t be handing over your case to a junior partner, so you can be confident that the insurance company will be dealing with someone who understands the law and is serious about protecting your right to disability.

Do I Qualify for Disability?

To qualify for short-term or long-term disability, you first need to have a policy in place. You may have a policy through your employer or by purchasing a plan from an insurer and paying premiums every month. In either case, it’s important that you review the policy carefully. Your policy will explain which illnesses and conditions are exempt and will also outline the deadlines and the process you will need to follow to apply.

In general, to qualify for disability in Ontario, you need to prove that you have what is known as a “total disability.” This means that you reasonably cannot complete the core requirements of your job, even if you can perform some daily tasks and aren’t completely bedridden.

You should know that short-term and long-term disability claims are different in that in a long-term disability claim, after a specific period of time outlined in the policy, the insurance company will define a disability as an inability to perform “any occupation.” This means that even if your doctor tells you that you can’t return to your job, the insurer will try to deny your claim if you can perform the regular duties of another job that you may qualify for, given your experience and training.

Keep in mind that even if you qualify and should rightfully get disability, there are many reasons why an insurance company may deny your claim. Common reasons for denial include:

• Incomplete or incorrectly filled out applications
• Inadequate medical evidence to support the claim
• Not enough evidence of reasonable medical treatment
• Lack of adequate information from doctors

Denials can even happen after you’ve been receiving benefits. For example, a common situation can involve you applying for short-term benefits. You may get approved, but when your condition persists and you try to transition to long-term benefits, your claim may be denied. You may receive long-term benefits for a while, and the insurance company may start to pressure you to return to work against your doctors’ orders.

Ultimately, if your doctor decides you can’t safely work, you shouldn’t be forced to return to your job, and you should get the disability you qualify for — and that you’ve been diligently paying premiums for. If you’re having a hard time getting your benefits and have received a denial, contact a long-term or short-term term disability lawyer in Ontario. Denials of legitimate disability claims are unfortunately all too common in Ontario, and disability lawyers know how to fight back and how to pursue the benefits you need.

What Are the Steps Required in a Case?

If you have been injured or have an illness that prevents you from working and you have a short-term or long-term disability in place, you may be covered. Check your policy to find out whether your specific condition may be covered.

You will also want to speak with your doctor as soon as possible to get an accurate diagnosis and a treatment plan. Your doctor is your strongest ally when filing a claim, so explain whether you are applying for disability when you see your doctor about your condition. This allows your doctor to start documenting how your medical condition may impact your ability to work.

If you’re one of the many Canadians without a family doctor, visit a walk-in clinic, urgent-care center, or other health service available to you. Try to request a visit to a specialist. For example, if you’re suffering from severe depression, try to get a visit with a psychiatrist who can monitor your condition and progress, even if you don’t have a family doctor. Even visiting walk-in clinics and getting on the waitlist for a specialist shows that you’re injured or ill and taking the needed steps to get treatment.

Short-term and long-term disability is meant to provide you with replacement income while you can’t work. If you qualify, you should apply by following the application process outlined in your policy. Your application will likely include many forms you’ll need to fill out. The following may also be required:

• An attending physician’s statement. Your doctor’s statement will outline your diagnosis, symptoms, treatment, and prognosis. This form will also explain what work duties you can’t perform. The insurance company will look at this statement closely, so it’s important that this form is filled out by the medical professional who is most familiar with your condition and who is willing to explain how your condition impacts your ability to work.
• A functional telephone interview. The insurance company will want to call you to conduct an interview over the phone to learn how your medical condition will affect your ability to work. You may want to have some notes ready for this so you remember exactly what treatment you’ve had and when, as well as what your doctor explained to you about your condition. The insurance company will want to see that everything is consistent, so having notes ensures you don’t misspeak or make a minor error that gets your claim denied.
• A plan sponsor statement. This is your employer’s statement, a form that your employer fills out to describe when you were hired, what your typical hours are, what your job title and duties are, what your salary is, and when you last worked. The plan sponsor statement is used to determine how much disability you may qualify for.
• A plan member statement. This is essentially an employee’s statement. It’s a form you fill out that explains your medical condition and why you can’t work, as well as the treatment you’re receiving. You may also be asked about your work experience and education on this form. It’s important that your description of your condition matches your doctors’ descriptions.

It’s important to offer as much information and proof of your condition as you can. Any blood work, surgical reports, reports from specialists, imaging test results, and any documentation you have access to can show that you can’t work. Your doctor can help you secure this information.

Make sure that every part of your application is consistent and correctly filled out. The insurance company will want to see that you have a specific condition that prevents you from working. They also want to see that you are getting reasonable treatment from the right medical professionals.

What Are Your Options When Your Disability Is Denied?

If you receive a disability letter after applying, you have options, but keep in mind that they’re not all the same. The insurance company may suggest you have the option of appealing through an internal review. You may want to skip this step entirely simply because it’s rarely a success for you.

Unless you have dramatically new medical evidence, an internal appeal means the same insurance company is looking at the same medical evidence that caused them to deny your claim in the first place. Why would the outcome be different? Worse, the internal process can be time-consuming. By the time you’ve exhausted all your appeals, you may not have other options for pursuing your rightful benefits.

There is another option: you can skip the internal appeal and immediately contact a long-term disability lawyer or short-term disability lawyer, depending on which disability claim has been denied. When you hire an Ontario disability lawyer, you don’t have to wait for the lengthy and complex internal appeals process. Your lawyer can get your case into court and into negotiations quickly, seeking to get you your rightful disability as soon as possible.

Denied Disability in Ontario? Contact Us for a Free Consultation

If you’ve received a denial letter after applying for short-term or long-term disability in Ontario, don’t wait. You can reach out to Derek Wilson Injury and Disability Law for a free consultation with me. I can answer your questions, and together, we can review why your claim was denied — and what we may be able to do about it. There’s no cost and no obligation in calling me, so you may as well get some more information before you decide what to do next.

Ultimately, if your doctors say you can’t work, I believe them and know you shouldn’t be forced to return to a job that could make your condition worse. You should be getting the benefits you qualify for, and if you’re not, just contact Derek Wilson Injury and Disability Law for your free consultation.