St. Catharines Disability Lawyer

St. Catharines is the eighth-largest city in Ontario and the largest in the Niagara region, offering plenty of work opportunities to residents. Whether you work for the Royal Canadian Henley Regatta, Brock University, a manufacturing facility in the area, or any workplace, you put a lot into your career and you rely on your paycheck. When you can’t work due to injury or illness, you expect that work benefits such as disability coverage will be there for you.

If you’re denied your disability benefits, like so many St. Catharines residents are when they first apply, contact me, Derek Wilson. My law firm, Derek Wilson Injury and Disability Law, is dedicated only to disability and personal injury claims, so I can put all my focus on helping you. If you have received a denial letter and are wondering whether a St. Catharines disability lawyer could help you, contact me, and let’s talk about your situation.

Understanding Disability Benefits

Whether you have a private policy or disability benefits through your employer, disability policies are designed to replace a portion of your lost income when you’re too injured or ill to work.

In Ontario, disability benefits include short-term disability (STD) and long-term disability (LTD). Short-term disability benefits are designed to replace a portion of your income for a few weeks to a year, depending on the policy. Long-term disability benefits, on the other hand, are for more serious conditions that prevent you from working long-term and can provide income replacement for several years or even until retirement.

It’s important to understand that these benefits are not automatic. You need to pay premiums every month to be covered, and once you’re injured, you need to apply to get benefits.

Navigating the Claims Process with Insurance Companies

The disability claims process begins when you’re injured or ill and submit a claim in accordance with the paperwork required by your insurance policy. Your claim requires documentation of your medical condition. If any of the required paperwork is missing or incomplete, or if the insurer questions the validity of your claim, you could face delays, or your claim may be denied.

While you are applying for disability or getting benefits, it’s important to meet all the requirements outlined in your policy. For example, most policies require you to get ongoing treatment from a qualified medical professional. Skipping appointments with doctors or not taking your medication, for example, could impact your benefits.

Eligibility for Long-Term Disability Benefits

When you secure long-term disability (LTD) insurance through your employer or a group plan, you’re protecting yourself in the event of a serious illness or injury that affects your ability to work and earn a living. However, it’s not unusual to face challenges when it comes time to collect these benefits.

One challenge is that you will need to meet the eligibility requirements for disability, which vary depending on the policy. Often, to qualify for disability, you must:

• Have a diagnosed injury or illness. Your disability must be diagnosed by a qualified medical professional and must significantly impair your ability to perform your work tasks. In addition, your medical condition must not be excluded from your disability policy.
• Be able to show medical documentation. You will need strong evidence from your doctor, such as test results, medical records, or specialist opinions, showing that your condition makes it impossible for you to continue working.
• Wait until the waiting period expires. Many policies include a waiting period, which could range from 30 days to several months before LTD benefits are activated. During this time, you may need to rely on short-term disability or other coverage, if available.

Keep in mind that your eligibility for disability will also change over time. At first, you are considered disabled if you cannot perform the core tasks of your “own occupation.” At about the two-year mark, however, this definition changes to “any occupation,” meaning that if your condition allows you to perform any job, you may start feeling pressure to return to work.

If your insurer has denied your claim, saying that you’re not eligible for benefits when you feel you should be covered, or if your insurance company is trying to pressure you to return to work while you’re injured, contact a St. Catharines disability lawyer to discuss your options.

Common Reasons for Denied Claims

Even when you try to do everything right in your application, your claim can be denied, or an insurance company may try to cut off your benefits. Here are some of the most frequent reasons why disability claims are denied:

• Lack of Sufficient Medical Evidence. Insurance companies may require specific types of documentation to prove the severity of your condition, such as MRI results, lab reports, or doctor’s statements outlining your limitations. If this evidence is lacking or unclear, your claim may be rejected, even if your doctor believes you are unfit to work. It’s crucial to work closely with your healthcare providers to ensure they submit the appropriate documentation that supports your claim.
• Pre-existing Conditions. Many LTD policies include a “pre-existing condition” clause, which means that any injury or illness you had before applying for the insurance may not be covered for a certain period — usually between 6 months to 2 years.
• Transitioning from Short-Term to Long-Term Disability. If you initially qualify for short-term disability benefits and then apply for long-term benefits, you are essentially starting a new claim, and your LTD claim may be subject to different requirements or even a new insurer. Just because you were approved for and received short-term benefits, there’s no guarantee you will get long-term benefits.
• Failure to Follow Medical Treatment. If you miss medical appointments, refuse recommended treatments, or do not show improvement in your condition, the insurer may argue that you are not adhering to the necessary care, as required by most policies. Be sure to keep records of your treatments and all visits and communication with medical care providers to avoid any issues.
• Surveillance. Insurance companies sometimes hire private investigators to observe applicants. If an investigator captures footage of you doing activities that may appear inconsistent with your claim (such as taking out your trash), they may use this as evidence to deny your benefits. This is where you’ll want to work with a St. Catharines disability lawyer, who can establish that while you may be able to do some everyday tasks, you cannot perform the key duties of your job. You don’t have to be totally bedridden or completely disabled to get disability benefits.

Whether you understand the reason for a denial or not, if you’ve been denied benefits or your benefits have been cut off, consult with a St. Catharines disability lawyer. Your lawyer can evaluate your denial letter and explain to you why the denial happened — and what you can do to make sure you get your rightful benefits.

The Benefits of Hiring a Disability Lawyer

Hiring a St. Catharines disability lawyer can feel like a big step, especially if you’ve never worked with a lawyer before. However, there are several advantages when you decide not to address a denial on your own. For one thing, disability lawyers understand the law, your rights, your policy, exclusions, and what options you have. They can explain, in clear language, what you can do and what kinds of results they’ve seen with other clients.

In addition, insurance companies often make the claims process more complicated than it needs to be. They may use complicated legal language, refuse to answer your calls or delay your claim. The role of a disability lawyer is to cut through the confusion and make sure you understand what is going on. Your disability lawyer also makes sure your insurer is treating you fairly.

Crucially, disability lawyers have experience with claims, negotiation, and courts. They know what evidence is most compelling and how to present your claim in a way that shows your most persuasive evidence. Best of all, your lawyer takes care of all the paperwork and communication with the insurer for you, so all the details of your claim are simply something you don’t have to worry about.

How a Disability Lawyer Can Help

A disability lawyer can play a crucial role if you have been denied benefits or if your disability benefits have been cut off. First, your lawyer will look at the details of your claim and find the evidence needed to prove your disability. Your lawyer will also explain your situation and rights to you. Even if you’ve never filed for disability before, your lawyer can explain the situation to you so you know what to do next.

If you’ve been denied, your lawyer can also give you more options than just an internal review. When you get your denial letter, your insurance company can make it seem that an internal review is your best or even only option.

This is not the case.

In fact, with an internal review, you’re potentially spending a lot of time asking the company that has already denied your claim to reconsider its decision. They’re likely to return the same decision.

Another option you have is to work with a St. Catharines disability lawyer to file a claim against the company. While the claim is ongoing, your lawyer can seek a settlement with the insurer. If a settlement is reached, you get the money you need, and you sever your ties with the insurance company. If you can’t reach a settlement, your lawyer will take the case to court if that’s the best way to proceed.

Every step of the way, your lawyer will take care of the details. Your lawyer acts as an intermediary in your communication with the insurance company, making sure you don’t misspeak and make a mistake that hurts your claim. While you ultimately are the one who decides what to do next, your lawyer explains all your options and offers suggestions that help you determine what the best course of action is for you.

Having a disability lawyer representing you may also significantly increase the chances of securing the benefits you’re entitled to. This is because a lawyer can prevent you from making mistakes that can hurt your claim. Your disability lawyer has also worked on many claims and knows what insurance companies can pay when they are pressed. This can ensure you don’t accept less than you deserve or simply accept a denial.

Compensation Options

Whether your disability stems from an injury at work, a serious illness, or an accident, Short-Term Disability (STD) and Long-Term Disability (LTD) provide you with income replacement while you can’t work, so you can pay your bills while you’re not earning income.

You will generally apply for short-term disability first, and you can often secure benefits quickly, often within two weeks of making a claim. Once you have exhausted these benefits, you may be able to transition into LTD benefits. Long-term disability benefits have a longer waiting period but can last for years or until you reach retirement age, depending on your policy terms.

Calculating the Value of Your Claim

The disability compensation you are entitled to depends on various factors, including the type of disability benefits you are claiming, the terms of your insurance policy, the extent of your medical condition, and how much you were earning before you applied for disability.

For example, those with long-term disability may pay 50% to 85% of their pre-injury salary, usually in a monthly amount. The more generous your policy and the higher your income, the more you can get in benefits, though some policies have a cap on what you can make per month.

Contact Us Today

If you’ve been denied benefits and want to pursue a settlement from the insurance company, your St. Catharines disability lawyer will evaluate how much to seek in a fair settlement. To find out how much your claim may be worth, based on the specifics of your case, contact Derek Wilson Injury and Disability Law for a free consultation.