Welland Disability Lawyer

Working Ontarians rely on their paycheck to pay for the essentials of life. With rising housing and living costs, especially, any disruption in employment can create financial distress, which is why many employees have insurance. Many employers offer long-term and short-term disability coverage as a benefit, and workers who aren’t covered by their job have the option of securing this coverage through a private plan.

If you’ve been paying premiums on long-term and short-term disability insurance, you may think you’re ready for any illness or injury that threatens your paycheck, but unfortunately, that’s not always the case. Your claim may be denied, you may face pressure to return to work, or you may find an insurance company threatening to cut off your benefits.

These issues happen for hard-working employees in Welland all the time. If they happen to you, contact me at Derek Wilson Injury and Disability Law. I founded my own law firm because I wanted to put my more than 30 years of experience towards helping employees.

Understanding Disability Benefits

In Ontario, you may have long-term and short-term disability insurance or one of these types of coverage. You may get disability insurance through a private or group plan, though many employees get this coverage as part of their work benefits.

Just like any insurance, you pay premiums for your policy. If you’re injured, ill, or suffer a covered event or condition, you can apply for disability benefits. Your benefits are meant to replace part of your income while you heal so that you can pay your bills.

Short-term disability benefits are meant to cover illnesses and medical conditions from which you’re expected to recover. Depending on your policy, your short-term disability benefits can cover 60% to 100% of your usual income and benefits can last anywhere from six weeks to a year, again depending on the terms of your policy.

If your illness or injury lasts longer than your short-term benefits, you may be able to transition to long-term disability benefits. These policies again vary widely. Some are fixed terms, covering you for 5 years, 10 years, or another set period of time, even if your disability lasts longer. Other policies may cover you until you recover or until your retirement, whichever comes first. How much you can secure in benefits also varies, with some policies paying 60% to 80% of your gross income and others paying above or below that range. Some policies also have a cap on the benefits paid.

Should you not have short-term and long-term disability, you may be eligible for some government programs. For example, you may be able to apply for CPPD (Canada Pension Plan Disability Benefits) if you need long-term disability benefits or Employment Insurance (EI) Sickness Benefits if you need benefits for up to 26 weeks in Ontario.

Challenging Denied Disability Benefits

Disability policies have strict guidelines, and your claim may be denied if the insurer feels you have failed to meet the policy requirements. When you are denied benefits, or you are at risk of having your benefits cut off, it’s important to read your policy, the denial letter, and any other correspondence from the insurance company to try to understand the insurer’s reasoning.

It is also important to contact a Welland disability lawyer. This is not an issue to take on by yourself because the insurance companies have a big advantage. They are the ones who created their policies to benefit them, and they have teams of lawyers representing them.

In contrast, you are usually applying for disability when you’re injured or ill and worried. You may not have experience with policies and their complicated language. Insurers may not tell you all the options you have when your claim is denied, but you do have rights. Working with a Welland disability lawyer levels the playing field and ensures there is someone looking out for your rights.

Eligibility for Long-Term Disability Benefits

To be eligible for long-term disability benefits, you must have a valid policy in place, and you must have been diagnosed with a medical condition that isn’t specifically disqualified in your policy.

In addition, your policy will have “tests” to determine whether you are eligible for long-term benefits. The most common of these are the “own occupation” test, the percentage test, and the “any occupation” test.

The “own occupation” test is a definition of disability that states you are eligible for benefits if you cannot return to your specific role because of your condition. If you work in a highly specialized field, you may be sacrificing income by taking on a different role, so if you qualify for benefits under this definition, you can secure benefits even if you could technically take on a lower-paying job with your limitations.

The percentage test in most policies also defines disability. For example, your policy could define disability as a condition that doesn’t let you perform 60% of your usual work duties. If you can perform 50% of the tasks of your role, you may not qualify.

The “any occupation” test is the strictest definition of disability. If your policy has this definition, it means that you are only considered disabled if you cannot work in any job you should reasonably be able to take on. Insurers will consider your training, skills, education, salary history, and work experience when deciding what work you’re reasonably suited to take on.

Common Reasons for Denied Claims

Even if you have a legitimate illness or injury, your insurance company may deny your claim. The most common reasons for denied claims include the following:

• Insufficient evidence. The most common reason for denied claims is a lack of objective medical evidence, such as MRIs, blood test results, x-rays, and other supportive evidence. Insurers also want to see reports from doctors and specialists who have treated you.
• Pre-existing conditions. Insurers may deny claims for conditions you’ve had before a policy was in place, especially in cases where you did not disclose the diagnosis. You may also be denied a claim if you didn’t seek treatment for a condition in a reasonable time frame or if you did seek treatment but during the period of exclusion outlined in your policy. Even if the denial seems legitimate, it is still valuable to have a Welland disability lawyer take a look at the denial letter to make sure the insurance company is adhering to their policy correctly and is acting in good faith.
• Lack of medical treatment. Most disability policies require you to get “appropriate ongoing care,” but not all policies define what this care should be. This allows the insurer to deny your claim if you have been getting medical treatment — but not the kind the insurance company thinks is “appropriate.” To reduce the risk of a denial, always see a doctor promptly when you are injured or ill and follow their instructions carefully, keeping a record of your treatments. Where possible, see a specialist or at least get on a waiting list to see one.
• Change in disability definition. Usually after two years or so, the policy definition of a long-term disability changes from “own occupation” to “any occupation.” Even if you have been receiving benefits, the insurance company can reassess your disability and try to pressure you to return to work.
• Surveillance. Insurance companies may work with private investigators, who may photograph you, talk to neighbors, or comb through your social media accounts. Insurers may try to use what they have found to try to deny your claim.

When you receive a denial letter from the insurance company, schedule a free consultation with my team at Derek Wilson Injury and Disability Law. Together, let’s go over why you were denied  —  and how you may be able to fight back.

The Benefits of Hiring a Disability Lawyer

The benefit of working with a Welland disability lawyer is that your lawyer can do the following:

• Make sure you meet all deadlines. Your lawyer will ensure you meet all deadlines for submitting additional documentation, contacting the insurer, or filing a lawsuit.
• Gather all evidence. Your lawyer will gather any medical records and anything else that’s needed to build a strong case.
• Negotiate with the insurer. Every time you communicate with the insurance company, any small mistakes you make can get used against you. Trying to talk to the insurer is also stressful. Your lawyer takes care of negotiations, protecting you from mistakes and worry.
• Reassure you. Being denied disability benefits raises fears about the future and about your ability to pay everyday living costs. When you work with a disability lawyer, you have someone who understands the law, is able to answer your questions, and is able to provide reassurance. Just having this help on your side can remove an enormous burden from your shoulders.

As soon as you have been denied benefits or as soon as you see the insurance company taking steps to try to cut off your benefits, consult with a Welland disability lawyer. Start protecting your rights.

How a Disability Lawyer Can Help

While there are no guarantees in any claim, and you should be skeptical of anyone making absolute promises, there’s no denying that working with a Welland disability lawyer increases the odds that you will get your benefits.

A lawyer can help you avoid many of the mistakes that can harm your situation. Your lawyer will speak with doctors, insurance company representatives, and any other party in your case, ensuring you don’t innocently say something that could hurt your claim.

A disability lawyer can also file a lawsuit for you and can build a strong case. An experienced lawyer knows how to fix any errors your doctor made on the paperwork submitted to the insurer. Your lawyer can also secure medical records that physicians and medical facilities may be reluctant to share with you.

Compensation Options

Many denial letters give you the option of an internal review with the insurance company. While this can seem like an alternative to working with a lawyer, internal reviews rarely result in a positive outcome for you. The insurer has already denied you your benefits once — why give them the chance to do it again?

An internal review can also be a costly mistake because it takes up time. By the time the process is over, you may have missed the deadline for filing a lawsuit against the insurance company, which is often a better way to try to get your benefits.

A Welland personal injury and disability lawyer can help you avoid this common pitfall. A lawyer will determine if a lawsuit is the best way to proceed, and if it is, your lawyer will file the claim. He or she will also continue to seek a settlement in your case up until the case is before the courts. A settlement is often the best resolution after you have been denied benefits because the insurance company pays you an amount that covers your benefits. You can then walk away without having to go to court.

Calculating the Value of Your Claim

How much should you be getting in benefits? When you work with me after getting a denial letter, I work to make sure the insurance company accurately calculates your pre-injury or pre-illness wage, and you get every dollar.

Should we file a lawsuit against the insurer, I aggressively pursue a settlement or court verdict that covers your expenses. I take into consideration your injury, the impact it is likely to have on your future earning potential, and how much in benefits you should have received. My job is to get you real results, and that means not leaving any potential money on the table.

Contact Us for a Free Consultation

If you’ve been denied disability benefits in Welland or any surrounding community, don’t try to go up against powerful insurance companies on your own. Go ahead and contact me at Derek Wilson Injury and Disability Law. Let’s talk about your situation in a free consultation.