Many employers in the Hamilton area and across Ontario offer short-term disability benefits. If you have a qualifying reason to need time away from work — for example, you’re injured, ill, in quarantine, on bed rest for pregnancy, or recovering from surgery — these benefits pay you a portion of your income so you can focus on healing. How much you get depends on your plan, but most pay between 60 and 100% of your earnings for up to six months, though some plans cover you for up to a year.
If you qualify for short-term disability benefits, you will need to apply, and a key part of that process will be proving your disability to the insurance company. If you file a claim and are denied, it’s likely that the insurer wasn’t satisfied with the medical evidence. If you’ve been denied short-term benefits, contact Derek Wilson Personal Injury Law today for your free consultation.
Proving Your Disability
Knowing how to prove disability is one of the most important parts of filing a short-term disability claim. Getting clear and accurate documentation of your injuries or medical condition begins with you. When you first notice symptoms or an injury, start documenting your condition. Here’s how:
- Write down any symptoms you notice, including their severity and when they happened, as well as how long the symptoms lasted.
- Take photos of any wounds, injuries, bruises, or any other signs of your condition, and be sure to label the photo with the date and time.
- Document any medication or treatment you tried.
- Note any time you’ve had to lose time at work because of your symptoms, including any time you left early or modified your activities because of your symptoms.
- Write down any instances when your symptoms prevented you from doing a simple activity, like typing or walking.
Your own documentation of your medical condition won’t be accepted as evidence by the insurance company, but it can be invaluable in working with your doctor to get an accurate diagnosis. With clear documentation, you can give your doctor an accurate picture of your symptoms, and he or she may even end up including this information in their own records of your condition, and those records are accepted by insurance companies.
Medical Documentation To Help Your Disability Claim
Your doctor is your greatest ally in proving your disability. You will be going to your doctor to get medical treatment and monitoring of your condition, but your physician is also key in proving to insurance companies that you’re seriously injured and can’t work.
In fact, before you start applying for benefits, you may want to speak to your doctor to find out whether your physician recommends taking time off work because of your condition. If he or she doesn’t, it will be very difficult to prove your disability.
One of the most important documents in your short-term injury claim is the Attending Physician Statement. This is a detailed report prepared by your family physician or the doctor who knows most about your condition. The Attending Physician Statement is sent by your doctor to the insurer, and it’s very important that this document contain the following:
- An accurate diagnosis and detailed description of the nature of your injury or illness
- A detailed review of your symptoms, including their severity, duration, frequency, and the way they impact your ability to work
- Information about how long you have been experiencing the medical condition or symptoms
- A detailed review of the treatment plan
- How and why your condition will prevent you from working
- How long recovery is expected to last
- A medical opinion about any restrictions on your work and whether you can return to your work or any type of work
- Clinical observations
- Your prognosis
- Any conditions or factors that could impact your illness or injury
Since there is so much weight placed on this document, it’s important to be very detailed and honest with your doctor so that your medical records reflect your symptoms and condition accurately. This is where documenting your symptoms at home can help — you can bring a busy physician all the details you can think of, and they can simply ask you follow-up questions, which saves them a lot of time and helps them accurately diagnose you and track your symptoms.
If you’re one of the 2.3 million Ontarians that the Ontario College of Physicians estimates is without a family doctor, getting medical evidence can be slightly more challenging. One of the benefits of a family doctor is that he or she can spend time with you over time, which allows them to get to know your medical situation and history. This can be beneficial when you need to prove a disability because your doctor will be able to compare your condition before and after an injury, for example.
Even without a family doctor, though, you do have some options. You could go to a walk-in clinic or even the emergency room if you’re seriously ill or injured. Telehealth services can also refer you to specialists and refer you for diagnostic tests, which can help you get documentation. You can also check in with your workplace. Some workplaces have occupational health services or wellness services that can put you in touch with a physician.
You will still need someone to prepare and file an Attending Physician Statement for your claim. This needs to be the physician who is most familiar with your condition, so you may try to get in to see a specialist, such as an oncologist, optometrist, gynecologist, surgeon, rheumatologist, psychiatrist, neurologist, or a speech pathologist. Keep in mind that reports from chiropractors, psychologists, and other practitioners who may not be licensed to prescribe medication may not carry as much weight.
What Medical Evidence Is Accepted?
The Attending Physician Statement should contain a lot of detail to explain to the insurance company exactly why you cannot remain at work for the time being. However, even more detailed information may be needed. You may choose to provide the following supportive evidence, or the insurer may request the following types of medical evidence:
Medical Records
These provide background information and the clinician’s notes and observations about your condition. You can secure medical records from anyone who has cared for you regarding your condition, including:
- Clinics
- Hospitals
- Emergency rooms
- Specialists
Medical records may provide more detail than the Attending Physician Statement about your treatment, prognosis, and medical history. For example, if you had to visit an emergency room because your condition suddenly got dramatically worse, the records from that hospital visit can contain a lot of information your family doctor might not know because he or she may not have seen you in that state of pain or distress.
Medical records are also valuable because they contain professionals’ opinions about your condition. For example, if you present with stress and visit a psychiatrist, that psychiatrist may note in your records that your stress may be caused by PTSD. This professional opinion adds a layer of specificity to your diagnosis and can strengthen your claim.
The insurance company will put a lot of emphasis on medical records submitted as part of your claim. They’re looking to see if you’re getting appropriate care from the appropriate doctor. For example, if you are experiencing pregnancy complications, you expect to see medical reports from a gynecologist, and you expect a treatment plan that is similar to what other individuals with the same complications get — and in the same treatment intervals.
If you’re getting a medical treatment that is significantly different, more or less frequent or is being offered by someone who isn’t a specialist in your specific condition, the insurance company will have questions and will be more likely to deny your claim.
Lab Test Results
Diagnostic tests can help prove your disability by objectively showing the severity of your condition. Your doctor may indicate in a report that you are in pain, for example, but lab tests can quantify and prove the severity of your condition, which helps prove your level of pain. Laboratory tests that insurers will accept include:
- Blood work
- Urinalysis
- Biopsy results
Many lab test results also contain an interpretation of results by a professional based on the results. This can further help explain to insurers the severity of your condition.
Imaging Studies
Imaging studies can show injuries and damage to bones and soft tissue, which can also objectively show the severity of any injury. Accepted imaging studies include:
- X-rays
- MRIs
- Ultrasounds
- CT scans
Like lab tests, these usually include notes from a doctor.
Treatment Records
Any medical professional who is involved in your care can create treatment records, which outline the treatment you’ve received, how well you’ve followed treatment protocols, and how well you’ve responded to treatment. If you miss any doctor’s visits or fail to follow doctor’s recommendations, it will show up in your records, and it could hurt your short-term disability claim.
Your treatment records are also valuable because they can chart any physical and medical limitations and how they change over time. For example, as part of your treatment, your doctor may note your ability to stand, lift, perform cognitive tasks, and perform other tasks that are essential for your job. It is important to prove your disability with medical evidence.
Finally, these records are especially important if an early prognosis was uncertain about when you might be able to return to work. As you focus on treatment, over time, it may become clear that your limitations will last longer than the six months to a year that your short-term disability benefits last. In that case, you may need to apply for long-term disability benefits, and having treatment records can help establish that an injury or condition was more serious than initially thought or didn’t respond as well to treatment, leaving you unable to return to work.
While all of the above medical evidence is accepted by insurance companies for your claim and may even be requested, not all documentation will help your claim. Older medical records, for example, are not relevant to your claim and will not prove your disability. In addition, any incomplete medical records, such as short doctor’s notes, are usually insufficient. All evidence must be as recent as possible, detailed, accurate, and provided by a licensed healthcare provider.
In addition, avoid submitting any medical documentation not related to your injury or illness unless it is relevant. For example, if you have depression and slip and fall and need to go to the emergency room, your emergency room record of that visit is usually not strong evidence unless it somehow exacerbated your depression.
How Do I Collect the Evidence Required?
Proving your disability and filing a short-term or even a long-term disability claim means working with healthcare providers. The first step is seeing your doctor when you have an appointment and calling your doctor’s office for a follow-up if your symptoms get worse or change. This allows your physician to chart your disability and record it.
When you talk to your doctor, explain that you will be applying for short-term disability benefits. Medical providers work with insurers all the time and will know how to help you. Some imaging centers, labs, and doctors will provide you with copies of test results and information you can share with insurers. Others prefer to send records to insurers directly.
In addition, insurers have their own policies for securing medical records. If an insurance case manager needs extra information, they may contact a doctor or specialist directly for patient records. They may also call your doctor or specialist directly to ask them questions.
If you get a letter from an insurance company requesting specific medical documents, or if you want to submit specific documents as part of your claim, let your physician know, and they will help you.
If you are given a medical record from a doctor, check it over carefully. Make sure that the information is accurate and detailed. In a busy clinic, it’s easy for someone to misspell your name or type in the wrong health card number, and you’ll want to get this information fixed. Even simple mistakes can cause delays or lead to a denial of your claim.
Avoid sending out your only copy of a medical record, and keep all medical records organized in one spot in your home. You never know when you’ll need to refer back to a document or when an insurer will ask for more information.
Contact Us Today for a Free Consultation
You may prepare a detailed short-term injury claim and provide as much medical evidence as you can, but unfortunately, your claim may still be unfairly denied. The unfair part of filing a claim is that you don’t have much control over what doctors and medical specialists write in their reports. They may miss essential symptoms, misdiagnose you, fail to understand the severity of your condition or make mistakes on your medical records. Unfortunately, their expert opinion carries a lot of weight.
Insurance companies, too, can review your file quickly and miss crucial details. In addition, insurance companies benefit when they deny a claim because it saves them money.
As a result, many hard-working employees in Hamilton, Welland, Niagara Falls, Mississauga and surrounding areas get a denial letter when they should be getting their rightful benefits.
This can be especially unfair because short-term benefits are meant to assist you during a difficult time. Without them, you may be worried about paying the bills or may even be considering risking your health and returning to work early.
You need your short-term benefits to focus on your health, so if you have been denied benefits, contact Derek Wilson Personal Injury Law for a free consultation with lawyer and founder Derek Wilson. He founded Derek Wilson’s Personal Injury Law to help people just like you, and he spent the early part of his legal career in insurance litigation, so he understands how insurance companies work — and how to prove disability in a way that insurance companies will respect. He understands the common reasons for denials of short-term and long-term disability claims and has developed strategies for securing fair compensation.
Working with Derek Wilson Personal Injury Law means taking the burden of proof off your shoulders. Our team can contact medical professionals, subpoena records, and track down medical documentation. Even if your doctor is reluctant to share your medical file with you, our team can secure medical evidence on your behalf. If a medical professional has made a mistake or you have been misdiagnosed, our team can address these issues that could be affecting your claim. If you have been denied the short-term benefits you were relying on, contact Derek Wilson Personal Injury Law for a free consultation with a Hamilton short-term disability lawyer. We’ll address your questions and explore ways to get the compensation you deserve.
