Hamilton Short-Term Disability Lawyer

Some employers offer short-term disability (STD) coverage, which provides wage benefits for up to six months in most cases. If you’re injured or sick but expect to return within six months, talk to your employer’s human resources department to find out whether short-term disability is an option.

If you apply and are denied short-term disability benefits, consult a lawyer — you can always do so by contacting Derek Wilson Personal Injury Law in Hamilton. You don’t always require the services of a short-term disability lawyer, but it can be useful to get a consultation if you’re having trouble getting your rightful benefits. A lawyer can secure the right documentation, and build a strong case for why you should get benefits.

Temporary and Short-Term Disability Overview

According to a poll by Equifax Canada, about half of Canadians live paycheque to paycheque. This means that any disruptions to their work can leave Canadians unable to pay for the basics.

Some employers offer temporary or short-term disability to help you get paid time off in the event of an injury or illness. This benefit is essentially an income continuance, covering part of your pay until you can get back to work. This benefit can reduce financial stress and allow you to heal or get better before you return to work duties.

Since short-term disability benefits are offered by your employer’s group insurance plan or by a private policy, they can look very different from the plan other Ontarians have. Here are just a few of the details that can vary between short-term disability policies:

• The benefit amount, which usually ranges from 60% to 100% of your salary
• The exact process you need to follow to apply for benefits
• How long benefits last 
• How long you need to wait before your benefits start

You’ll want to read your policy carefully and speak with the HR department at your workplace to make sure you understand the policy. If you’ve been injured and find your policy confusing, your HR department can also help you understand your policy.

There are a few things to keep in mind with short-term disability in Ontario. One thing is that to get your benefits, you will go through an application or claim process. This is different depending on your employer’s insurer, but you will generally follow these steps:

• See a doctor about your symptoms and see whether your doctor supports the idea that you need time off work.
• Correctly fill out the Notice of Claim and submit it to the insurance company.
• Have your employer fill out the Employers Report and submit it to their insurer.
• Ask your doctor to fill out and submit the Attending Doctor’s Report to the insurer.
• Continue any treatment prescribed by your doctor.
• Submit any additional information the insurer requests.
• Wait for the insurer’s decision.

Short-term disability isn’t the only option when you’ve been injured at work. Ontario offers Employment Insurance (EI) Sickness Benefits. If you don’t have short-term disability coverage through a private plan or your employer, you may qualify. EI Sickness Benefits cover 55% of your earnings, or no more than $668 per week, for up to 26 weeks. You cannot receive both short-term disability benefits and EI Sickness Benefits at the same time.

In Ontario, in addition to short-term disability, long-term disability benefits are also available if you’re seriously injured or disabled and can’t return to work for an extended period of time. You may need to move from short-term disability to long-term disability benefits if you develop complications or your injury is more serious than you initially thought.

If you’re seriously injured and think you may qualify for long-term disability benefits, keep in mind that these tend to be even more expensive cases for insurance companies. That means insurance companies have plenty of motivation to carefully investigate these cases and deny claims when possible. If you’re denied benefits, consult with a disability lawyer in Hamilton to make sure you have the best chance of getting the benefits you deserve.

Short-Term Disability Eligibility

To be eligible for short-term disability benefits, you must:

• Have coverage. You must be employed and must have short-term disability coverage through a private policy or your employer’s group insurance plan.
• Be unable to work. Your inability to work must be due to a covered medical condition, which can include an injury, mental health issue, or illness.
• Have documentation. You must be able to show the insurer that you have evidence of your medical condition (and your inability to work due to that condition) from a healthcare provider.

Even if you think you qualify for short-term disability benefits, you may still encounter problems. Insurance companies have a financial motive for denying claims: they make more money for their shareholders when they pay policyholders less.

You can be sure the insurance company will review the medical documentation you provide with your application very carefully. They will be looking at your recovery outlook, the details of your condition, your treatment plan, and any other details. For this reason, it’s important to build a strong case right away so there is nothing in your application that would give insurers a reason to deny your claim.

Common Reasons for Disability Denials

Sometimes, there are signs your disability claim will be approved. For example, your injury could be well documented and may be mentioned specifically in your insurance paperwork as a condition that’s covered by your policy.

However, there are no guarantees. Even if you are legitimately injured or sick, can’t work, and should be covered by short-term disability, your claim can be denied. Many hard-working Hamiltonians and Ontarians have their claims denied, and these are the most common reasons this happens:

Not Enough Medical Documentation

Sometimes, a doctor won’t provide enough documentation about the severity of your condition, how it can affect your ability to work, or how long you may be expected to get treatment. The information may be incomplete or even filled out incorrectly, which can lead to a denial.

In some cases, your doctor may minimize or dismiss your claims, even if you have a legitimate injury or medical condition. Unfortunately, this is not uncommon, and you may need to see more than one doctor to get an accurate diagnosis and feasible treatment plan.

Lack of Treatment

To get short-term disability benefits, you need to have a diagnosis from a doctor and to get treatment for your condition. There are legitimate reasons why you might not have sought treatment. Perhaps your symptoms crept up very gradually, and you delayed seeking treatment, so you ended up working for a while with your injury. You may have delayed seeing a doctor because of the long wait times to get healthcare or because you suffer from anxiety. Even if you have a valid reason, an insurance company may deny your claim.

Even after you’re diagnosed, it’s crucial to continue to get all medical treatments and to follow all of your doctor’s recommendations. This is important not just for your health but also for your disability claim. If you fail to comply with your treatment plan, that paves the way for the insurer to claim you weren’t as injured as you claimed and to deny you benefits.

If you were denied benefits because you didn’t attend all medical treatments or didn’t follow your treatment plan the way the insurer felt you should, contact a lawyer. Your Hamilton short-term disability lawyer can build the strongest appeal possible and gather evidence of your medical condition.

Mistakes On Your Application

You may have made a small error in the paperwork, failed to meet a deadline, or left a section of a document blank. You might have accidentally applied for the wrong benefit, even. All of these can lead an insurer to deny your claim.

Keep in mind, too, that you’re not the only one submitting forms. Your doctor and employer also have to submit their own forms to the insurer, and if they make mistakes or delay submitting the forms, your claim could be denied.

Your Symptoms Aren’t Considered Severe Enough

You must be able to meet the insurance policy’s definition of “disability,” which usually means you must show that your symptoms prevent you from completing core job duties.

With some conditions, it can be challenging to prove the severity of your symptoms. For example, if you have stress or burnout, how can you prove your condition is severe enough that you can’t work? This is where working with a good doctor can help.

For example, if your stress is causing you to miss work, it can be more accurate and persuasive if your doctor is able to explain the stress through a diagnosis. If you have PTSD, depression, anxiety, or another specific condition, this can make it clearer that you qualify for benefits. An accurate, precise diagnosis can also help you get proper treatment for your condition.

The Insurance Company Thinks You’re Not Being Honest

Your claim for disability will be denied if the insurer has any reason to think you’re not ill or if they think you’re exaggerating your injuries. In some cases, insurance companies may check your social media accounts or even check up on you in other ways to make sure your claim is legitimate. If your social media shows you have been attending parties or going on vacation when receiving short-term disability or applying for benefits, your claim may be denied, even if you have posted an old picture.

These are not the only reasons for a denial. Insurance companies can essentially refuse to pay benefits or may stop benefits if they notice any errors or if the claim isn’t strong.

What To Do When Disability is Denied

When your claim for short-term disability benefits is denied, and you can’t work, you may be facing some big financial challenges. You may be worried about covering your everyday expenses, and you may even be tempted to return to work while injured or ill just to make sure you have income coming in. Here’s what you’ll want to do next:

• Read the denial letter. The letter your insurance company sends you outlining their decision will explain why they found you ineligible for short-term disability benefits. Read this letter carefully so you understand the reasoning, and save this letter in a safe spot.
• Document everything. Hopefully, you have been doing this all along, but it’s especially important if your application for disability benefits has been denied. Write down the details of any medical treatment you get, any communication from your employer or their insurer, any symptoms you experience, and anything else that could be relevant.
• Understand your policy. Read any paperwork your employer gave you about your short-term disability benefits. Pay especially close to any deadlines so you understand how long you have to file an appeal, pursue a legal claim, and submit more documentation.
• Continue your medical treatment. Show that you are continuing to take your medical condition seriously. When you keep seeing your doctor, he or she can also update your medical records so there is more documentation of your symptoms. Your doctor can also send you to a specialist who can provide more documentation and information about your condition.
• Reach out to a short-term disability lawyer. As soon as you get a denial letter, it’s useful to reach out to a short-term disability lawyer in Hamilton. Addressing the situation promptly gives your lawyer more time to prepare and create a strategy for moving forward so you can pursue your rightful benefits.

Getting a denial letter is disheartening, but it’s not the end of the process. With the help of a Hamilton short-term disability lawyer and a better understanding of why you were denied, you may have a better chance of getting your rightful benefits.

When To Reach Out to a Short-Term Disability Lawyer

You may not need a lawyer to apply for benefits, but there are a few situations where you may need a short-term disability lawyer:

You’re Denied Benefits

If you’ve been wrongfully denied disability benefits, a lawyer can review why an insurer denied your claim and can use this information to put together an appeal that addresses those concerns. This can improve the chances of a successful appeal, so you won’t have to wait even longer for your benefits.

You’re Worried About Paying Your Bills

If you’ve been denied benefits, you may be worried about your financial future.  If you know that you could face significant financial distress if there are any delays or denials in your appeal, you may want to see a short-term disability lawyer to make sure you have a strong claim that has a smaller chance of being denied.

You’re Worried Your Benefits May be Cut Off

The insurer may be requesting additional testing or suggesting reviews of your case. You may be feeling pressure to return to work from your employer or their insurer.

If you receive a letter saying that your payments will be ending, it’s time to call a Hamilton short-term disability lawyer to protect your benefits and to prevent them from being ended prematurely.

Benefits Denied? Contact Derek Wilson Personal Injury Law for a Free Consultation

If you’ve been denied short-term disability benefits, contact Derek Wilson Personal Injury Law for a free consultation with a Hamilton short-term disability lawyer. We can look at any letters you’ve received and can review your injury or illness. We’ll look for any red flags or any reasons for your denial and then develop a plan to seek fair benefits for you.

Derek Wilson Personal Injury Law is proud to serve the entire Hamilton area, including Dundas, Ancaster, Stoney Creek, Burlington, and surrounding areas. Derek Wilson, the owner of Derek Wilson Personal Injury Law, started his career in insurance litigation in 1993, and over his career he has become familiar with how insurance companies work and the strategies they use to deny claims.

Derek Wilson Personal Injury Law was founded because Derek Wilson wanted to help people in the Hamilton area during some of the most difficult times of their lives.

When you work with Derek Wilson Personal Injury Law, you’re working with Derek Wilson directly. Your case isn’t handed to juniors, so you get to work with a lawyer who has more than 25 years of experience — a lawyer who also cares about your case and wants to get you results.

Remember — short-term disability benefits are supposed to be there to protect you when you can’t work. If you’re facing any difficulties getting your rightful benefits, contact Derek Wilson Personal Injury Law for a free consultation with a Hamilton short-term disability lawyer.

Related Pages

• The Differences Between Short-Term and Long-Term Disability
• How to File a Successful Short-Term Disability Claim
• How to Prove Your Disability
• Legal Rights and Protections for Disabled Workers
• Pre-Existing Conditions and Disability Claims
• How to Transition from Short-Term to Long-Term Disability Benefits