What would you do if you suddenly couldn’t work because of an injury or illness and found your income interrupted? If you’re fortunate enough to have disability benefits through a group plan or your Ontario employer, you may feel you have a safety net.
Unfortunately, for many hard-working Ontarians in the Hamilton region and beyond, disability benefits prove hard to secure when they’re most needed. Or workers find themselves pushed back to work by the insurer when their doctor still tells them they can’t work. That’s why it’s important to understand the role of a disability lawyer. If you’re wondering, “What does a disability lawyer do?” and are wondering whether a disability lawyer could help you, this guide is for you.
My firm, Derek Wilson Injury and Disability Lawyer, explains here what you need to know about disability lawyers. If you’re in the greater Hamilton area and need a disability lawyer, contact me and my team for a free consultation, where we can talk more about what we can do for you.
Understanding Disability Benefits and the Role of a Disability Lawyer
Most Ontarians rely on their jobs to pay for essentials like housing, food, and more. If you have disability benefits through an employer or group plan and suddenly can’t work because of a qualifying condition, such as an injury or illness, you should be able to apply for — and receive — benefits that replace part of your wages.
There are two types of disability benefits in Ontario — long-term and short-term. The exact benefits you receive and the qualifying conditions and terms will vary, depending on the policy.
In general, short-term disability covers conditions from which you’re expected to recover in six months. Some generous policies can cover you for up to a year. Covered conditions can include complications in pregnancy that require bed rest, injuries from which you’re expected to recover relatively quickly, chemotherapy, and other medical situations outlined in your policy. With short-term disability, you may get 60% to 100% of your wages covered, though this depends on the policy.
Long-term disability is intended for conditions from which you’re not expected to recover quickly — or at all. This can include a severe injury that permanently affects your memory, vision, mobility or mental health. In some cases, you can start out with short-term disability benefits but transition to long-term disability if your condition gets worse or if there are complications.
Long-term disability benefits cover up to 60% to 80% of your earnings, but in some cases, insurance companies impose a cap. For example, if the cap on your policy is $3,000, you will not get more than that amount, even if 60% of your earnings amounts to more than $3,000.
Both long-term and short-term disability require you to apply for benefits, and this is where many employees run into problems. Even if you believe you have solid benefits and you follow the application instructions very carefully, you may wrongfully be denied your benefits. Or you may be granted benefits but the insurance company may threaten to stop the benefits because they claim you’re ready to return to work — even if your doctor says you cannot return to your job duties.
If you are denied disability benefits in Ontario, one option you have is to work with a disability lawyer. For now, let’s look at the disability lawyer role and how an experienced lawyer can help if you’ve been denied your rightful benefits.
Gathering and Compiling Medical Evidence for a Strong Claim
One of the most common reasons for a denial letter for disability insurance comes down to a lack of medical evidence. The insurance company needs to understand exactly how injured you are, what your diagnosis and prognosis are, and be very sure you do have a qualifying condition.
The challenge is that some policies don’t specifically require you to provide medical evidence. Despite this, you can still be denied your rightful benefits if you don’t have objective evidence of your condition. In addition, overworked Ontario doctors can make mistakes in your medical documents, which can lead to a denial.
A common cause of denial happens when your doctor tells you that you can’t return to work, but the insurer claims you can return to some duties. For example, you may be unable to move your arm because of an injury, and your job at a factory may require you to use both arms to operate heavy machinery. Your doctor and physical therapist may both say that you cannot work, but the insurer may still deny your claim by stating that you are able to take on some types of work — even if no work that can accommodate your injury is available in your workplace.
An experienced disability lawyer can help you in this situation. A lawyer can gather hard data, including imaging scans, lab results, medical opinions, medical records, and other information to support a diagnosis and support a strong claim. More importantly, your lawyer can determine what medical information, if any, was missing in your disability claim so the right data can be submitted. If there is a mistake in your medical records, your lawyer can address this, too, to make sure you aren’t denied benefits because of an error.
Interacting with Agents on Your Behalf
Any insurance claim involves a lot of communication, both by phone and by paperwork, and this can quickly become complicated. For example, let’s say that you need documents from your doctor outlining how your condition prevents you from working and explaining the type and severity of your injury or illness. What if your doctor makes a mistake on your documentation or loses paperwork? Your disability lawyer makes sure that accurate information is submitted to the insurance company and that hard data and medical opinions about your condition don’t get lost.
Another crucial point of communication is with the insurance company. The insurance company may reach out by letter or even by phone, and any information you share can impact your case.
Never forget that insurance companies have a financial interest in keeping payouts low or even denying claims. Insurers make money when they collect premiums but don’t pay out as much as they earn. They have teams of lawyers to protect them and processes that are hard for the average person to navigate, and that can lead to denials of even a legitimate claim. You may reply to insurers’ questions honestly and in good faith only to find your claim denied.
One role of your disability lawyer is to speak with medical professionals, insurers, and anyone else relevant to your claim so you don’t have to. Your disability lawyer understands what to say and what not to say and relieves you of the stress of worrying.
One common situation with Ontario disability claims is that insurers and even employers will sometimes try to force employees back to work, even if doctors say the worker can’t return to work. Your disability lawyer can communicate with everyone involved to make sure you aren’t forced back to work.
When you’re ill or injured, you want to focus on your medical treatments and your healing. Your disability lawyer not only contacts all relevant parties so you don’t have to but also shields you from potential mistakes you could inadvertently make when speaking with insurance companies. In addition, your lawyer frees up your time so you can focus on your health and protects you from the stress of having to deal with insurance companies and their requests.
The Appeals Process for Denied Claims
The appeals process and even your insurance coverage may be complex. Your insurance policy can be hard to interpret and filled with legal jargon, making it hard to understand what benefits you may be able to apply for, what your deadlines are, and what the limits of the policy are. An Ontario disability lawyer can help explain your policy and the rules in plain English. A lawyer can also answer your questions and explain how (and by when) you need to file a claim against the insurance company if you’ve been denied. In addition, your lawyer can clearly explain your options, rights, and the process for getting your benefits. With this information, you’re in a better position to make the best possible choice for your future.
If you do decide to fight for your benefits after getting a denial letter, the process can be complex. This is where a disability lawyer can make a big difference. The process after getting a denial letter is usually to file a claim against the insurance company. While you may also have the option of an internal appeal, these are rarely successful.
Your lawyer can file your claim by the deadline and in the right venue. Your lawyer can also calculate how much your disability payments should be and how long they should continue.
Finding the Right Disability Lawyer for Your Needs
If you’ve been denied disability benefits in Ontario, you don’t just need any lawyer. The lawyer you used to close your house or draw up your will may not have experience with disability denials or disability insurance companies.
What you need is a lawyer with extensive experience and an understanding of insurance companies and their processes. My name is Derek Wilson, and for more than 25 years, I have been working solely in personal injury and insurance litigation. In fact, I started my career at a Toronto firm specializing in insurance defense litigation, where I saw how insurance companies deny claims. This helps me create a custom strategy for your situation because I understand how insurance companies — and their lawyers — think.
I founded my own firm because I wanted to provide attention to each client and to offer honest and fair representation for those who were struggling to get their rightful benefits after an injury or illness. This is why I have worked to create a boutique law firm, where you always work with me and never a junior lawyer who has less experience. I’ll be the one meeting with you, taking your calls, and using my more than 25 years of experience to work on your claim.
Contact Derek Wilson Injury and Disability Lawyer for a Free Consultation
Let me help you. If you receive a denial letter after applying for long-term or short-term benefits or if your employer or the insurance company are trying to push you back to work when you’re still injured, contact my law firm, Derek Wilson Injury and Disability Lawyer, for a free consultation. Bring your denial letter with you so we can review it together and discuss — at no cost to you — what you might be able to do to get your rightful benefits.
I founded my law firm, Derek Wilson Injury and Disability Law, to help hard-working people in Hamilton and beyond. I understand that when you can’t work due to an illness or injury, you may be facing significant financial stress. That’s why I don’t charge for your first consultation.
It’s also why I work on a contingency fee arrangement, which means I won’t charge legal fees until and unless we reach a lump sum settlement or get your disability benefits reinstated. Your legal fees will be deducted from the final settlement amount, so you don’t have to worry about paying these upfront. I am transparent about my fees and would be happy to explain more about legal fees and contingency fee arrangements during your free consultation. If you’ve received a denial letter after applying for disability benefits, the decisions you make next could impact your financial future for years to come. Fighting back and seeking your rightful benefits can help you protect your assets and can ensure you seek the resources you need to pay for essentials. Contact my law firm for a free consultation to review your denial letter and to discuss what you may be able to do next to protect your future. You can contact us by phone at 855-769-0418 or reach out online to schedule your free consultation.
