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What you Need to Know About a Potential Disability Claim

portrait of injured young man use crutch and arm sling

If you have been unable to work as a result of injury or illness, and/or are a full time employee of an employer who provides medical/dental and disability benefits, then you may be entitled to apply for long term disability insurance benefits.  

Long term disability insurance is provided either privately through a policy you have purchased on your own or more commonly as part of a package of benefits provided through your employer.  These packages can be provided by a disability insurance company or provided directly by your employer but administered through a separate insurance.

Filing a claim for long term disability benefits

To bring a claim pursuant to a long term disability benefit policy the claims process begins by completing an application which will be provided either by your employer’s human resource department or by requesting an application directly from the insurance company.  These forms are usually filled in the blanks questionnaires designed to help the applicant explain the nature of the disability and allow the insurer an ability to assess whether the applicant meets the criteria for disability under the policy.

Do you qualify for long term disability benefits?

Qualifying for long term disability varies from policy to policy based on the insurer and how much has been paid for the plan. Typically a long term disability insurance policy provides for coverage from the start of a designated waiting period following the disability until age 65. 

It is common for a disability insurance policy to state that for the first two years following onset of disability that the insured will receive the benefit if they are partially or mostly disabled from their own occupation.  This is sometimes qualified by a percentage of hours or earnings which you have to be disabled from working.  

What do you do if your long term disability claim is denied? 

Contacting a lawyer when you first receive a denial letter is important to protect your rights, because there are deadlines for responding to denials.  These letters will explain your rights of appeal and how to initiate the appeal process, and will contain a detailed analysis of your claim, the test for disability and the reasoning behind the insurance company’s denial.  

It is important that you review the letter so you understand the insurer’s position.  This will tell you why you are being denied. This denial will also outline the route to fight this denial, and explain to the insurer why their assessment of your disability is incorrect, and you do qualify for the benefit.  

A disability lawyer can help!

A disability lawyer will explain your rights under your disability insurance policy, the potential reasons for a denial, and assist with both financial support and the appeals or litigation process so you can fight against an insurer’s denial.

A disability lawyer will require a copy of your policy to review the terms and conditions set out within.  This in turn will also assist you in understanding of the test that you must meet, as every disability insurance policy is unique.  It is important to remember that your disability insurance policy is an insurance product you or your employer purchases for you and your rights under that product are only as good as they are set out under the policy and as interpreted by case law and statute.  

Qualifying Under Your Policy 

The tests for qualifying for disability vary from policy to policy however.  The meaning of your specific policy can be reviewed by your disability insurance lawyer and explained to you so you know the test you must meet and how to gather evidence that you do in fact qualify. 

Next a disability lawyer will assess your medical situation, the records from medical professionals you’ve seen, the treatments you’ve had in the past, will require in the future, and formulate a plan for how to compile the sorts of evidence that will convince an insurer that you meet their test for disability.  This may require the arranging of additional medical assessments. If this is the case, your disability insurance lawyer will make those arrangements for you and forward the results onto the insurance company. 

Finally if the insurer remains unconvinced of your condition, your disability lawyer will make sure your claim is filed with the appropriate level of court and initiate litigation for you including document and oral examinations for discovery and eventually mediation and or trial. This can be a long and complicated process, and as such, experienced legal representation will make this already stressful process understandable. 

Ferguson Deacon Taws Can Help

As you will have seen above, going through the process of a long term disability claim can be long and complicated. It can include further medical examinations, time, energy, and costs in an already stressful time. If you have been injured or suffer from an illness and you believe you may have a long term disability claim, it is important to act quickly in order to protect your rights. Our teams of disability lawyers are prepared to help guide you through this process. If you feel you have a valid long or short term disability claim and you have questions or need assistance at any stage remember to contact the Disability Lawyers at FDT Law at 1-800-563-6348 to get a consultation.


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