Navigating your LTD Claim
If you cannot work due to illness or injury, employees often assume their long term disability insurance benefits will provide a secure source of income replacement to allow for financial obligations and also to provide peace of mind allowing you to focus on recovering your health instead of financial worries. While this may be the understanding, disabled employees are often overwhelmed by daunting administrative hurdles when they attempt to actually access those benefits, only to discover that their claim is repeatedly denied and denied until they finally give up.
Insurance companies often rely on the applicant’s lack of tenacity or limited resources to avoid paying out benefits to employees who would otherwise be entitled.
What You Can Do
1. Apply for benefits as soon as you and your doctor determine that you can no longer perform the essential duties of your occupation. Involve your treating professionals and have the discussion with them about whether or not your illness or condition is interfering with your ability to work.
2. Fill out the claim forms completely. You should request a copy of the benefits policy describing the details of your coverage and the application forms from your employer or the insurer. When completing the application, be sure that you do not overlook or choose not to answer questions on the forms. If something does not apply to your particular situation, note that on the form. Avoid creating the situation where an incomplete application causes significant delays. Double-check and answer all the questions in the application correctly.
3. Submit detailed medical support with your initial application. The insurance company only requires a short form called the Attending Physician’s Statement, which is to be filled out by your doctor, but the reality is, they will most likely ask for more detailed medical information later on. If possible, expedite this process by submitting comprehensive reports from your medical specialists.
The more detailed information should specifically address the issue of why you cannot work, especially if your health condition is also being affected by conditions such as depression, anxiety, chronic pain, PTSD or other invisible disabilities which do not show up on an x-ray. Speak to those involved in your treatment to describe how you are functionally limited by your symptoms, the treatment you are receiving and whether you have cooperated with their treatment recommendations. The information should focus on your accommodation needs, such as how much time off of work you need, and whether you are able to perform the actual duties of your own or an alternative occupation.
4. Cooperate with your insurance company’s requests in a timely manner, within their specified deadlines. Remember that insurance companies are looking for any excuse not to pay you. You will want to carefully consider what medical and health information you agree to allow the insurer to share with your employer and others involved in your claim. The insurer does have an obligation to respect your privacy rights.
5. Stick with It. The biggest mistake you can make is to abandon your LTD claim prematurely. The claims process can be difficult and the insurer is motivated to delay and make things more complex than perhaps necessary. This is happening when you are unwell and at your most vulnerable, making it a very difficult process to navigate successfully without assistance and guidance.
We are here to help navigate the LTD application process. Consult Ella Forbes-Chilibeck, an experienced disability lawyer, if you are considering making a claim for disability benefits or if your claim for benefits has been denied.
Forbes-Chilibeck Employment Law
http://www.employmentlawottawa.ca/
Phone: 613-722-4468 — Fax: 613-722-4395