While earning your daily bread is essential to humans, finding ways to protect your income is just as important. No one anticipates bad times when a threatening event alters their lives and leaves them disabled. The very first question that comes to mind is, “How will I cover my expenses?” Your inability to move and do your job may lead to a job loss or a wage cut. Is there a way to secure your finances?
Whether purchased privately or available through your position of employment, one way to protect your income stream in the event of impairment or disability is long-term disability (LTD) insurance coverage, which typically compensates between 60 to 70 percent of the disabled person’s salary in case they are unable to work due to a physical or psychological illness.
This blog post discusses LTD insurance benefits in Ontario and helps people know their rights, protecting them from insurers’ tactics which are often used to undermine and avoid payment of legitimate claims.
How To Seek Long-Term Disability Insurance Coverage
You can seek coverage for long-term disability in several ways, which include:
1. Employer Group Insurance Plans
Many Ontario companies offer group benefits to their employees, which may include LTD coverage. In such cases, the company generally partners with a private insurance company to seek LTD benefits.
2. Private Insurance Plans
Individuals who run their own businesses or whose employers have not provided LTD coverage might consider purchasing a private LTD policy.
Am I Eligible for LTD Benefits
While LTD insurance plans may vary, the eligibility criteria are often similar. To be eligible for these benefits, you must ensure the following:
- The individual must have a physical or psychological medical condition that affects their ability to perform their job.
- To prove your condition, your healthcare provider must provide documents supporting your inability to work.
- You must be undergoing treatment under the care of a qualified medical professional.
- Before applying for LTD benefits, you must have moved past the waiting or elimination period.
While filling out the LTD application, you may come across the “own occupation” definition in some policies, which spans the first two years. It usually requires that you are substantially unable to perform most or all of the responsibilities of your current occupation. After two years, most policies change to the “any occupation” definition, meaning you are completely unable to perform any job under any occupation for which you are qualified based on your training, education or experience.
What Are My Rights as an LTD Insurance Benefits Seeker
1. Right to a Fair and Timely Process
Insurance providers must clearly communicate the time it may take to process your claim. There is a pre-determined time for such processes. If any delays or unreasonable requests for documentation happen, they must be addressed immediately.
2. Right to Appeal a Denied Claim
The claimant has the right to question insurers if their long term disability claim is denied without a valid explanation. You may file a legal complaint or internally appeal the denial to the insurer.
3. Right to Legal Representation
The claimant has the right to hire a disability lawyer at any stage of the claiming process. Lawyers who have prior experience in handling LTD claims know the tactics to deal with insurers, helping you collect medical proof and represent your case in court if needed.
4. Right to Privacy and Respect
Your insurer can only request medical evidence without disrespecting your privacy. They cannot ask for any kind of personal information from the claimant. The information must relate to your disability, impairment or your position of employment.
What Should I Do If My LTD Claim Is Denied
Many claimants face LTD denials, often due to unclear policy language, inconsistency in medical records, or lack of rightful representation of their disability. Here are your next steps if your LTD claim gets denied:
1. Request a Copy of the Denial Letter
The denial letter must state the reason your claim was denied. Explanations like lack of sufficient medical proof or doubt that the claimant is capable of performing some kind of work are common.
2. Gather Medical Proof
Work closely with your doctor to gather proper records. These may include detailed medical reports, test results, and treatment plans that prove your inability to work.
3. Consult an LTD Insurance Lawyer
While you are already facing a denial and trying to gather enough evidence, it may not be possible to get through judicial proceedings without the help of a professional. Most disability lawyers offer a free initial consultation. Discuss with your lawyer to find the best possible course of action.
4. File an Appeal or Lawsuit
Depending on your situation, you can either appeal your denial to the insurer or file a legal complaint against the insurer. Your disability lawyer will evaluate your situation and suggest what should be done.
Can My LTD Benefits be Terminated
Even if your LTD claim is approved, your insurer can terminate it later. Usually, such cases happen after the two-year waiting period when the definition changes from “own occupation” to “any occupation”.
Other factors that can lead to the termination of your benefits include:
- Your insurer thinks you are no longer disabled.
- You are not following your treatment plans.
- The insurer’s internal medical specialist does not believe you are entitled to the benefit.
- You are not agreeing to take an independent medical exam (IME).
Whatever the reason, you can always appeal or challenge the termination in court.
Disputing LTD Benefits with SG Injury Law
Facing a denial on your LTD claim or getting your LTD benefits terminated can add to the frustration and anxiety you have been feeling from not being able to work. You have the right to challenge your insurer in court. At SG Injury Law, we help individuals dispute their refusal of LTD insurance benefits.
Our experienced long-term disability lawyers review your case, assess the claim, and suggest the right steps to get you the benefits to which you are entitled. We sympathize with your circumstances and want to help you recover your lost benefits, reducing some of the stress you have been experiencing.
If your LTD insurance benefits were denied or terminated, let our experts guide you. Book your first free consultation with our long-term disability lawyers today!