Hamilton Disability Lawyers The insurance claim process explained by a disability lawyer

The insurance claim process explained by a disability lawyer

Insurance claim process for getting long-term disability

Getting a disability claim can be difficult for persons who are unable to work due to illness or injury. It might be tough to know where to begin when you require assistance during a particularly trying period.

That’s where I enter the picture. As a disability lawyer, my major responsibility is to communicate directly with insurance companies on behalf of my clients in order to obtain compensation when their insurance claim is denied or their benefits are terminated.
I also assist people in understanding disability claims from beginning to end. I’ve worked in the insurance industry before, so I’ve seen both sides of the process.
Here are some of the most typical questions I get about disability compensation, as well as the steps I advise people to follow.

Is it better to apply for short-term or long-term disability?

The first step is to determine which disability program or plan you are eligible for. If you’ve suddenly lost your job, the first thing you should do is take use of any sick pay or vacation days you have available via your company.
Some businesses provide short-term disability benefits (STD) or salary continuation benefits when your disability stops you from working for more than a few days. These benefits are designed to provide income to persons who are unable to work for up to six months due to illness or accident.
Because not every employer provides STD benefits, you’ll want to be sure they’re available for the duration of your disability leave.
If you do not have STD benefits, you may be eligible for unemployment benefits or other government financial assistance programs.

When a covered plan member is unable to work for an extended period of time due to an accident, illness, or injury, long-term disability (LTD) benefits are available. The benefit can give income replacement up to the age of 65, depending on the extent of the condition.
You must be insured by a disability plan or insurance policy to be eligible for LTD compensation. This could be a group disability insurance coverage given by your employer or union, or an individual disability insurance policy purchased on your own.
LTD benefits will be coordinated with workers’ compensation benefits if your disability was caused by a job accident. Benefits for this type of aid vary by province. For example, Alberta’s Workers’ Compensation Board, British Columbia’s WorkSafe, and Ontario’s Workplace Safety and Insurance Board are all available.

What is the best way to find out if I am eligible for disability benefits?

To qualify for disability benefits, disability plans and insurance policies have nearly identical requirements: it all comes down to what your doctor thinks.

If your doctor decides that you are unable to work due to your health, you should be eligible for LTD compensation.

When you apply for disability benefits, your doctor will need to fill out a medical form and give you with clinical notes. The insurance company will not approve your application unless you provide this paperwork from a medical practitioner.

What is the procedure for applying for disability benefits?

Every insurance company has its own application forms, which you should be able to obtain through your employer or on the insurance company’s website. Most group disability policies need you to fill out three forms: an employee statement, an employee’s doctor statement, and an employer statement. The insurance firm must get these documents. Each disability plan will have its own deadline for filing for benefits.

How do I fill out disability benefit application forms?

Make sure all relevant forms are filled out completely and accurately, and include any additional information or documents that support your STD or LTD claim. My colleagues and I have seen far too many legitimate disability claims refused because the forms are incomplete or the information presented is ambiguous. It’s also a good idea to double-check that your doctor has filled out their form completely and that the information they submit matches what you’ve written on yours.

All of your diagnoses and restrictions, as well as any limits in physical, cognitive, or emotional functioning, must be disclosed to your doctor. They should also include a list of any treatment providers, such as therapists and experts, as well as any current or scheduled treatment.

All of your diagnoses and restrictions, as well as any limits in physical, cognitive, or emotional functioning, must be disclosed to your doctor. They should also include a list of any treatment providers, such as therapists and experts, as well as any current or scheduled treatment.

Is it necessary for my employer to supply any information in order for me to be eligible for disability benefits?

Your company is expected to submit a form to the disability insurance that details your position, salary, job duties, and vital responsibilities. This information is used by the insurance provider to determine if you are eligible for the STD or LTD benefit.

As a result, it’s critical to notify your employer in writing that you’ll be out sick. I propose getting a medical certificate from your doctor indicating that your absence is due to your illness or impairment.

I’ve witnessed cases when an employer tried to persuade an ill employee to leave their job or even fired an employee for taking a leave of absence.
But I always advise clients to visit an employment lawyer in our community before resigning, retiring, or accepting a severance payout. Because you are unwell or on medical leave, your employer cannot legally terminate you. They can’t also make you quit your job. Our firm would almost certainly be able to secure a full severance payout, which could be as much as 24 months’ pay, as well as human rights damages, if you were fired or forced out due to medical leave.

What happens once I’ve submitted a disability benefit application?

Fill up a disability application and send it to the insurance company. Your claim will be reviewed by an adjuster or case manager, who will contact you directly within a week to ten days. They’ll inquire about your disability claim, as well as your health and treatment. They may also ask you a series of questions regarding your level of daily functioning in order to assess if you are eligible for disability compensation. Since you have a duty to cooperate with the process of analyzing your claim, I always encourage clients that honesty is the best policy. If more information is needed to make a determination about your claim, the adjuster may call your doctor.

When will my claim be decided by the insurance company?

The entire disability benefits application procedure should take no more than a few months. Within 30 to 45 days of submitting your application, you should get a decision on your disability claim. You have every right to inquire as to why the decision is taking so long. Once a decision has been made on your claim, get it in writing and double-check that you understand it. A copy of the decision letter will be sent to your employer, with any references to medical or health information removed.

What happens if my STD or LTD claim is turned down?

Contact my team at the Hamilton lawyer community right away if your short- or long-term disability claim is refused or your payments are terminated for any reason. A free consultation with a disability lawyer will help you figure out how to collect the compensation you deserve.