Long Term Disability Lawyer Markham

A disability claim is a request for financial support that you make to the insurance company that holds your long term disability policy if you cannot work due to a severe illness or injury. This financial support can help you cover living expenses, medical costs, and other necessities while you are unable to earn an income.

If you experience a significant health issue, you might need to stop working for a while. A disability claim allows you to recover a portion of your salary to maintain your financial stability while you cannot work. Insurance policies usually have specific criteria that define what qualifies as a disability, such as the severity of your condition and how long you expect to be unable to work.

Long-term disability policies vary, but most cover a significant portion of your salary, usually between 50 and 70 percent. These policies can last for a specific number of years or until you reach retirement age, depending on the plan.

To qualify for long-term disability benefits, your ailment must meet your policy’s definition of a long-term disability. This often involves proving that your condition prevents you from performing your job duties for a certain period. Insurance companies typically require medical records, doctor’s notes, and other documentation to support these claims.

Various conditions could allow you to qualify for long-term disability benefits.

Chronic Pain

Chronic pain can significantly impair your ability to work. Conditions like fibromyalgia, chronic back pain, and arthritis are common sources of long-term disability claims. Chronic pain affects daily activities and makes it difficult to perform job tasks. If you suffer from persistent pain that prevents you from maintaining regular work hours or fulfilling job responsibilities, you might qualify for disability benefits. Your claim will require medical documentation demonstrating the severity and duration of your chronic pain. Detailed records from your healthcare providers, including documentation of treatment plans and the impact on your daily life, can strengthen your case.

Mental Health Conditions

Certain mental health conditions can also qualify you for LTD benefits. Disorders such as depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD) can severely impact your ability to work. These conditions might make it hard to concentrate, interact with colleagues, or handle work-related stress. To qualify for benefits, you must provide evidence of your mental health condition from a licensed mental health professional. This includes your diagnosis, treatment history, and how the condition affects your work performance. Proof of consistent treatment and ongoing therapy sessions can demonstrate the severity of your condition and your need for support.

Physical Injuries

You could qualify for long-term disability benefits if you have physical injuries that prevent you from working for an extended period. Injuries from accidents, such as fractures, spinal injuries, or severe sprains, often lead to disability claims. Even with proper medical care, some injuries take a long time to heal and may permanently affect your ability to work. If you suffer from a physical injury that prevents you from working, gather medical documentation to support your claim. This includes doctor’s notes, treatment plans, and records of any surgeries or physical therapy sessions. Showing that your injury limits your physical ability to work is crucial for a successful claim.

Illnesses That Prevent an Individual from Performing Their Job Duties

Many illnesses can prevent you from performing your job duties and entitle you to long-term disability benefits. Conditions like cancer, heart disease, multiple sclerosis, and chronic respiratory issues can severely impact your health and ability to work. These illnesses often require extensive treatment, ongoing medical care, and prolonged recovery periods. To qualify for long-term disability benefits with an illness, you must prove that the illness prevents you from fulfilling your job responsibilities. This might require comprehensive medical records, including documentation of your diagnosis, treatment plans, and the illness’s impact on your daily activities. 

Factors Considered by Insurance Companies

When you file a long-term disability claim, your insurance company will carefully evaluate various factors before deciding whether you are entitled to benefits. Understanding these factors can help you prepare a strong claim and increase your chances of approval. 

Medical Condition

Your insurance company will first consider the nature and severity of your medical condition. The adjuster must see that the condition meets your policy’s definition of disability. This often involves showing that your illness or injury prevents you from performing your job duties. Conditions like chronic pain, mental health disorders, severe physical injuries, and debilitating illnesses can qualify. 

In addition to evaluating whether your condition is severe enough to prevent you from working, your insurer might also consider how long your provider expects your condition to last. Temporary conditions won’t qualify if they don’t prevent you from working for an extended period. 

Medical Records

Medical records play a critical role in the long-term disability claim evaluation process. Your insurance company will require comprehensive and accurate medical documentation to support your claim. These records might include doctor’s notes, test results, imaging studies, and hospital records. They enable the insurance adjuster to understand the history and progression of your condition. 

When you file your claim, ensure the medical records you include are complete and up-to-date. Any gaps or inconsistencies could raise doubts about your eligibility. Include records from all healthcare providers involved in your treatment. Detailed medical records showing consistent and ongoing treatment demonstrate the severity of your condition and the fact that you are actively seeking the medical care you need to manage it.

Treatment Plan

Treatment plans are another important factor your insurance company will consider. They want to see that you are following recommended treatment protocols and actively trying to improve your condition. A well-documented treatment plan commonly includes prescribed medications, physical therapy, counselling, and surgeries. Adhering to a comprehensive treatment plan shows your commitment to recovery and your efforts to manage your condition. 

Your insurance company will also look at how your treatment plan affects your ability to work. For example, if your treatment requires frequent doctor visits, hospital stays, or intensive therapy sessions, it could impact your ability to maintain regular work hours. Documenting these aspects of your treatment plan can demonstrate the challenges you face in returning to work and your need for financial support.

Additional Factors

In addition to medical conditions, medical records, and treatment plans, your insurance provider will consider other factors in determining your eligibility for long-term disability benefits. These other factors might include your age, education level, and typical job duties. They might evaluate whether you can perform alternative job roles or if your condition prevents you from working in any capacity. Understanding these factors and providing thorough supporting documentation increases your chances of having a successful claim. A legal professional can manage the claims process for you and present a strong case to the insurance company.

The duration of long-term disability benefits depends on the specific policy or program. For private insurance policies, benefits typically last until a specific age, such as 65, or until you recover and can return to work. Workers’ compensation benefits continue as long as your condition prevents you from working, subject to periodic reviews. At age 65, you will receive a retirement benefit. The ODSP provides ongoing support as long as you meet the eligibility criteria. CPPD benefits last until you turn 65, at which point they convert to regular CPP retirement benefits. A knowledgeable long-term disability lawyer can help you determine the potential duration of your benefit payments and manage your finances accordingly.

If the insurance company denies your LTD claim, a long term disability lawyer can assist you in challenging the decision. They understand the legal and procedural aspects of disability claims and can identify any errors or missing information in your application. A disability lawyer can gather additional evidence, such as medical records and expert testimony, to strengthen your case. They can also communicate with the insurance company on your behalf and represent you in appeals or legal proceedings. With a lawyer’s help, you significantly increase your chances of overturning the denial and securing the benefits you need. Seeking assistance from law firms early can save you time and stress in the long run.

Filing a long-term disability claim can feel overwhelming, but understanding the process can make the experience less stressful and increase your chances of a successful outcome.

Preparing a long-term disability claim requires gathering detailed information about your medical condition, work history, and the impact of your disability on your ability to work. Start by reviewing your insurance policy to understand its specific requirements and definitions of disability. Collect all relevant medical records, including doctor’s notes, test results, and treatment plans. These documents should clearly show the severity of your condition and how it prevents you from performing your job duties.

Next, fill out the claim forms from your insurance company. Answer all questions thoroughly and honestly, providing as much detail as possible. Attach all necessary documentation to support your claim. It’s essential to meet all applicable deadlines and follow the instructions carefully to avoid delays. If you feel uncertain about any part of the claims process, consider consulting a legal professional who can guide you and ensure your claim is complete and accurate.

If your insurer denies your long-term disability claim, you have the right to appeal the decision. The first step in the appeals process is to understand the reason for the denial. The insurance company will provide a written explanation, which can help you identify any missing information or documentation errors. Addressing these issues in your appeal is essential.

You will likely need additional evidence to strengthen your case, such as updated medical records, expert opinions, or witness statements. You can also include a detailed appeal letter explaining why you believe the denial was incorrect and providing any new information that supports your claim. You must submit the appeal within the timeframe your insurance policy specifies, usually within 60 days of the denial.

If your initial appeal is unsuccessful, you might have further options, such as requesting a review by an independent third party or taking legal action. Experienced Markham disability lawyers can provide valuable support during the appeals process. They can help you understand the appeals process, gather compelling evidence, and present a strong case on your behalf.

Experienced long term disability lawyers in Markham, Ontario, can provide valuable assistance throughout the claims process and increase your chances of achieving a successful outcome by:

• Reviewing your insurance policy to understand its terms and conditions
• Gathering and organizing all necessary medical documentation
• Filling out your claim forms accurately and completely
• Communicating with the insurance company on your behalf
• Advising you on the ideal strategies for presenting your case
• Meeting all relevant filing deadlines and preventing delays
• Advocating for you during any necessary medical examinations
• Writing detailed appeal letters if your claim gets denied
• Gathering additional evidence to support your appeal
• Representing you in negotiations with the insurance company
• Filing legal actions if necessary to pursue your claim

Your financial well-being depends on getting the long-term disability benefits you’re owed. Don’t make the mistake of trusting your insurance provider will do the right thing. Instead, turn to a committed professional for help pursuing your claim and securing the peace of mind you deserve.

Since 2011, Joshua Goldberg has been proud to stand up to insurance companies on behalf of his fellow Ontarians. A law graduate who attended both the University of Ottawa and the University of Toronto, Joshua has appeared in front of the Social Benefits Tribunal and the Social Security Tribunal, as well as the Court of Appeal, the Superior Court of Ontario, the Ontario Small Claims Court, and the License and Appeal Tribunal. The results he’s achieved on behalf of clients like you have won him a reputation as being dedicated, compassionate, and able to deliver life-changing results—and why Joshua Goldberg Law has been named to Streets of Toronto/Post City Magazine’s 2023 list of Toronto’s Top Lawyers and to the Toronto Star‘s list of top personal injury firms for three years in a row.

If you need help with your long-term disability claim, don’t delay. Contact us today for an initial consultation about your case, and let us fight for the LTD benefits you deserve.