Why you need to act fast to make disability insurance claims

May 24, 2024

You’ve just been injured or developed a disability that is preventing you from being able to work. Your top priority should be a full recovery and returning to normal life when your situation allows. But what happens if you can’t return to work in the near term and need more time to recuperate? In that case, you may need to consider promptly filing a disability insurance claim to replace lost income as you recover.

The reality, however, is that you could be forced to navigate a great deal of red tape before securing the compensation you deserve. If you don’t file your claim on time, fill out the necessary paperwork, or read the fine print, you could be denied the disability insurance benefits you need, putting your full recovery at risk.

That’s because insurance companies don’t make money by paying claims; they make money from the premiums you’ve paid, likely over many years. An insurer is incentivized to question, delay—or potentially deny—your claim. Knowing your rights and engaging personal injury lawyers skilled in disability claim management, can mean the difference between a claim denial, or an eventual lump sum settlement.

But first it’s important to know the difference between short-term and long-term disability claims, the steps to applying and what to expect if you’ve been injured.

Understanding short-term disability and long-term disability benefits

No matter the extent of your disabling condition, the claims process can be lengthy and time-consuming. For example, many claimants are unaware that long-term disability payments may not reach their bank account for 90-120 days. Most insurance policies in Ontario have what’s called an elimination waiting period. The reason for this waiting period is because:

  • Your insurance company may need time to review your claim
  • It gives medical professionals adequate time to determine if you have a long-term or permanent illness or injury
  • You can’t collect long-term benefits while also receiving short-term benefits

Depending on your policy, your waiting period may begin on the first day that you’re unable to work, or the date your doctor has stated that you’re unable to work due to your medical condition. In the meantime, you can (and will likely be required to) apply for short-term disability insurance in the waiting period.

Short-term disability insurance: What you need to know

Short-term disability is meant to replace some or all of your income while you’re in the long-term disability insurance waiting period. Some employers don’t offer short-term disability coverage through their employee benefits, which means you’ll need to apply for federal Employment Insurance (EI) sickness benefits in the meantime. Long-term disability is designed to provide income for a pre-determined period after your short-term disability insurance benefits have been exhausted.

Long-term disability insurance: Pitfalls to avoid

Just because you’re injured doesn’t mean you’ll be covered. That’s why it’s crucial to act fast after experiencing a disabling condition that impacts your ability to work. If you don’t submit your long-term disability insurance claim paperwork on time and correctly, coverage may be delayed, denied or terminated, sometimes requiring legal action to obtain the benefits to which you’re entitled. There are several reasons why your claim could be denied or terminated, including:

  • Your insurance company simply doesn’t believe you have a valid claim
  • You didn’t file your claim on time, as outlined in your insurance policy
  • Your insurer requests more evidence or medical information
  • Your doctor incorrectly filled out your medical assessment
  • You refuse to comply with reasonable medical treatment/examination, which can include various evaluations, appointments, etc.
  • You don’t attend interviews or promptly communicate with your insurer
  • Your insurer claims there was a pre-existing condition that nullifies your coverage
  • Your insurer has determined that you fail to meet a changed definition of disability, often after the two-year mark following the onset of your disability condition

Your insurance provider may also go to great lengths to prove that you’re not as injured as you claim, which could include monitoring your social media accounts to determine whether your daily activities are indicative of a less-severe injury. This is why claims tend to be resolved more efficiently and successfully for individuals who have retained the services of a personal injury lawyer to help them manage interactions with their insurer—including appealing coverage denials and/or issuing a statement of claim against the insurer—and, ultimately, obtain access to long-term disability benefits (or damages).

Navigating the disability insurance claims process

Acting fast and being detail-oriented are key components of a successful disability insurance claim. Knowing what to do is crucial. For example, the personal injury lawyers at Leone Murray LLP offer a complimentary case assessment to help you understand your rights and focus on the next steps in your recovery.

That includes building an effective medical team to diagnose your injury and recommend an appropriate treatment regimen. While you may think—or may have been told—that your insurer’s doctor is the only option to assess your needs while applying for or receiving disability benefits, that’s typically not the case. In fact, an insurer’s doctor(s) may make recommendations that don’t align with the care protocols recommended by your own doctor or treatment team. You will, however, be required to attend your insurer’s medical assessments as requested.

Personal injury lawyers—advocating on your behalf

Embarking on the disability insurance benefits claim process means navigating a maze filled with complex rules and unexpected turns. Having a personal injury lawyer advocating on your behalf, obtaining accurate medical assessments and diagnoses and building a treatment team dedicated to your physical, mental and emotional recovery is key to rebuilding your life—and living on your terms—in the wake of a significant personal injury.

An individualized approach is also vital, considering the varied long-term disability eligibility criteria, benefit calculations, and termination policies across plans. Engaging with a legal team to review your application early in the process and having them in your corner to manage disputes with your insurer can dramatically improve your chances of obtaining the compensation you deserve.

The Leone Murray LLP team

Contact a member of our team for assistance in managing your disability insurance claim. Let’s schedule your complimentary case assessment today.

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