Has your Short-term (STD) or Long-term disability (LTD) claim been denied?
If you have been denied for Short-term (STD) or Long-term disability (LTD) claim, it’s important to know that you may have the right to sue. The denial of a disability claim can adversely impact your life with dire consequences ranging from social, financial, mental and physical complications. It is always advised to have strong legal representation that can advocate for your rights.
Due to your disability, you may be unable to temporarily or even permanently continue employment. High medical costs and loss of income can also be quite frightening. At Affinity Law, our experienced Toronto disability lawyers can help protect your rights and fight to get you the maximum compensation possible.
The nature of every Long-term disability (LTD) and Short-term disability (STD) claim is unique. Our Toronto long term disability lawyers help you navigate these unique claims and help you in confidently reaching a beneficial settlement.
If you have recently had an LTD claim rejected or stopped receiving payments prematurely, we can help. Qualifying for a disability claim at the time of your claim denial is very important. Connect with our experienced and compassionate Toronto employment lawyers at Affinity Law, who will help fight for your rights.
What are the Most Common Reasons for Denial of a Long Term or Short-Term Disability claim?
There can be various reasons why the disability claims can be denied. The following outline some (not all) of the possible reasons that can lead to a denial.
In many cases, insurance policies have a legal language with a specific definition of ‘total disability’ including but not limited to:
- Incapacity to perform your job without injuring yourself
- Inability to correctly complete your job duties without harming yourself
- Presence of questions such as ‘are you completely disabled?’
- If due to sickness or injury you are unable to perform the material and substantial duties of
Your regular occupation
- Have a 20% or more loss in indexed monthly earnings due to that sickness or injury
- Clinical notes and records of your family physician
In such situations, employer/insurer may also deny coverage based on a policy exclusion clause.
Unfair Policy Modifications & Termination
Your insurance company may also unfairly terminate your long-term or short-term coverage. Below are some scenarios that may fall under this umbrella.
- Unfair termination of the policy without the presence of adequate time or sufficient cause
- Modification in particular clauses of the policy without giving you sufficient time or notice
- Disability definitions or requirements may be changed
A qualified long term or short-term disability claim may be rejected due to a lack of complete information or documents. For any disability claim to be considered, complete and valid reasons and supporting documentation (medical or otherwise) is essential.
Disability claim documentation may include but not limited to:
- Complete medical records including the tests, blood work reports, doctor’s diagnosis along with treatment protocols and long-term prognosis
- Complete Employment information – job duties, responsibilities confirmed by employer, nature of the job, duration of employment
- Impact of the injury on your daily life – supported with evidence of you being unable to perform simple daily tasks necessary for living
Every disability insurance policy has certain time limits in which claims need to be filed. Insurance companies can reject disability claims not filed within specified time limits.Not attending medical appointments or providing medical documentation are other reasons that can result in claim denials.
Which Injuries Qualify for LTD And STD?
Coverage of STD and LTD benefits are majorly dependent on your insurance policy. An employee may be entitled to short-term disability benefits if they are considered to be continuously totally disabled for a specific time period.
Injuries arising as a direct result of motor vehicle accidents (car/bike/boat etc.) and slip and fall cases are generally included under the coverage. The treatment time is different for every disability, based on the intensity of injuries and the time required to get back to normal health.
A long term and short-term disability claim can include several types of injuries causing disability including physical and mental disabilities. Chronic pain, fractures, partial or full body paralysis etc. are types of physical disabilities while examples of mental injuries include (but not limited to) anxiety, depression, phobias, Post-traumatic stress disorders (PTSD), mood swings, irritability and aggression.
These illnesses and injuries can adversely affect your ability to work temporarily or permanently, giving you a valid reason to file a disability claim.
Medical conditions that may qualify for long term or short-term disability claims include but are not limited to:
- Professional Athletes Disability
- CPP Disability
- Mental Health Issues (Depression and Anxiety)
- Irritable Bowel Syndrome (IBS)
- Bipolar Disorder
- Chronic Pain
- Headaches & Migraines
- Military Disability
- Kidney Failure
- Employment Termination arising from LTD/STD
- Neurological Disorders
- Post-Traumatic Stress Disorder
- Carpal Tunnel Syndrome
- Heart Disease & Stroke
- Other Health Issues
What Are the Long Term and Short-Term Benefits That I Am Entitled to Under the Insurance Policy?
Long term and short-term disability insurance policies can be purchased privately by individuals or are provided by employers to their employees.
Generally, the benefits covered under the policy differs based on the issuing company, policy terms, and conditions, duration, and amount of coverage. Typically, disability benefits refer to income given to the
claimant for a specified period until they are unable to work due to an injury or illness.
As a claimant, you may be required to complete a ‘qualifying period’ to be eligible for the disability benefits. On satisfactory completion of this period, you will need to complete a valid disability claim application. The next step is to submit this application along with all the requisite supporting documentation to your insurer.
You may be required to undergo treatment or rehabilitation suggested by the insurance company and any other conditions as per the terms of the policy document. The exact amounts of the disability benefits are determined as per the policy terms and conditions. As a general rule, monthly benefit amounts are between 50-85% of your pre-injury monthly income.
Taxability rules may differ and need to be checked as per specific insurance policy terms.Alternative options include reinstatement into the previous or similarly matched job role with your ex-employer or opting for a lump-sum full and final settlement.
Retaining our expert Toronto disability lawyers can help you navigate the many legal complexities involved in the disability claims process.
What Are LTD/STD Disability Claims Deadlines?
It is of vital importance, to adhere to the noted policy deadlines, if you are planning to make a disability claim. Failing to adhere to these deadlines, gives the insurance companies an exposed reason to deny your request.
Different policies often have varied timelines based on the issuing company, coverage plan, and the amount. It is essential to review your long term or short-term disability policy to avoid missing the vital deadlines. It is advisable to submit the disability claim with supporting evidence and complete documentation within the time limits specified in the policy.
If your disability claim has been denied, contact our experienced Toronto disability lawyers today. Schedule your free consultation to understand the legal options available to you.
How Can I Sue My Insurance Company?
If you have received a disability claim denial, you may have a case against your insurance company. It is very common for the insurance companies to have unfairly breached the contract or denied a disability claim unreasonably. It is important to speak to a Toronto disability lawyer immediately to understand the legal options available to you.
Every case is unique, and we can advise you on the different options available. A few of the methods that can be used are mediation, arbitration, or litigation.
Mediation is a negotiation process that involves a third party. In this process, parties resolve the dispute amongst themselves with the help of the mediator, who is a neutral third party.
Arbitration involves a neutral third party who has the power to make decisions. It is a more formal method as compared to mediation. The arbitrator’s decision is legally binding on both parties.
Litigation involves the courts and is often considered the final approach. Our lawyers have many years of court room experience to advocate on your behalf and protect your interest. We assist you in preparing the claim against your insurer advocating strongly for your entitlements and rights that are being denied.
What are the Costs Involved for a Disability Claim?
At your free initial consult, we answer every question with refreshing honesty and candor and make recommendations that protect your interest. We invest time to understand you. We work on a contingency basis which means that unless we win a settlement, we will not seek any payment.
Call us at your earliest convenience to schedule your free consultation.
Why Do I Need A Lawyer?
At Affinity Law, we help our clients navigate complicated and puzzling legal requirements of disability claims. Our expert Toronto long term disability lawyers help you understand your rights and secure the maximum possible compensation you deserve.
Our lawyers know how to fight for your rights and entitlements that the insurance companies, either partially or completely, are not willing to grant. We can help you secure those rights as we have for hundreds of our clients. If your claim has been denied or not being handled by the insurer properly, call us today; it does not cost you anything to speak to us.
Our lawyers specialize in the following Disability claims in Ontario:
- Long-term Disability
- Short-term Disability
- Bipolar & Mood Disorders
- Depression & Anxiety
- Chronic Pain
- Post Traumatic Stress Disorder
- Life Insurance
- Critical Illness
It is of vital importance to be aware of your rights and options with respect to a denial of benefits and to understand that you can pursue a court action against your insurer. We can assist by helping you understand the legal terminology, providing the legal options available and advocating fiercely for your rights.
Contact Affinity Law
Our lawyers have a unique advantage over other law-firms in the practice of disability claims. Our lawyers have previously defended insurers that provide disability insurance. We intimately know the criteria that is applied in the claim denial process and we effectively advocate for our client’s best interests, fighting the very same insurance providers that have denied your disability claim.
If you need help, schedule a free consultation by calling us at (647) 846-2037 or reach us by filling out the Consultation Form. We look forward to helping you gain the compensation you deserve. We serve the whole Greater Toronto Area including Hamilton, Caledon and Ajax.