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Disability Insurance

Long term disability coverage is an important and complex insurance benefit system.

To ensure compliance, there are many regulations and standards governing long term disability, including eligibility requirements, claim filing procedures, and dispute resolution processes. 

Therefore, if you are considering claiming long term disability, it’s important to stay informed, understand the key components of the claims process, and know your rights under this type of insurance coverage. 

With proper knowledge and guidance from an experienced long term disability lawyer, you can be confident in your application and ensure that you receive the benefits you deserve.

What is Long Term Disability?

Long term disability, or LTD, refers to a type of insurance coverage that provides financial support for people who are unable to work due to illness or injury. It is intended to help protect these individuals and their families against the financial and emotional impacts of prolonged disability.

In today’s competitive work environment, being unable to work due to long term disability can have significant consequences, including: 

  • Loss of income
  • Increased stress and anxiety
  • Disrupted family relationships

Therefore, it’s important for those who have a work-preventing illness or injury to know about LTD coverage, as well as their rights surrounding access to this type of benefit.

What Illnesses and/or Injuries Qualify for Long Term Disability?

There are a variety of illnesses and injuries that are eligible for long term disability benefits.

According to Disability Credit Canada, qualifying conditions include:

Musculoskeletal Issues

Musculoskeletal conditions refer to a wide range of medical issues that affect muscles, ligaments, joints, and bones. 

Common symptoms of musculoskeletal conditions include muscle pain, joint stiffness, and swelling. Other symptoms may include reduced range of motion in affected areas and decreased mobility overall.

Examples include: 

  • Arthritis 
  • Sciatica
  • Scoliosis
  • Fibromyalgia
  • Carpal Tunnel
  • Spinal Stenosis

Personal Injuries 

Personal injury occurs when an individual suffers harm through an unfortunate incident. Common events that cause personal injury include car accidents, slip and falls, medical malpractice, defective products, and dog attacks.

Injuries can include:

  • Chronic pain
  • Penetrating head injury
  • Brain injury
  • Bone fractures 
  • Dismemberment
  • Significant scarring or disfigurement

 

Chronic Pain

Typically characterized by long-lasting and intense pain that does not respond to standard treatments, symptoms associated with chronic pain include stiffness, muscle spasms, persistent nausea or fatigue, changes in mood and behaviour, and ongoing difficulty sleeping. 

Chronic pain can arise from:

  • Back pain 
  • Irritable Bowel Syndrome 
  • Nerve pain 
  • Cancer 
  • Endometriosis 

Mental Health & Psychological Illnesses

At its core, psychological illness refers to a problem with the person’s functioning in one or more areas of their life due to biological, social, and cognitive components. This dysfunction may manifest through various symptoms, such as changes in mood or behaviour. 

Examples include:

  • Posttraumatic Stress Disorder
  • Anxiety
  • Depression
  • Schizophrenia
  • Bipolar Disorder

Cardiovascular Conditions

Cardiovascular conditions include a range of medical issues that affect the heart and circulatory system. 

Examples include:

  • Hypertension
  • Heart Disease
  • Heart Attack
  • Coronary Artery Disease
  • Angina

Neurological Disorders

Neurological disorders are characterized by disruptions in the normal functioning of the brain and nervous system, and symptoms can include cognitive impairment, changes in mood or behaviour, and loss of motor function.

Examples include:

  • Stroke
  • Parkinson’s Disease 
  • Multiple Sclerosis
  • ALS
  • Epilepsy 
  • Alzheimer’s Disease
  • Huntington’s Disease
  • Dementia 
  • Cerebral Palsy
  • Severe migraines 

Respiratory Conditions 

Respiratory conditions are a group of illnesses that affect the respiratory system, either by affecting breathing or the organs and tissues involved in breathing. 

Examples include:

  • Chronic Obstructive Pulmonary Disease
  • Asthma 
  • Cystic Fibrosis 
  • Emphysema 

Long Term Disability Claim Process

As much as we would like to think that insurance companies are designed to protect us, keep in mind that they are first and foremost a business, meaning that their main objective is…

Profit.

Insurance companies don’t make money by paying for claims – they make money by not paying for claims. As a result, an inordinate number of long term disability claims are regularly denied or disputed by insurance providers every year. 

While each long term disability policy differs, most require a relatively similar – and often convoluted – claims process.

Eligibility Requirements 

When it comes to long term disability coverage, there are several key eligibility requirements that individuals must meet in order to qualify for benefits. 

These requirements can include: 

  • Demonstrating that you are unable to work due to illness or injury
  • Meeting specific medical criteria defined by your insurance provider
  • Having a long term disability policy in place with an insurer who is approved to offer long term disability coverage 

Additionally, long term disability policies generally require that you have a long history of employment in order to meet the eligibility requirements, as insurers typically look at an individual’s overall employment record to determine if they are able to work long term or not.

It’s also worth noting that eligibility requirements for LTD insurance conventionally include restrictions based on age, length of service with an employer, and the type of job being held.

Claim Filing

Claim filing normally involves gathering documentation to verify your condition and work history, such as: 

  • Medical records
  • Employment records
  • Wage verification forms

You may also need to provide additional information and documentation depending on the specifics of your situation and the requirements of your long term disability insurance provider.

Claim Approval 

After submitting your long term disability application, it will be reviewed by a claims examiner or adjudicator, who will evaluate the documentation provided against the terms of the policy to determine whether or not you are eligible for benefits. 

If approved, you will receive ongoing payments for a specified period of time, depending on the details of your claim. 

Dispute Resolution Processes

Once your claim has been filed, you may need to engage in dispute resolution processes in order to resolve any disagreements or denials with your long term disability insurer. 

This may involve working with an impartial third-party mediator to help facilitate negotiations, or pursuing legal recourse through the courts, if necessary. 

Should I Hire a Long Term Disability Lawyer?

Long term disability claims are complex, and navigating them on your own can be complicated and overwhelming. 

Working with an experienced LTD lawyer who understands long term disability law minimizes stress and ensures that your claim is properly handled from the start, especially if legal assistance is sought out immediately. 

In addition, a lawyer can help you stay organized and proactive in managing your long term disability claim. This can include: 

  • Keeping detailed records of all communications with your insurance provider or LTD carrier
  • Staying on top of paperwork deadlines
  • Regularly communicating with your provider about the status of your claim

Lastly, long term disability law includes specific dispute resolution procedures that apply when you have questions or concerns about your long term disability coverage. For example, you may need to file an appeal if your claim is denied, and a lawyer can advocate on your behalf if you believe that your long term disability insurer has acted in bad faith.

Choosing the Best Lawyer for Your Claim

When choosing a lawyer to represent your long term disability claim, it is important to consider several factors that will help ensure you find the right legal representation. 

Key actions should include: 

  • Evaluating the lawyer’s experience and qualifications in long term disability law
  • Confirming that the lawyer is well-versed in the specific requirements of your particular situation
  • Identifying how the lawyer approaches LTD cases and litigation
  • Researching the lawyer’s prior cases and client reviews 

Ultimately, choosing the right long term disability lawyer is essential to ensuring your claim is appropriately filed, managed efficiently, and that you are given the best possible guidance throughout the process.

Do your research and select wisely.

General Tips When Selecting a Lawyer

When seeking help from a lawyer for a LTD case or otherwise, it’s crucial to keep the following factors in mind during your candidate assessment:

  1. They are accessible and responsive
  2. They have reasonable fees and billing practices
  3. They are backed by a strong reputation and social proof
  4. They have an effective communication style

Given the wide range of potential qualifying injuries and illnesses, it is important to work with a professional long term disability lawyer in order to determine your eligibility and file a claim that meets all legal requirements. 

Accomplished LTD lawyers can help you navigate the complexities that exist within the long term disability claim filing process and provide expert guidance as you work through any disputes with your insurance company. 

If you are struggling with a long term disability and need assistance traversing the legal system, don’t add to your stress. Contact the experienced team at Pourgol Law as soon as possible.