When an illness or injury makes it impossible to work, long-term disability (LTD) benefits can be a much-needed lifeline. However, the process of filing a claim is often complex and filled with potential pitfalls that can lead to a denial. For many, the stress of this process is an extra burden on top of managing a serious health condition.
By understanding the most common mistakes people make, you can significantly increase your chances of getting your claim approved the first time. This guide is designed to help you navigate the process with confidence and protect your rights from the very start.
1. Failing to Seek Consistent Medical Treatment
One of the most common reasons insurance companies deny claims is a lack of sufficient medical evidence. It's easy to feel "fine" on some days and skip an appointment, but this can be a major red flag for insurers. They will look for a consistent and ongoing treatment plan that directly correlates with your inability to work.
How to avoid this mistake:
- Follow Your Doctor's Orders: To the best of your abilities, stick to all appointments, therapies, and treatments recommended by your doctor. Any gap in your medical record is often used by the insurance company to argue that your condition is not as severe as you claim even if that's not true.
- Keep Detailed Records: Maintain a journal of your symptoms, pain levels, and how your condition affects your daily life. This personal account can be powerful supporting evidence.
2. Not Providing a Complete and Accurate Application
An incomplete or inaccurate application can lead to significant delays or an outright denial. The insurance company's goal is to find reasons to deny your claim, so any missing information or inconsistency can be used against you. This is why a simple mistake in your application can have a devastating impact.
How to avoid this mistake:
- Be Thorough: Fill out every section of the application completely. Do not leave any questions blank. If a question is not applicable, state that.
- Be Honest: Provide an honest and realistic assessment of your condition, your symptoms, and your limitations. Do not downplay your pain or your struggles, as insurance adjusters are trained to find inconsistencies.
3. Trying to Go It Alone Against the Insurance Company
Insurance companies are not on your side. Their goal is to protect their financial interests, not to make the claims process easy for you. Trying to negotiate with them on your own can be a daunting and often unsuccessful task.
How to avoid this mistake:
- Get Expert Help: A long term disability lawyer understands the tactics insurance companies use to deny claims. They can handle all communication, paperwork, and negotiations on your behalf.
- Know Your Rights: You have the right to legal representation. Consulting with a long term disability lawyer Toronto can help you understand the full extent of your legal rights and options.
4. Missing Key Deadlines
The LTD claims process is governed by strict deadlines. Missing a deadline for submitting an application, providing additional medical information, or filing an appeal can result in a permanent denial of your claim.
How to avoid this mistake:
- Stay Organized: Keep a calendar of all important dates and deadlines.
- Be Proactive: Submit forms and documentation well before the deadline.
- Learn from Others: To understand how a mistake like this can put your entire claim at risk, read our blog post on Losing Your Job While on Long-Term Disability in Ontario? which highlights the importance of staying organized.
5. Not Understanding How LTD Intersects with Employment Law
Your LTD claim doesn't exist in a vacuum. It is often tied to your employment status, and an error on either side can jeopardize your claim. For instance, what happens if your employer wrongfully dismisses you while you are on disability leave?
How to avoid this mistake:
- Understand Your Policy: The legal definition of "disability" often differs from the medical one depending on the circumstances. A lawyer has a deep understanding of these policies and can help you frame your claim in a way that meets all the legal and contractual requirements.
- Know Your Rights: If your employment is terminated while you are on disability leave, it's crucial to understand your rights regarding severance. To learn more about this complex issue, read our blog post on How Severance Pay Affects Long-Term Disability Benefits in Ontario.
The Value of a Long-Term Disability Lawyer
Navigating the LTD claims process can be a minefield of potential errors. The consequences of making a mistake are often too high to risk going it alone. The best time to engage a lawyer is not after a denial, but before you even file your claim. This proactive approach can make all the difference.
If you have questions about your LTD claim or have been denied benefits, we invite you to read our blog on Do I Need a Lawyer for Long-Term Disability? for more information on how a lawyer can help.
Your Path Forward
For many, the financial and emotional stress of a long-term disability is amplified by the claims process itself. Our employment lawyer Toronto team understands this and is here to provide guidance. We have the expertise to help you build a strong case and protect your financial future.
For information on government-provided disability benefits, such as eligibility and how to apply, you can refer to the official Ontario Disability Support Program (ODSP) website. In addition to ODSP, there's also the Canada Pension Plan Disability Benefit, which provides monthly income support to people under 65 who have contributed to the CPP but can no longer work because of a severe and prolonged disability.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
