Source: https://www.awaxmanlaw.ca/blog/long-term-disability-filed-claim-tips
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LTD Series: Part 2 - Important Tips If You've Filed A Claim - Aaron Waxman Law
Long-term Disability Series: Part 2 - 7 Important Tips for People Who Have Filed LTD Claims
If you have been injured or are suffering from an illness that prevents you from working for a prolonged period you might be considering making an application for disability benefits, or you may already have an ongoing short-term or long-term disability claim. There are many things you might want to keep in mind when you make an application for disability benefits and throughout the course of your claim.
We understand that the process of applying for disability benefits and having your application denied at the outset or at any point in your claim is a frustrating and stressful experience when you need income replacement as a result of being unable to work.
As an insured person, or “claimant”, there are things you should know, or do that can help make your case run smoothly.
This is part 2 in our new long-term disability blog series. This blog post will provide you with some helpful tips you should consider when filing a claim for short-term or long-term disability benefits.
#1 – Get To Know Your Insurance Policy
You will want to and are entitled to have a copy of your policy, so you can become familiar with the policy and its wording.
​You should look for information that answers these questions:
How much time do you have to appeal a denial?
​It is important to make notes from every call and keep an ongoing record of all the conversations and contact you have with your insurance company. This will help you to remember a timeline of events for your claim.
As well, take notes of all your doctors, specialists, medications, treatments and symptoms as you will be asked to provide this information when you apply for disability benefits (on the Employee Statement), and by the insurance claims adjuster. This is also information your lawyer will require.
#3 – Keep Your Documents
Keep records of everything related to your disability case. You will want to keep a copy of your application package. Important documentation also includes all correspondence received from your insurer, all correspondence sent to your insurance company (including e-mail exchanges) and all copies of medical records relating to your case.
When you hire a lawyer, you will want to provide your lawyer with the necessary documentation relevant to your claim including a copy of your policy, correspondence from the insurance company and a list of your doctors, treatment centres and medications. It is also helpful if you have business cards from your doctors, hospital admission sheets, prescription receipts, and copies of your application for disability benefits.
#4 – Requests for Information/Documents
If you are still on claim or have not yet commenced a lawsuit and have not hired a lawyer, be aware that every conversation you have with your claims manager/claims adjuster is documented by him/her. You want to be honest in your conversations with your claims adjuster and give them the necessary information to adjudicate your claim but know that he/she is a representative of the insurance company and is not calling you to become your friend.
When processing your claim, the insurance company may ask you to submit further medical information to substantiate your claim and explain how your symptoms prevent you from working. Your physicians can help you by providing this information, if you give them authorization to. Your insurance company needs to be able to review the relevant medical information, so they can understand why you are unable to work.
As well, in order to understand your medical condition, the insurance company may request you be assessed in person by one of their specialists and you will be expected to attend, unless you are unable to due to medical reasons, supported by your treating physician(s).
#5 – Be Honest About How You Feel
It is important to be honest with your doctors about all of your symptoms, pains and difficulties you are having and to report any changes in your status. This will help to determine your limitations and restrictions.
When your doctors/specialists can identify your limitations and restrictions, they can provide medical evidence to support them and your claim.
#6 – Seek and Attend Treatment
Attend rehabilitation and treatment that is appropriate for your disability, i.e. if you have chronic back pain and physiotherapy is recommended, attend physiotherapy treatments. You must show you are seeking reasonable treatment and be under the care of the appropriate physician for your condition (i.e. a psychiatrist if you went on disability leave for depression).
If you require medication, it is necessary to show that you are compliant with your medication.
It is important in a long-term disability claim to receive ongoing treatment and regularly attend your doctors’ and specialists’ appointments.
If treatment becomes unaffordable, ask your physician if there are any OHIP funded treatments available or find out what coverage you may have through your employer for extended health benefits.
#7 – Don’t Just Settle
Short-term and long-term disability benefits cover claims related to both physical and mental illnesses. It is important to consult a long-term disability lawyer when benefits are denied or if your claim is not being handled properly by the insurance company.
Don’t settle for less. Be sure that if you are offered a settlement it is fair and you review it with your lawyer. If you are pursuing your claim through your lawyer, your lawyer can assist you in negotiating a fair settlement. An experienced lawyer who practices long-term disability law can assist you in negotiating the best possible settlement.
Hiring a lawyer is an important step to take as lawyers who practice long term disability law know how to interpret insurance policies and understand what specific terminology and clauses mean, and in turn, your lawyer can explain these things to you.
The legal process can seem like an uphill battle at times, but your lawyer is your representative, and will do everything to get you the best possible settlement and fully advocate for your rights as an insured person.
The law firm of Aaron Waxman and Associates offers a free initial consultation with a licensed lawyer that can be arranged at a date and time that is convenient for you. Do not hesitate to contact us with your questions or to schedule a consultation – there are no bad questions.
Latest update on December 21, 2018
Part 1: Types of Disability Claims
Part 3: How Long Can LTD Benefits Last?
​Part 4: Your Responsibilities During A Claim
Part 5: 11 Important LTD Terms