In British Columbia, long-term disability (LTD) insurance policies are commonly provided as a part of employment benefit packages. These policies provide income protection for people who become ill or injured and unable to work. Or at least, that’s what they’re supposed to do.
In practice, LTD insurers can behave like other insurers, denying perfectly legitimate claims for the flimsiest of reasons. Some of those reasons are baked into the policy, like intentionally obscure definitions of “disability” or deceptively expansive exclusions from coverage.
But disabled workers can sometimes make the insurance company’s denial more likely by failing to follow proper claims procedures or providing insufficient evidence of disability. To help workers avoid those pitfalls and hold insurance companies to their word, this article introduces the basics of LTD policies, disability denials, and alternative sources of benefits.
If you are covered by an LTD policy, you should read your policy booklet for information on what coverage you have. You may find the description of the policy hard to follow. Don’t hesitate to ask questions of your insurer to help you understand what’s covered, what’s not, and how to make a claim. You can also consult a lawyer for help interpreting your policy.
Pay special attention to how your policy defines “disability”, what exclusions may apply, and what disability standards it uses.
Most LTD insurance policies have two disability standards: an “own occupation” test and an “any occupation” test. The “own occupation” test usually applies to the first two years after stopping work. In order to meet it, you must be unable to perform the essential duties of your own job.
The “any occupation” test usually applies after receiving two years of LTD benefits. In order to meet the test, you must be unable to perform any similarly salaried and prestigious job that you are reasonably qualified to do.
Your policy has deadlines for when you must submit your application and your physician’s supporting statement after becoming unable to work. If you miss these deadlines, your claim might be denied. When applying for disability benefits, make sure to submit all records in time.
Also, make sure that you submit enough medical information to the insurance company so they can fairly assess your claim. If you have seen specialists or other health practitioners, it may be useful to submit their clinical records or a letter from them explaining why you are unable to work.
However well you understand your LTD policy, and however thoroughly you prepare for your claim, your insurance company may still deny it. LTD insurers are still businesses, after all, and they can try to maximize profits by denying claims—even for spurious reasons. In other cases, insurance adjusters will make mistakes by not understanding your health condition or even the terms of your LTD policy.
Our lawyers commonly see LTD claims unfairly denied because an insurance company ignores doctor reports, does not understand our client’s health condition, or tries to suggest that our client is caught by poorly defined exclusions such as “pre-existing conditions”.
Fortunately, if you are denied disability benefits, then you will usually be offered an appeal. Unfortunately, insurance companies can be reluctant to approve your appeal after your claim has already been denied. Once you are notified that your claim has been denied, it is usually a good time to talk with a lawyer for help with your appeal or starting a legal claim.
It is generally recommended that you apply for the Canadian Pension Plan Disability (CPP-D) benefits if you will not be able to return to work long-term. CPP-D benefits are available for people of all ages who have paid into CPP for a sufficient amount of time and have a serious and prolonged disability. Your CPP-D benefits will help ensure you have income coming in if you are denied LTD benefits.
You can learn more about CPP-D benefits or apply via the Government of Canada’s CPP website.
Also, if your disability was caused by a car accident or other personal injury for which another person was at fault, you may be entitled to recover damages for lost wages, lost earning capacity, and similar items. (You can also recover No Fault benefits from the ICBC if your injury resulted from a car accident, including income-replacement benefits.)
The lawyers at Preszler Law Firm routinely handle and win LTD cases for our disabled clients. If you have a question about an LTD claim, then we will talk to you for free, there is no upfront cost, and there is no fee unless we resolve your case. Contact us today.