An Introduction to Long-Term Disability Denials

Long-term disability benefits (“LTD benefits”) are commonly provided as a part of employment benefit packages. These benefits provide income protection for people who are ill or injured and unable to work. Read your policy booklet for information on what coverage you have.

When applying for disability benefits, make sure to submit all records in time. Your policy has deadlines for when you must submit your application and your physicians supporting statement after becoming unable to work. If you miss these deadlines, your claim might be denied.

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.

It is generally recommended that you apply for the Canadian Pension Plan Disability 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 enough years 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. To apply, visit here: https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit.html

Most LTD benefits policies have two tests: 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.

If you are denied disability benefits, then you will usually be offered an appeal. Unfortunately, insurance companies can be reluctant to approve your appeal once your claim has been denied. Once your claim is denied, it is usually a good time to talk with a lawyer.

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 they are caught by exclusions such as “pre-existing conditions”.

The lawyers at Preszler Law 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.

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