Succeeding with a Disability Benefit Claim

If we cannot work due to illness or injury, we tend to expect that our short-term (STD) or long-term disability (LTD) insurance benefits will provide income replacement so we can continue to meet our financial obligations.  Knowing that insurance is in place provides peace of mind and allows you to focus on recovery instead of fretting over financial concerns. While this may be your understanding, the administrative process involved often overwhelms disabled employees. You are trying to navigate what is typically a complex and unfamiliar process at a time when you are not feeling well.  Your claim may be repeatedly denied until you are ready to throw in the towel and abandon it. This ‘application fatigue’ is advantageous to insurance companies.  A significant number of claims are abandoned even though the claimant would otherwise be entitled to the income support.

 What You Can Do:

1. Involve your treating professionals and have the discussion with them about whether or not your illness or condition is interfering with your ability to work. Apply for benefits as soon as you and your doctor determine that you can no longer perform the essential duties of your occupation.   

2. Request a copy of the benefits policy describing the details of your coverage and obtain copies of the application forms from your employer or the insurer. Fill out the claim applications forms completely, being careful to answer all the questions.  If something does not apply to your particular situation, note that on the form. Avoid creating the situation where an incomplete application causes significant delay. 

3. Talk to your doctor and provide them with a copy of the insurance form to be completed by them. The insurance company typically only requires your doctor to complete a short form called the Attending Physician's Statement, but the reality is you will likely be asked for more detailed medical information later on. If possible, expedite this process by submitting comprehensive reports from your medical specialists with the initial application. 

The more detailed information should specifically address the issue of why you cannot work, especially if your inability to work is being affected by medical conditions such as depression, anxiety, chronic pain, PTSD or other invisible disabilities that do not show up on an x-ray. If you are diagnosed with an episodic disability such as multiple sclerosis, arthritis or schizophrenia, you will also want to provide detailed medical information. Speak to those involved in your treatment so they can explain precisely how you are functionally limited by your symptoms; the treatment you are receiving; and whether you have cooperated with their treatment recommendations. The information should focus on your accommodation needs, such as how much time off of work you need, and whether you are able to perform the actual duties of your own or an alternative occupation.

 4. Cooperate with your insurance company's requests in a timely manner, within their specified deadlines. Remember that insurance companies are looking for any excuse not to pay. You will want to carefully consider what medical and health information you agree to allow the insurer to share with your employer and others involved in your claim. The insurer does have an obligation to respect your privacy rights. 

 5. Stick with It. The biggest mistake you can make is to abandon your disability claim prematurely. The claims process can be difficult and the insurer is motivated to delay and make things more complex then perhaps necessary. This is happening when you are unwell and at your most vulnerable, making it a very difficult process to navigate successfully without assistance and guidance. 

 We are here to help navigate the LTD application process. If you are considering making a claim for disability benefits or if your claim for benefits has been denied please contact our office.

Ella Forbes-Chilibeck