Long-term disability (LTD) insurance is a type of insurance coverage that provides financial assistance to individuals who become disabled and are unable to work for an extended period of time.
Assuming the entitlement provisions of the policy are satisfied, LTD policies usually cover a percentage of the policyholder’s income, for an extended period of time, often up to age 65. However, obtaining LTD benefits is not always a straightforward process, and individuals may find themselves facing denials or delays in receiving their benefits.
In this blog post, we will explore the LTD claims process in Ontario, how to handle a denial, and when involving a lawyer may be beneficial.
LTD Claims in Ontario
The first step in the LTD claims process is to file a claim with the insurance company. To do so, you will need to provide medical documentation from your doctor or other healthcare providers that supports your disability and your inability to work. It is important to carefully review the terms of your LTD policy to ensure that you meet the eligibility criteria and that you have provided all the necessary supporting documentation.
Once you have submitted your claim, the insurance company will review the documentation and may request additional information from you or your healthcare providers. It is important to cooperate fully with any of the insurance company’s reasonable requests and to provide the information in a timely manner. Failure to do so could result in a denial or a delay of your claim.
If your claim is approved, you will begin receiving your LTD benefits. However, if your claim is denied, you will need to take further steps to appeal the decision.
Handling a Denial
If your LTD claim is denied, the first step is to carefully review the reasons provided by the insurance company for the denial. In some cases, the denial may be due to missing or incomplete information, in which case you may be able to provide the necessary documentation to support your claim.
In other cases, the denial may be due to a disagreement between your healthcare providers and the insurance company regarding the severity of your disability or your ability to work. If this is the case, you may need to provide additional medical documentation or seek a second opinion from a qualified healthcare provider.
If you are unable to resolve the denial on your own, you may wish to seek the assistance of a lawyer who specializes in LTD claims. An experienced lawyer can help you navigate the appeals process and provide legal advice and representation throughout the process.
When to Involve a Lawyer
If you have been denied LTD benefits, it may be beneficial to involve a lawyer. A lawyer can provide valuable assistance in a number of ways, including:
- Reviewing the denial letter and supporting documentation to identify any potential errors or omissions.
- Providing advice on the strength of your claim and the likelihood of success on appeal.
- Preparing and submitting an appeal on your behalf, including gathering additional medical documentation and other evidence to support your claim.
- Representing you in any hearings or other proceedings related to your appeal.
- Negotiating a settlement or other resolution with the insurance company.
- Providing ongoing legal advice and representation throughout the appeals process.
Working with a lawyer can be particularly beneficial if you are dealing with a complex or high-value claim, or if you are facing significant financial hardships as a result of the denial.
Conclusion
Obtaining LTD benefits can be a critical source of financial support for individuals who are unable to work due to a disability. However, the claims process can be challenging, and denials are not uncommon. If your LTD claim has been denied, it is important to carefully review the reasons provided by the insurance company and to seek the assistance of a qualified lawyer if necessary.
A lawyer can provide valuable advice and representation throughout the appeals process, increasing your chances of success and helping to ensure that you receive the benefits to which you are entitled.
About the Author
Chris Clifford
Chris Clifford is a Queen’s University graduate and former professional goaltender with the Chicago Blackhawks and Pittsburgh Penguins organizations.
Chris’ legal career began with the Toronto firm of Cassels Brock and Blackwell. He then began working for one of Eastern Ontario’s top insurance defence firms – Templeman Menninga. In the fall of 1999 Chris joined forces with Ted Bergeron and since that time they have limited their practice to the representation of injured plaintiffs and their families.
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