If have been denied long term disability benefits, there are a few important things you need to know.
1. Limitation Period
If you have been denied long term disability benefits, your policy handbook will be essential in advising you how long you have to commence a lawsuit against your insurer for the denial.
Each policy of disability insurance will contain specifics with respect to limitation periods. If you miss your limitation period you will be unable to dispute the denial by way of a lawsuit
2. Transition Provisions & Denials
A waiting period must be completed before you are eligible for long term disability benefits. During this time you may be eligible for short term disability benefits, if offered under your policy.
Long term disability benefits may be denied after the waiting period. This means that the insurer has denied initial entitlement. The test for disability will be contained in your policy and you must meet this test in order to be eligible for benefits. Generally, the test to be met is an inability to complete the tasks of your own occupation.
Most long term disability policies will also contain a 2-year period after which the test for entitlement changes. This again will be policy specific.
Generally, the test to be met after the first two years of disability is an inability to complete the tasks of any occupation. Continuation of long term disability benefits is often denied at this point due to the increased requirement to satisfy the definition of disability.
It may be difficult for you to know what it means to “meet the test” for disability. An injury and disability lawyer can work with you to make that determination based on the medical evidence.
3. CPP Disability Benefits
Many long term disability policies will require you to apply for Canada Pension Plan Disability Benefits (CPP Disability Benefits). If approved for CPP Disability Benefits, they are deducted from the amount the long term disability insurer pays you.
If it is part of your long term disability policy, you must apply. If you have been denied CPP benefits, an injury and disability lawyer can assist you in disputing the denial.
Most long term disability policies will have exemptions from coverage. These are policy specific.Common exemptions are pre-existing conditions, alcohol or drug use, and illegal acts. Some policies will list specific types of injuries or illness that are not covered and/or have a shortened period of eligibility.
It is important to review your policy with a lawyer if you think an exemption may apply, as it is not always straightforward.
5. Common Reasons for Denials
- failure to provide medical documentation
- pre-existing conditions
- procedural or clerical error /non compliance with time lines
- contradictory surveillance
- failure to meet disability definition
- non-compliance with recommended treatment
- non-compliance with retraining program
6. When to Call a Lawyer
If you have been denied long term disability benefits at any stage, for any reason, you should call an injury lawyer who is familiar with disability benefits.
Disability benefit denials are not straightforward matters. They will vary in complexity and will be highly case specific. A lawyer will be able to advise you of your legal rights, provide an opinion on your eligibility, and guide you through the complicated process to ensure you secure the benefits you are rightfully entitled to.
Please call 519-836-6849 for more information on disability benefits or to schedule a free one-hour consultation.
SmithValeriote Law Firm LLP, Guelph’s Personal Injury Lawyers
The content of this article is intended to provide a general guide to the subject matter and is not legal advice. Specialist advice should be sought regarding your specific circumstance.