kotak: five mistakes to avoid when applying for long-term disability benefits

these mistakes, while common, can result in causing unnecessary stress and even denied disability claims.

by nainesh kotak

jul 25 2023

3 minute read

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five mistakes to avoid when applying for long-term disability benefits

before applying for long-term disability, it's important to give your physician as much information as possible about the nature of your job, your health issues and when they arose. getty

after almost three decades in legal practice advocating for injured workers, i’ve seen too many long-term disability (ltd) applicants make life difficult for themselves. they derail their benefit application claims at the outset with the same recurring mistakes, causing unnecessary stress and claim denials.

according to the canadian survey on disability reports , disabilities related to pain, flexibility, mobility and mental health are the most common disability types. in 2017, one in five (22%) of the canadian population aged 15 years and over — or about 6.2 million individuals — had one or more disabilities. among those with disabilities aged 25 to 64 years who were not employed and not in school, two in five (39%) had potential to work. this represents nearly 645,000 individuals with disabilities.

if you have a disability and plan soon to complete your ltd benefits application, here are five common mistakes to avoid.

1. overstate the truth

there’s a temptation for employees forced off work by an injury or illness to exaggerate their difficulties, but overstating the truth concerning your struggles tends to cause more trouble than it saves.

credibility is often a key issue in ltd claims, particularly when a claim is denied, and a judge will not look kindly on a person whose truthfulness can be reasonably questioned. the best approach is to be factual and straightforward at all times.

2. forgetting functionality

as impressive as a long list of medical diagnoses may seem, it’s not enough on its own for an ltd applicant to have their benefits approved. injured workers must also draw a clear line between these conditions and their impact on their ability to perform their job functions.

rather than listing medical ailments, applicants will boost their chances of success by describing, in detail, how each condition or issue has played out in terms of functionality, both at work and in their day-to-day lives at home.

3. ignoring your policy documents

when it comes to qualifying for ltd benefits, there is no more important document than your insurance policy. if the policy itself is too dense with legalese for you to comprehend or you simply don’t have a copy, employees with group ltd coverage should, at the very least, have a policy booklet that explains how to qualify for benefits.

in most cases, for the first two years of a claim, injured workers must show that they are totally disabled from performing the essential tasks of their “own (usual) occupation” in order to be entitled to benefits.

although individual policies differ, at the two-year mark, the test generally switches to a more stringent version that requires claimants to show that they are unable to obtain employment in “any occupation” for which they are currently qualified or could be trained.

your policy booklet will also outline critical deadlines you must meet to qualify for benefits.

4. keeping your doctor out of the loop

you must visit your doctor if you plan to apply for ltd benefits, since medical evidence will be key to an insurer’s decision on your application.

give your physician as much information as possible about the nature of your job, your health issues and when they arose. it is also helpful to provide him or her with the terms of your ltd insurance, so they can be as accurate and detailed as possible when reporting your functional limitations.

those with multiple disabling conditions should not be afraid to raise all of them with their family doctor or other treatment providers. by detailing your symptoms and explaining how they impact your functionality, your doctor can provide the insurance company with the most comprehensive assessment.

5. disregarding medical advice

consulting your medical professional is not the end of the story for ltd applicants. if you want to maximize your chances of claim success, you will also need to follow their advice and treatment recommendations.

as well as helping with recovery and symptom management, sticking to a treatment plan demonstrates to your insurer that you are doing everything you can to get better and prevents you from being tripped up by policy exclusions that could result in a denial of benefits.

nainesh kotak , is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he also serves as the chair of the long-term disability section of the ontario trial lawyers’ association.

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kotak: five mistakes to avoid when applying for long-term disability benefits