top 5 disability claim questions answered
lawyer nainesh kotak has the deets on the amount of money you could be eligible for, how to dress for a medical assessment and what to do if your claim is denied.
3 minute read
some tips to prepare for a medical assessment include bringing medical reports, being honest about limitations and not exaggerating pain. getty
many of the calls, emails and inquiries to our legal disability practice concern disability claims, and over many years of working with clients, we have put together the top five most common questions about disability claims.
how much can i expect to receive monthly?
for employer-sponsored, group long-term disability (ltd) insurance, benefits usually cover between 60 to 70 per cent of your salary. keep in mind that many policies may have monthly maximums, which can limit the amount of money you are able to receive.
for those who purchase private disability policies, benefits are typically predetermined by the disability policy and are a fixed amount. amounts are based on the type of policy purchased, so one advantage is there is no guesswork as to what you will receive if you are unable to work.
can i make an ltd claim for stress?
workplace stress is on the rise, and employees who are unable to work as a result can apply for short- or long-term disability benefits through their insurance company. as part of the application process, they will need a doctor to fill out a form known as the “attending physician’s statement,” which must include specific medical information about the claimant’s condition, as well as the expected recovery time.
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make sure your doctor understands the nature of your job and any adverse impact it may have on your mental health, as this could be key to conveying why you are unable to perform your occupational duties.
how long does ltd last?
a long-term disability policy is a contract. this contract will state that benefits will terminate when you no longer meet the definition of disability, as defined in the policy or if you reach a certain age — usually 65. the length of time you may be entitled to receive benefits will depend on the precise wording of your policy.
for the first two years of a claim, you have to prove that you are unable to perform the essential tasks of your pre-disability employment due to injury, sickness, illness or disease. the test often changes after two years to whether you are totally disabled from performing any gainful occupation that you are suited to by way of education, training or experience.
insurance companies may cut off your benefits before you turn 65 and even before the two-year mark. they may use one of these familiar grounds or reasons: you haven’t participated in the right treatment program; your social media posts show that you should be able to work; there is insufficient medical evidence; you should be able to do a sedentary job; or, your disability was due to an issue with your employer.
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why is the insurance company requiring me to have an assessment done with a doctor they have chosen, even though i have already seen my own doctor?
independent medical examinations (ime) are a common practice in ontario, and are often used by insurance companies to deny benefits, or by employers to challenge accommodation requests.
an ime is a medical assessment conducted by an independent physician, rather than the doctor who normally provides treatment. the objective is to have a neutral, third-party opinion of the extent of injuries claimed by the policy holder, though the independence of these examinations is questionable, since the physician is recommended and paid by the insurance company and does not owe a duty of care to you, as the policy holder.
some tips to follow regarding this medical assessment include: bringing a list of your medications, physicians who have provided treatment, symptoms, and restrictions; bringing any important medical documents (x-rays, ct-scans, ultrasounds, etc.); being honest about your limitations, and not exaggerating pain or symptoms; taking notes after the assessment and recording types of questions asked; dressing appropriately; and being polite and respectful.
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how do i appeal an ltd denial?
disability insurance companies typically offer an internal appeal process to challenge denials or terminations of benefits. however, the whole procedure tends to be a waste of time — just like students grading their own tests, ltd providers rarely find fault with their original decisions and usually stick with their denials, leaving claimants frustrated and no further ahead weeks or months later.
you may decide that a lawsuit against the insurance company is a more effective solution, having a disability lawyer move promptly to commence claims on your behalf and then moving the case quickly toward a possible settlement.
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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