To prove you are disabled under long-term disability law, you first have to know how disability is defined under your policy. Not all definitions are created equal. Many policies draw a distinction between “own occupation” and “any occupation” disabilities. If your policy defines disability as the inability to perform your “own occupation,” you must show that you are no longer able to perform the duties of your specific job. On the other hand, if your policy requires that you be unable to engage in “any occupation,” you must show that your condition makes you unable to engage in any occupation to which you would be reasonably suited due to education, training, or experience.
Medical Evidence
Medical evidence is, without question, the single most important component of any LTD claim. Disability insurance companies also rely significantly on documentation from your treating physicians when considering your claim. You will need extensive records, including diagnoses, treatment plans, test results, and progress notes. Furthermore, your doctors must clearly state that your condition prevents you from working. Vagueness or incompleteness of such documents can significantly affect your case. Regular and frequent visits to your health providers ensure treatment, but this also builds a good case history that strengthens one’s claim.
How to Work with a Disability Lawyer
If your claim becomes complicated or is denied, it may be helpful to consult with a LTD lawyer Toronto. An experienced attorney will be able to guide you through the complex legal and procedural demands of an LTD claim. They will be able to help you develop evidence, correspond with the insurance carrier, and appeal a denial. Many claimants are successful in handling the initial stages of a claim on their own; however, if the insurer contests your claim or requires substantial documentation that you may have difficulty compiling, legal representation is particularly crucial.
Independent Medical Evaluations
Insurance companies often request independent medical evaluations (IMEs) to assess your condition. While the term “independent” may suggest impartiality, these evaluations are typically arranged by the insurer and can be biased. However, refusing to attend an IME could harm your claim, so it is important to approach this process carefully. During the IME, provide honest and accurate information about your condition and limitations. Keep in mind that the evaluator is likely looking for inconsistencies. Having your own doctor go over the report of the IME will outline the mistakes and omissions a claimant needs to challenge.
Other Documentations apart from Medical
Other documentation from medical evidence for your LTD are necessary. As stated earlier, personal journals depicting how your impairment has affected or affects your day-to-day activity can be potent. For example symptom lists, as it states day and time to include your medications and what their side effects are. Statements from colleagues, friends, and family members can also add credibility to your claim by providing an outside perspective on how your condition has changed your abilities. The more evidence you present, the harder it will be for the insurer to dispute your disability.
The Importance of Consistency
Consistency is a cornerstone of proving disability under LTD law. Any inconsistencies in your statements, medical records, or actions will just raise suspicion to the insurer. For example, if you claim that you can’t stand more than ten minutes and there you are on social media doing some activities that contradict your claim, that could really hurt your claim. Similarly, discrepancies in what you tell your doctor and what you tell your insurance company will hurt your credibility. It is important to be truthful and precise in every step of the process.
Importance of Employer and Job Documentation
In determining how your condition affects your work, it may be necessary to have documentation from your employer. This can be as specific as a job description that outlines the physical, cognitive, and emotional demands of your job. Comparing these lists to your functional limitations can give a pretty clear picture of why you can’t do your job. If you have employer performance reviews or records of accommodations made for your condition, this can help substantiate your claim by demonstrating how your work abilities have deteriorated over time.
Insurance Company Surveillance
Insurance carriers will often employ surveillance to verify your disability, especially when your symptoms are subjective, like pain or fatigue. This may include monitoring your social media, watching you when you go out, or even videotaping you when you attend your IMEs. To help protect your claim, it is advisable to avoid activities that demonstrate you can perform something you have stated you cannot, and post items online with caution. Many times, innocent posts and innocent activities are taken out of context and used against you.
The Timeline for Proving Disability
Proving disability is not a single event but rather a process. Many policies require the claimant to submit regular updates and medical evidence to prove their continued need for benefits. This means being proactive at all times is key. Continue seeing your doctor, follow your treatment plan, and promptly answer requests from your insurance carrier. Failure to provide timely updates may lead to your benefits being suspended or terminated, even after initial approval of your claim.
Preparing for Denials and Appeals
Unfortunately, too many LTD claims are initially denied, even when the evidence is very strong. If this happens, do not lose heart. You are entitled to appeal the decision, and many denials are overturned in the appeals process. In order to build a stronger appeal, you first need to identify why you were denied and directly address those reasons. This can be done by the submission of additional medical evidence, updated opinions of your treating physicians, and even vocational assessments. Appeals take time, but usually, this is the case of perspiration paying off.
Litigation
Sometimes, establishing that you are disabled may involve litigation. When all appeals have failed, a lawsuit against the insurance company is perhaps the only way to go. This must not be a step considered lightly, since litigation involves a great amount of time and resources. However, litigation can at times result in a favorable resolution, particularly when the insurer’s denial was arbitrary or did not have a good basis. Once you have reached this point, professional legal representation is invaluable in developing an ironclad case and properly representing your interests.
Proving you are disabled under long-term disability law requires careful planning, thorough documentation, and a commitment to consistency. From understanding what the definition of disability is in your policy to marshaling comprehensive medical evidence and responding to insurer challenges, no step is too small. Though the process can be overwhelming, taking a proactive approach and seeking professional help where needed may make all the difference in securing an optimal outcome. Remember, this is a time when one should focus on recovery and well-being while making the best possible case for benefits to which one is entitled.
