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Tips on getting your Long Term Disability Claim approved (Ontario)

Our law firm often gets calls from soon to be Long Term Disability claimants asking our lawyers to fill out their forms. We realize that the LTD application forms can be overwhelming, complex, with some hard to answer questions. Not all questions can be answered in a “yes/no” fashion.

Filling out LTD application forms is not something which our lawyers do. But, we can help give you a few tips on how to get your Long Term Disability claim a fighting chance of getting approved. Without further ado, here are Goldfinger Personal Injury Law’s tips on how to get your LTD claim approved at first instance:

1. If you want a benefit, you first need to apply for it! This seems like such a simple premise, but you would be amazed at how many people don’t understand it. Your Long Terms Disability benefits won’t just land magically in your lap without you first applying! Do you really think that an LTD insurer wants to pay you money without you not even yet applying for said benefit? LTD insurers don’t exist to give away money for nothing… There are mounds and mounds of forms which need to be submitted. And just because those forms have been submitted, doesn’t mean they will be looked at in a timely manner. Get those application forms submitted, and don’t sit around on it. There are  provisions in every LTD policy our lawyers have seen with respect to the timing of the application in relation to the last day you may have worked. Waiting around on getting that application in will jeopardize that timing and may give the insurer a reason to deny your LTD claim for failure to abide by the limitation periods as set for in the LTD policy.

2.  Make sure that your family doctor or specialist is on board with the LTD application. You will need a doctor or specialist to complete a medical certificate in support of your LTD application. If your family doctor or specialist doesn’t believe that your disabled, chances are the medical certificate which s/he completes will also NOT support your LTD application. That unfavourable medical certificate will give the LTD insurer a reason to deny your claim. If you have a more supportive doctor of your disability, consult that doctor for his/her assistance in completing the medical certificate.

3. Less is sometimes more when it comes to how you feel or a description of your disability. There may be a section in your LTD application which ask how you’re feeling, or to describe your pain, injuries, functional status or disability. Some people feel the need to write a novel in this section, attaching pages upon pages of addendum such that the LTD application becomes a book. The ability to write coherent thoughts is a skill which requires concentration, logic and attention to detail. If an LTD claimant writes a rather eloquent, clear, and lengthy disability summary expressing that they cannot sit, think, concentrate or put together coherent thoughts, preventing them from writing, typing, etc.; then something doesn’t jive! The insurer may not know that the summary you prepared took you weeks, or that your spouse wrote it. Don’t contradict yourself in this section. Let your medical records do the talking. Less can be more.GoldFingerBanner

4. Let your medical records do the talking. You Long Term Disability insurer will want to see pre-disability and post disability medical records. Why? Because the medical records are the evidence upon which each and every Long Term Disability case is made or broken. It’s not enough to rely on self serving evidence of you stating that you’re disabled. Of course you’re going to state that you’re disabled when you stand to gain the most out of the claim. LTD insurers need to see medical evidence to corroborate your claim for disability benefits. And if you are in fact truly disabled, your medical records will show that. Seeing a psychiatrist, surgeon, physiatrist, counselor, psychologist, neurologist, rheumatologist….all of these factors point to something wrong with your mind or body. A healthy person would NOT be seeing these doctors/specialists if nothing was wrong with them.

5. You have to jump through some hoops. Rule of thumb: if you want the insurance company’s benefits, then you have to play by their rules. The reality is that you didn’t draft your long term disability policy. You probably have never even read it until you realized that you needed to apply for LTD benefits. Within that policy, it will contain a litany or rules, procedures, and protocols. The wording of these policies isn’t there to protect you. Rather, it’s there to minimize the insurer’s exposure in your case. There are likely provisions in your policy stating that if requested, the insured is required to produce medical records. Or, if requested, the insured is required to attend at a medical examination with an expert of the insurer’s choosing. The wording contained in these policies makes it such that if you refuse to co-operate with the insurer’s request(s), you may be found in non-compliance with the policy. If you’re found within non-compliance with your LTD policy, then the insurer has reason to deny your LTD benefits. No doubt, these requests need to be made within reason. But having said that, if you refuse to jump through their hoops, then don’t expect the insurer’s LTD benefit to flow.

6. Watch what you say over the phone with the adjuster. All of your phone calls with the adjuster will likely be recorded. What you say, can and will be used against you in your case or in the assessment of your LTD claim. Be careful of what you say.

7. Social Media will hurt your case! If you have Facebook, Twitter, Instagram, Snapchat, etc., those social media posts will be found by the insurer, carefully analyzed and scrutinized. There are investigators who are entirely devoted to tearing down you and your claim based on your social media posts. It’s not even the posts or photos that will jeopordize your claim. Even if you’re on line playing a game for long periods of time like Farmville, BeJewelled, Clash of Clans etc; an insurer will draw a negative inference towards that activity. They will suggest that it requires prolonged sitting or concentration. They will also suggest that if you can stare at a screen for a prolonged period of time, then perhaps you will be suited to performing a data entry job. This would not fare well towards the LTD application.

 

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