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Getting the most out of your Long Term Disability or Critical Illness Application (Ontario)

Long Term Disability Insurance, and Critical Illness insurance are both “living policies“. They differ from a death benefit or life insurance policy in that the insured is still alive and the beneficiary; while alive; is able to recover the benefits.

In a “death policy” or “non living policy” only the designated living beneficiary, trust or corporation can recover the benefit. Somebody will need to have died in order to make a claim or recover benefits.

When making a claim for long term disability or critical illness benefits, it’s important to know what you’re getting in for.

Those application forms and questionnaires are very important. They are source documents for your case. They will go on to provide evidence upon which an insurer will use to potentially defeat your claim. These forms will also be scrutinized by a Judge or Jury with respect to how they were completed, what they say, and even when they where filled out.

There are some important considerations before applying for LTD or critical illness benefits. What this Toronto Injury Lawyer Blog Post hopes to accomplish is providing you some more insight to distinguishing from a successful vs. an unsuccessful LTD or critical illness claim.

  1. Is your family doctor or treating physician supportive of your claim? This is a very important question. If your family doctor or treating physician does not believe in your disability, then chances are the information which they completed on the application form will NOT be helpful. You will have no way of knowing this until you see what your doctor writes of the application form or questionnaire itself. Some doctors refuse to hand out completed forms or questionnaires directly back to their patients. Instead, they will mail or fax them directly back to the insurer. By doing so, the patient/applicant has no chance to see what the doctor has written down. There is no way for the patient/applicant to see if what the doctor is writing is helpful, accurate or not. Doctors aren’t perfect. Even they have been known to make mistakes from time to time. If you know that your doctor or treating physician won’t be supportive of your long term disability application, perhaps having a chat with them to understand their reasoning will be helpful. Or, maybe it’s best to have a more supportive doctor complete the form for your LTD or critical illness benefits.
  2. Fill of the LTD or Critical Illness application in a timely manner. The longer you wait to get the forms filled out and sent to the insurer, the greater the chance that a time period will lapse. Every policy will have different waiting or application periods. These timelines differ depending on what the policy says. Find out from your insurance adjuster and the policy itself how long you have to send in your application form. Failing to meet these time periods MAY be a bar to your claim. Or, it may simply make the approval process that much more difficult or slow. You want neither of those options.
  3. Be careful what check marks you complete on the form or questionnaire. These forms and questionnaires are designed by insurers. Their questions are tricky! They are designed to trap you in a corner and defeat your claim. If you aren’t sure about an answer, what box to tick off, talk to a lawyer about it. The ramifications for completing a form incorrectly can be devastating.
  4. Send in your application by fax, email and registered mail. Multiple ways of sending in your application will safeguard against the insurer coming back and telling you that they never received your LTD or critical illness application. Whatever way you chose to send it, make sure you have proof it was sent in case you get an answer from the insurer that it didn’t arrive. If you drop if off, then get something stamped in the mail room indicating that the package has been received.
  5. If your application for LTD benefits gets denied, don’t appeal! Instead, call a lawyer right away. By appealing your LTD application, all you’re doing is playing in to the insurer’s hands of helping them establish a pattern of independent denials. The more denials which pile up on your claim, the more people they can say all independently examined the LTD claim and deemed it deficientLondon Head Shot Brian Goldfinger
  6. With your LTD or Critical Illness Application, be prepared to submit medical records to the insurer. Your medical records will form the basis of the evidence in your LTD or Critical Illness Claim. Without proper medical records or medical evidence, the insurer will deny your claim. Unfortunately, the insurer will likely NOT reimburse you for the production of these medical records prior to the litigation stage. You will have to pay for these records out of your own pocket.
  7. Be mindful of what you say over the phone to the insurance adjuster. The insurance adjuster will be taking careful notes of your conversations. Some conversations may even be recorded. If you tell the adjuster that you’re “doing well“, “fine” and that “everything’s great“, then this will likely not lead them to believe that you’re disabled. If however you’re not doing well, then let the adjuster know exactly what’s wrong with you. Failing to articulate your injuries or medical problems in a cogent and coherent matter is problematic for a long term disability case. You have to be able to express your injuries so that people understand what you’re dealing with everyday.
  8. Be mindful of what you do, and what you post on the internet. Surveillance is a real thing. It’s very cheap for an insurer to retain a private investigator for $2,000 or so as opposed to paying you $2,000/month in LTD benefits. This makes financial sense for the insurer. Keep in mind that they have unlimited resources to defeat your claim. So, if you’re claiming a disability on account of nagging back problem, but then you go to the cottage for a water skiing session which is caught on tape; this will not lend well to your long term disability case, or your credibility. In addition, if there are picture of you posted on Facebook of you working, or doing something contradictory to your disability, this too will not lend well to getting your claim approved.
  9. After you get denied, call a lawyer right away. Don’t wait. And certainly don’t give up.
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