If you are fortunate enough to have access to a policy that provides you with income during a period in which you become unable to work congratulations. However, what happens when the provider of that policy (Sunlife, Great West Life, Desjardins, Industrial Alliance, Manulife, SSQ, RBC) decides that your disability is not severe enough to prevent you from working? This is known as a denial of disability benefits. A denial often worsens the mental stress and anguish you already suffer from due to your disability. Here are five things you should do if your short term or long term disability claim has been denied.
1) The first thing you should always do when you have a medical condition is seek the assistance and support of your family doctor. They will provide you with the advice and treatment you need to feel better and get you back working as soon as possible. Be sure to follow whatever recommendations or treatment plans they make. Doing otherwise may compromise your entitlement to LTD benefits and more importantly, your health.
2) You should also apply for other private or governmental benefit programs you may be entitled to, such as the Ontario Disability Support Program (ODSP), Canada Pension Plan Disability (CPPD) or the Income Replacement Benefit (IRB) if your disability was caused by a car accident.
Since you have been denied short term or long term benefits, accessing the above noted benefits can act as a safety net and carry you through tough financial times. Applying to these programs may decrease any disability benefit you eventually receive from your insurer.
There can be consequences if you are entitled to one of these benefit programs and fail to apply for them. Most disability policies allow your insurance company to estimate how much you would get under one of these benefit programs and deduct that estimated amount from your short or long term disability benefits. This is typically known as an “offset”.
3) Many long term disability insurance companies offer claimants the option to appeal a denial. Typically, you should not appeal your denial. These appeals are usually unsuccessful, however if you proceed with an appeal ensure you have as much medical documentation as possible before doing so. Appealing a denial is, in theory, the most time efficient and cost effective way to get your benefits going again. In practice, it is the least successful method and arguably the most frustrating and aggravating way to try and get your benefits back. Most denials must be appealed within twelve months. This can vary by company and policy. Generally, Ontario law restricts the time you have to start a lawsuit to two years, if you choose to go that route.
4) If you are unsure about what to do about your claim following a denial, consult a disability lawyer. Many disability law firms, such as TSF Law, offer free consultations and handle your case without taking fees until it settles. You may lose your right to sue if you wait too long to speak with a lawyer or appeal your claim.
5) Lastly, do not get angry and lose your temper on your employer or your long term disability claims representative. This is extremely personal for you, and an emotional time, but disrespecting the claims representative will not lead you to a better outcome. If you have been denied disability benefits, and are becoming increasing anxious and depressed, do not go it alone. Feel free to contact our office to discuss your options and get answers to any questions you may have.