If you get disabled and consequently unable to work, you expect your disability insurance to help you meet at least some of your financial obligations. Unfortunately, this is not always the case as a large number of disability claims are denied. So what do you do when your claim is denied? Do you try to find alternative ways of financially supporting yourself and your family? Considering your health status, your alternative sources of income may be limited. Even if you had saved some money, you may end up spending most of it in therapy expenses related to the disability. The solution is appealing the disability denial and this is where a disability appeal lawyer comes in. Remember that disability benefits are your right and not a favour from the insurer. Even where you have not been paying for the insurance directly, your employer has been deducting your salary to pay for it.
Common Reasons for Denial of Disability Claims in Canada
The most common reason given for denial of disability claims is that the medical condition does not meet the insurer’s definition of disability. For you to be considered disabled, your medical condition should prevent you from performing the requirements of your current job. After meeting this criterion and receiving benefits for 104 weeks, the eligibility criteria changes. You are then required to demonstrate that your disability prevents you from performing not only your previous job but any other job for which you are qualified.
Failing to comply with the insurer’s request for medical examinations, documents and information is also a common reason for denial of disability claims. Insurance companies will often require you to attend a medical examination with their appointed medical practitioners to help them verify your condition and its severity. Always try to comply with these requests, however stressful they may be,lest you give the insurer a reason to deny your claim.
Your disability claim may also be denied based on the definitions of “disability” and “impairment”. This includes the duration for which a condition must have lasted for it to be considered as a disability. If the insurer believes that your condition has not met any of these thresholds, it will deny your claim. Generally, disability claims are handled technically and you may need a disability lawyer to succeed even on appeal.
Do you need a Disability Appeal Lawyer to Lodge an Appeal?
In Canada, there is no legal requirement to hire a lawyer when lodging a disability appeal. However,it is in your interest to have one on your side to increase your chances of success. Many claims are denied on technical grounds which you may not address appropriately in your appeal without the assistance of a disability appeal lawyer. A lawyer will also handle your appeal in a way that will not compromise your chances of success if you are later forced to sue the insurer.
How to Win a Disability Appeal Case
The following points should increase your chances of success in your disability appeal.
With the current high rate of denial of disability claims, you may be tempted to exaggerate the symptoms of your disability, hoping to increase your chances of success. However, this may make the insurer to consider your claim invalid. Once your initial application is exaggerated, your chances of success on appeal are slim as the entire case will be founded on falsehood. Changing your grounds later to reflect the true state of your health will only worsen the case by portraying you as being not genuine and diminish your chances of success.
Hire a Lawyer without Delay
When you are disabled, you will spend most of your energy in trying to overcome the disability. You may have made your initial application without a lawyer hoping that the insurer will accept it. If the claim is denied, that means more work for you. If you try to handle your disability appeal by yourself, chances are that you will be overwhelmed and fail to meet the timelines within which you are required to appeal, further complicating your claim. Additionally, a lawyer is best placed to handle a disability appeal because they understand the process and the technical points to address.
After going through the claims’ process only to have your claim denied, you may be inclined to accept defeat. However, denial of your initial application is not the end, with a valid claim, a disability lawyer will help you get your rightful benefits despite the initial denial. Never feel intimidated by the insurance company. A disability lawyer is all you need to level the playing field.