Making A Disability Claim

You can claim disability benefits if you suffer a long-term disability (LTD) that impacts how you work and are insured. You need to file a claim supported by the required documents and reports to receiving LTD benefits.

Disability Plans or Programs

There are varying types of disability benefits plans and programs in Canada. Each plan has its eligibility criteria meaning that you don’t automatically qualify for these benefits.

The first step in making a disability claim entails taking stock of the disability benefits you might qualify for. It’s possible to be eligible for more than one disability benefit.

Some disability benefits you may qualify for include:

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Sick Pay from Employer

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Employment Insurance (EI) Sickness Benefits

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Short-term Disability Benefits

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Long-term Disability Insurance Benefits

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Canada Pension Plan Disability

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Disability Tax Credit

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Workers Compensation Benefits

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Veterans Affairs Canada Disability Benefits

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Provincial Disability Benefits or Income Support Programs

Get support from your doctor

To get approval for your LTD benefits to claim, you must prove that you have a disability. You will need to provide documents and medical records from your healthcare providers to prove the existence of physical or mental conditions that impact your ability to work.

The healthcare provider can be any of the following professionals:

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Medical doctor

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Medical specialist

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chiropractor

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physiotherapist

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psychiatrist

Your health care provider will usually:

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Complete a medical certificate to support your LTD application.

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Make recommendations towards improving your symptoms and ability to work.

Complete the application and attach supporting documentation

Your claim application will consist of different forms depending on your insurance policy and providers. Generally, the applications will include the following:

Plan Member Statemen

You will fill in the details about the circumstances of your claim. You will also provide authorization for the insurance company to communicate directly with your health care providers and/or legal representative.

Plan Sponsor Statement

The form is completed and signed by your employer and sent directly to the insurer.

Attending Physician’s Statement

It will be completed by your medical doctor or another medical professional.

Job Description

It will ask for the description of the major duties and responsibilities of your job, as well as any physical requirements of the job. It should be signed by both you and your employer.

Submit the application

You are required to submit the application form alongside all stipulated documents and reports to the insurance provider. Some insurance companies will ask that you mail, fax, or email your application form and other information. Usually, the insurance company provides complete instructions about where and how to apply.

There are time constraints/deadlines for submitting a claim application. Always confirm with your insurance company or personal injury lawyer what the deadlines are so that you don’t affect your chances of getting approval for your claim. Missing a deadline may mean having your claim denied.

Claim Assessment

Following the submission of your application, your insurance provider assigns a case manager/adjudicator/claim representative to your case to review the application and offer their assessment.

The case manager will interview you via telephone or home visit to evaluate the following:

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the provided medical information

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how the condition affects your ability to complete your job

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the occupational demands you face

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the ability to complete daily living activities

The case manager may also do the following:

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reach out to your healthcare providers

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reach out to your employer

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request that you take an independent medical evaluation arranged and paid for by the insurance provider

The assessment period takes anything between 7 and 30 days, after which your LTD benefits application will be decided.

Outcome

If your claim is approved, your insurance provider will notify you and your employer in writing. The written notice will outline the amount and length of time you will receive benefits. The benefits are paid monthly.

If your claim is denied, written notification is given in writing outlining the reason for denial. You have the opportunity to appeal the decision.

Seek Legal Advice

The process of filing an LTD claim can be a lengthy, difficult, and confusing process. Policies differ markedly between insurance providers. The submission of an incomplete and inaccurate application lead to the claim being denied.

Get the help of a disability lawyer or personal injury lawyer towards understanding the details of your policy, guiding through the process, reviewing forms, notifying you of approaching deadlines, and dealing with the insurance company. Ottawa Disability Lawyers will do everything in their ability to secure timely and acceptable benefits. Insurance companies deny claims or offer a lower amount even when an individual has a legitimate claim for long-term disability benefits.

Contact Ottawa Disability Lawyers for a free consultation and help with long-term disability claims. We focus on representing our clients against all major insurance providers in Canada.

Making A Disability Claim