MA Disability Lawyers have helped many find themselves in your situation: you’ve been a model employee but sadly suffered an injury or illness which now prevents you from working.
So, what do you do now?
You have a right to apply for long-term disability benefits, otherwise known as LTD benefits. These benefits supplement your income to help support you and your family financially while you cannot work.
What is the source of these benefits?
You either receive LTD benefits through an insurance plan you have privately purchased or through a plan offered by your employer as part of benefits available to you when starting your employment.
If you suffer a disability but were not in the workforce at the time of injury or illness, then you must apply for similar benefits through the Ontario Disability Support Program.
What injury or illness qualifies me to apply for LTD?
This will largely depend on how your insurance plan has defined the term “disability.” There are both physical and psychological related medical conditions or injuries which may qualify you.
Prior to the COVID pandemic, many suffering from mental health issues struggled to obtain coverage. However, such health issues are now more prevalent and therefore recognized and accepted as the basis for many LTD claims.
Do I need medical support to apply for LTD?
Before applying for benefits, discuss your condition with a trusted healthcare provider, as he or she will have to support your application. In other words, a medical professional has agreed to vouch that you have a disability that prevents you from working.
It is important to discuss this with your healthcare provider before you stop working as otherwise, you will not qualify for LTD benefits.
Who qualifies as a healthcare provider?
Persons who can support your application must fall into one of the following professions:
- Chiropractor
- Medical doctor
- Medical specialist
- Psychiatrist
- Psychologist
Where do I get the forms to apply for LTD?
If you have purchased your insurance privately, you can contact the insurance company directly to request the application package. Otherwise, you can request the package directly from your employer.
How do I make sense of the application package?
Understanding the types of documents contained in your package and their purpose will help you manage the process better.
The Application package generally consists of 3 documents:
The Employer Statement (completed and submitted by your employer)
This is a standard form that employers are familiar with. The purpose of this form is to let the insurance company know who you are and what your job consists of. It also provides basic information such as how much you earn, how long you have worked, and how you have performed at your job.
The Employee Statement (completed and submitted by you)
The employee statement should be completed accurately and to the best of your knowledge. Take your time; don’t rush it, and make sure you have answered every question asked of you. After all, this is your chance to tell your story and to explain what you have suffered and how it has affected you and your inability to work.
It is your responsibility to make sure this form is given to the insurance company. Some companies will accept this online, whereas others will require a paper copy. Make sure you know which is preferred before you start your application.
The Attending Physician’s Statement (completed and submitted by your healthcare provider)
This statement is by far the most important document insurance companies consider when assessing your LTD claim. Being honest with your doctor about your condition, symptoms and ability to work is crucial.
Your job is to give your provider with a blank copy of this statement and he or she will complete it. Best to book an appointment with your doctor first. He or she will answer questions regarding your symptoms, diagnoses, prognosis, etc. Don’t worry, your healthcare provider is familiar with this form and will complete it in support of your disability claim.
When do I have to submit my application by?
When getting your application package make sure you know how many days you have to submit your statement. Different companies have different deadlines and it’s best to get your application in before or on the day of the deadline.
I’ve submitted my package what’s next?
The insurance company will assign you a case manager who will likely be your point of contact throughout the process.
This will start with a phone call to discuss your application. Be prepared to answer questions such as:
- When did your disability start?
- What caused your disability?
- How has your disability affected your day-to-day activities (for example: what can’t you do now that you used to be able to do)?
- How has your disability limited you from working?
- What efforts have you taken to get better (for example, medication, therapy, counselling, etc.)?
Again, this is another chance to tell your story, so take your time and answer as best you can.
Sometimes, the claims manager may ask for additional information or documentation; don’t worry, as this is part of the process. However, you must ensure you get the information or documentation to the insurance company on time.
How do I know if my claim has been accepted?
Once your case manager has interviewed you and has received the various statements from you, your employer, and your healthcare provider, he or she will then decide whether you should or should not receive LTD benefits.
Generally, this process takes about a month after which you will be notified of the decision by phone and in writing.
If you are approved, you will be notified of the process and the amount of LTD benefits you will receive each month.
If you are denied, you will be provided with the basis for the denial and a right to appeal.
My LTD application has been denied now what?
At MA Disability Lawyers, we are here to help you with what comes next. We have helped many people in your situation who feel defeated and need help to get the benefits they rightfully deserve.
If you have any questions about what you’ve read so far or find the process of applying for benefits overwhelming, please give us a call and let us walk you through it step by step. Our job is to make the process as easy as possible and to increase your chances of being approved in the first place or approved after the initial denial.
Contact MA Disability Lawyers for a free consultation. We’re on your side.
