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Injuries and illnesses like depression, anxiety, chronic pain and fibromyalgia are often referred to as ‘invisible’ because they have no outward signs. But they are just as real as a broken hand or leg and can be severe enough that a person suffering from one is unable to work.
If that’s the case, they need the support of the long-term disability benefits offered by the insurance policy either they or their employers pay for. Unfortunately, because of the nature of these conditions, it’s a lot easier for insurance companies to deny the claims.
If your claim for LTD benefits was denied, don’t be discouraged or intimidated, for disability lawyers in Toronto this is just a routine part of the process for getting their clients the benefits they deserve. But speak to one right away, there is a time limit to take action that starts running as soon as you get the denial letter.
What’s the Process, How Does Someone Get LTD Benefits?
While each insurance policy is different, to be eligible for long-term disability benefits, a policyholder has to show that as soon as they were injured or became ill, they sought out medical care and have been receiving treatment ever since. They must be able to describe how, specifically, their injury, illness or condition prevents them from completing tasks that are essential to their work. Some policies also require that an employee has used up other supports like sick leave, short-term benefits or Employment Insurance (EI) sickness benefits in order to qualify for benefits under their long-term disability policy.
An employee will fill out the top portion of an application for LTD benefits, have their doctor or specialist fill out another portion and their employer must also fill out a section which they usually send directly to the insurance company.
It takes some time after the employee sends the application to the insurance company before they receive a response. Often, you will be called by the insurer and interviewed. Insurance companies, however, routinely deny the application, even for physical or “observable” injuries. This is when most people seek the help of an LTD lawyer.
The process is the same for an insured employee who is suffering from an “invisible” illness, injury or condition. The difference is the denial rate is a lot higher.
LTD Claims and ‘Invisible’ Injuries and Illnesses
“Invisible” disabilities are called that because there is no ‘objective’ way to show or measure them through traditional tests and imaging equipment like blood tests, X-rays and MRIs. They include conditions like:
- Chronic pain
- Post-Traumatic Stress Disorder (PTSD)
- Soft tissue injuries
- Traumatic brain injuries (TBI)
It’s easier for the insurance company to dismiss these claims, and they do, because that lack of observable, objective evidence means the application for LTD benefits relies solely on the employee’s subjective description of the pain or mental illness they are suffering.
When that happens it’s crucial that the insured employee seeks out a lawyer. There is a strong temptation for many in this situation to give up, feeling there’s nothing they can do.
But as with physical or observable injuries and illnesses, a denial letter for an invisible injury or illness is just a routine part of the process of getting LTD benefits.
How a Lawyer Gets their Clients the Benefits They Deserve
No matter the reason for the disability, if it prevents you from being able to perform a significant part of your job, an LTD lawyer can still get you your benefits after the insurance company denies your claim.
Your lawyer will contact your doctor(s) and start putting together a package of records and other evidence that shows you are, in fact, disabled. The vast majority of the time, when an insurance company receives this package from a lawyer, they are willing to negotiate a settlement that gets you the benefits you need and deserve.
In other cases, your lawyer will file a lawsuit against the insurance company but the end result is the same – you get your benefits and can start focusing on improving your quality of life.