In this article I discuss four important things you need to do while preparing your application forms and before you send them in to the insurance company.
Insurance companies routinely deny applications they know to be legitimate. Therefore it is not enough for you to prepare an application that shows you meet the basic criteria for payment; rather, your goal has to be to make it as hard as possible for the insurance company to deny your legitimate application.
You do this by avoiding the traps that they set for you during the application process and by gathering overwhelming evidence in your favour. It is only when there is overwhelming evidence in your favour that the insurance adjuster will worry about denying your application. He or she will approve your application, and then move on to deny the applications of other people who make easier for them to do so.
This article is part of our Ultimate Guide to Long-term Disability Benefits. Click here to learn more.
Four things to do before you apply for long-term disability
1. Read Your Insurance Policy
One of the first things you need to do is get (and read) your group benefits booklet. This seems like common sense, but most people I meet have not seen their disability insurance booklet or insurance policy, and the only information they have is what the insurance company representatives have told them in letters and emails.
You get the group benefits booklet from your group benefits plan sponsor, which will be your employer, union or professional organization. Most often they will give you a paper booklet, but sometimes this information is only available online, so they may direct you to a website. Once you have your benefits booklet (or have found the online information) read though it and try to answer the following questions:
- Do I have short-term disability benefits? If yes, how much is paid per week? What is the maximum number of days or weeks paid
- What is the waiting period for long-term disability benefits?
- What is the formula for calculating the long-term disability monthly payment amount?
- What is the benefit period for long-term disability benefits? Is it a specific number of years (i.e., 2, 5, or 10), or is it payable to a certain age (i.e., age 65), or is it some combination of both (e.g., payable for 5 years or to age 65, whichever happens first).
- What is the definition of total disability?
- Is there an “own occupation” clause? If so, how is it defined? How many months or years will the occupation criteria apply?
- Is there an “any occupation” clause? If so, how is it defined?
- Are there any other restrictions on payment of benefits?
2. Decide when to stop working
Deciding on what day to stop working is one of the most important decisions you will make. Most people give this no thought at all and just stop working on any random day. Picking the wrong day to stop working can guarantee your claim will be denied and can make it very difficult for you to win at court, even if you are legitimately disabled.
Most people lose the ability to work gradually over time due to chronic illness or injuries. If this sounds like you, then you need to start preparing to apply for disability insurance benefits while you are still working. If your disability arises from chronic illness, then you have to be very strategic on when you decide to stop working, if your intention is to qualify for disability insurance benefits.
Understand that you will only qualify for disability benefits if you can prove that you far exceed the definition of “total disability” that is found in your policy. Every insurance policy or plan has a different definition. Therefore it is critical that you not stop working until you are confident that you can get evidence to show that you far exceed the insurance company’s criteria.
If the insurance company denies your application, the insurance company and its lawyer will carefully examine and question why you chose to stop working on the day you did. This becomes difficult for you to answer if you worked for weeks and months up to the day you went off work. You need to make sure your medical records show that you had a gradual decline over time and justify your decision to stop working on the day you did.
Most people give no though to when to stop working and this is a big mistake. It is not enough to just rely on your doctor’s advice to stop working (because you know that insurance company’s routinely ignore doctors). It is not enough to just rely on your employer’s opinion that you can’t do the job. When deciding when to stop working you need to review your disability benefits plan; review your entire doctors file; and then choose a date that you can support with overwhelming evidence.
3. Make sure your doctor supports you
It is critical that you not stop working until your doctor supports your decision to do so. The insurance company will never approve a claim for a person who does not have full support from his or her family doctor. Remember, they will likely deny your claim even if your doctor supports, you, so if your doctor is not supportive, or is just neutral, then you have no chance.
What do you do if your doctor doesn’t agree that you are unable to work due to disability? This is a difficult situation that you need to handle very carefully. Understand that doctors are human and there is a wide range of competence, attitudes and biases between individual doctors.
You have a few options depending on why you believe the doctor is not supportive of you:
A. You doctor needs more convincing: With chronic illness it is hard to say when it becomes unreasonable for someone to keep working. It is hard for a doctor to know when you cross the line from being reasonably able to work in discomfort to it being unreasonable for you to work. Sometimes all that is needed is for you to show to the doctor that you have done all you can do to remain employed. A lawyer experienced with disability benefits cases can give you examples of how you can show your doctor that you have done all you can do. There is no dishonesty or trickery involved.
B. Your doctor is incompetent or biased: If you truly believe you cannot work much longer, and have taken steps to show your doctor you have done all you can do, and your doctor still doesn’t support you, then you need to get a new doctor. There is a wide range in competence and attitudes between doctors in Canada. Just because your current doctor doesn’t support you, does not mean you that you can’t qualify for disability benefits. Your doctor may lack an understanding of your illness or condition, or he or she may simply be biased or prejudiced against anyone who applies for disability benefits. Such doctors are rare, but I have certainly encountered them in my law practice and they create problems for their disabled patients. Changing doctors should always be the last resort and only done after you are satisfied that you hare really done all you can do to show the doctor you legitimately cannot keep working.
4. Make arrangements with your employer
Once you have informed your employer you can’t work because of disability, an have a medical note from your doctor confirming this, your employment will be protected under provincial labour laws and human rights codes. From a legal point of view, there is a big difference between resigning (or quitting) your job and having to leave of absence from work for medical reasons. While on medical leave you continue to have the status as being “employed”, which continues your participation in your medical and dental plan, pension plan, and other workplace benefits.
Do not impulsively quit or resign from your job. Most people are better off taking a medical leave from work, as opposed to resigning or quitting. There are some situations where it makes sense for you to resign, but your need to carefully consider such a decision. Impulsively quitting or resigning your job can cause all kinds of unnecessary problems for you: You may un-necessarily lose entitlement to other workplace benefits, like your medical and dental plan. You open the door for the insurance company to deny your application on the basis that you quit your job for reasons other than disability. By quitting earlier than you need to, you can cost yourself tens of thousands or in some cases hundreds of thousands of dollars. You want to avoid all of these problems. You employer may want you to quit, resign or take a severance package because it is financially better for them.
You absolutely need to prepare BEFORE you submit your application for disability benefits. Do not make the mistake of blindly moving forward with your application. If you have a serious disability, it is important that you give yourself the best chance of having the insurance company approve your application. It is not enough for you to prepare a valid application — insurance companies knowingly deny valid applications all the time. You need to prepare an application that presents overwhelming evidence in your favour. Your preparation needs to start before you start filling out your application forms.
Still feeling unsure about your long-term disability claim? Sometimes a quick call with us can help you move forward with confidence. Call us at 1-888-732-0470 or click on the chat icon to start a conversation.