Going out on long-term disability leave and filing claims are often particularly daunting for sales agents and representatives. Whether you work for a larger company that’s able to have others represent your interests—and protect your clients—in your absence, or you’re working on your own, you may feel that going on long-term disability can have serious repercussions for your career.
Unfortunately, that leads all too many sales agents and representatives to wait too long to take long-term disability leave. As a result, you may find it more challenging to get the full range of treatment you need, and it may actually take longer for you to get back to work.
However, working with a lawyer can help prepare you for the challenges potentially associated with long-term disability claims and help you protect your job when you return.
Preparing to Go on Sick Leave
Chronic medical conditions cause a high percentage of long-term disability claims for sales agents. In fact, they are the most common reason for those claims. Chronic medical conditions, in general, tend to get worse over time, rather than leaving you suffering from sudden symptoms out of nowhere. As a result, you will likely have time to plan ahead.
Understanding your long-term disability policy
As you prepare to go on sick leave, the first step is understanding your company’s long-term disability policy. Get a copy of your benefits booklet and take a look at the long-term disability benefits. If you need to get a copy of an individual policy rather than an employer’s, you can ask your broker for a copy.
As a sales agent or representative, there are several key questions that you must ask yourself when reviewing your insurance policy, group benefits booklet, or other long-term disability benefits that you may use to help cover your leave.
1. What type of policy do you have?
Is it an employer-sponsored policy, often a group policy? An individual policy? You need to know what type of policy you’re using and what coverage you likely have as you start planning to take advantage of those benefits.
2. When does long-term disability start?
It can take time for long-term disability to kick in—between 90 and 180 days after you leave work, depending on the terms of your policy. Make sure that you have a solid understanding of when your policy will kick in so that you can prepare accordingly.
3. What short-term disability options do you have while you wait for long-term disability to kick in?
Short-term disability benefits can help bridge the gap between your usual paycheck and your long-term disability coverage. It’s critical, however, that you know what options you have so that you can take full advantage of those policies.
4. How does the provider define ‘disability,’ and what limitations does the provider place on your ability to file for disability?
Often, long-term disability policies will include a relatively narrow definition of disability that will define when you can apply for coverage. Does your policy require you to be totally disabled in order to make a claim, or does it include partial disability clauses? Particularly if your policy only covers total disability, you may also need to consider how the policy defines “total disability” and what disabling conditions will likely qualify.
Furthermore, look into how long your policy will allow you to claim “disability from your occupation” versus “disability from any occupation,” which may determine how long you can take advantage of disability payments.
Protecting your job
Before you go on disability, you need to take several steps to help protect your job when you’re ready to return.
1. Let your employer know about your disability or condition
One mistake sales representatives often make is not notifying their employers that work is suffering as a result of a medical condition. Chances are, your employer can see the fact that your work is suffering. Suppose you don’t notify your management team about your medical condition. In that case, they may assume that your work is suffering for other reasons: you have lost interest in the job, for example, or aren’t putting forth enough effort. Ideally, you need to make them aware of your disability as soon as possible.
Once your employer is on notice regarding your medical problem, they can’t fire you before you make a disability claim. However, if you don’t give your employer all the information, they can. What’s more, if you inform them about your medical concerns after the fact, it could look like you’re making it up.
2. Look into your employer’s job description for your position
Does your employer have an accurate job description? If not, it’s time to update it, if at all possible. When you return from disability leave, you want to be able to return to your former position. Without a clear job description, it may be harder to step back into your former role—or to prove that your employer has not made that position available to you.
3. Determine how your employer typically treats employees going on sick leave
Pay attention to how your employer has handled other employees going on sick leave in the past. Do they try to claw back commissions? Do clients often get transferred to different representatives? Will they potentially give away your territory?
Will you need to fight to protect your rights?
If your employer has a history of treating people poorly, you will need to plan ahead. Get legal advice from an experienced disability attorney so that you can protect your rights and your job.
Applying for Short and Long-Term Disability Benefits
Once you have taken the steps necessary to prepare for long-term disability and determined what you might need to do to protect your job as a sales agent, you can get ready to apply for short-term and long-term disability benefits.
Short-term disability and why you may need it
Typically, you cannot apply for long-term disability immediately, unless your policy includes a partial disability clause. Most policies require you to wait for between 90 and 180 days before you can apply.
During that waiting period, however, you can apply for short-term disability insurance. Short-term disability insurance can help you manage your expenses and provide a source of income during that time period.
You can also apply for EI Sickness Benefits, government sickness benefits that provide financial assistance to individuals who are unable to work because of injury or illness.
When should you start working on your long-term disability application?
You do not have to wait until you have hit the 90 or 180-day mark before you start working on your long-term disability application. In fact, in most cases, you will want to start working on that application well ahead of time. If you think it is likely that you will still be unable to work within that time period, you should start your application as soon as possible.
Get the forms from your employer or the insurance company, and work with your care provider to get them filled out with full, accurate information.
By starting the process early, you can be better prepared to handle any challenges that may come up and put yourself in a better position to start getting those long-term disability payments as soon as possible.
Sales representative applications for long-term disability are often much more complicated than the applications for most other jobs. Job duties can vary widely, even between representatives with the same company. Having them described accurately during the application process can increase the odds that your long-term disability will be approved.
Appealing a Denial of Long-Term Disability Claims as a Sales Agent
If your claim gets denied, you aren’t stuck. You have the right to appeal. Often, however, the process for appeals will not be described in your policy or benefits booklet. Working with a lawyer can make it much easier to effectively appeal a claim denial and increase the odds that you will get the payments that you deserve.
The denial letter
You will get a denial letter from your insurance company that lays out the reasons why your claim was denied. Some examples include a lack of a clear medical diagnosis or detailing of how your disability impacts your ability to function. However, while these may be the official reasons, there may be other reasons that the insurer hasn’t (or won’t) put in writing.
How to appeal
You appeal a long-term disability benefits denial by putting together a letter that gives the reasons why you disagree with the insurance company’s decision to deny your claim. You may need to:
- Fill in gaps in the information you initially presented. For example, you may need to provide additional medical records.
- Establish the limitations posed by your disability, and how they impact your ability to complete your job duties clearly.
- Include unwritten reasons for denial as well as the written ones.
A lawyer can help you put together an effective, compelling letter, from helping you understand the reason for the claim denial to pulling together more evidence and resources based on your medical needs.
Unique Challenges of Long-Term Disability Claims for Sales Agents
Sales agents and representatives may have some unique difficulties in managing their long-term disability claims.
1. Proving your job duties
Insurance companies typically rely on the Federal government’s National Occupational Classification (NOC) description of job duties for sales representatives and most other professions.
Sales, however, is one of the most broad categories in the NOC, and it contains multiple subcategories. You must make sure that the category that the insurance company uses to classify your job is correct for your situation.
Complicating the situation further, your employer may not have an up-to-date job description for you. It may be inaccurate or fail to include all the job duties you have taken on over your tenure with the company. The insurance company will typically, however, try to rely on that description as a basis for your disability claim even if it no longer accurately reflects your work.
Generally, your employer will fill out an insurance form that will ask them to describe your duties. The person filling out the form, however, may face problems like these:
- They may not be familiar with your work, which means they may fill the form out generally rather than specifically.
- They may not know what your actual job duties entail.
- If they do not understand the importance of the form, they may not put a lot of time and effort into it.
The form will usually go directly to the insurance company, not through you. However, you should ask for a copy of the form so that you can review it for accuracy.
2. Proving your work is more than a sedentary job
Insurance will often try to prove that your job is easy by emphasizing the physical aspects of your role. The company may claim that it is a sedentary job with relatively light duties. That strategy, however, ignores the psychological and mental aspects of the job as well as the stressful nature of those responsibilities.
Make sure that your job duties are being presented accurately. Are they correctly stating both the physical and mental work demands? Consider:
- Are they taking any travel into account?
- Are they considering lifting heavy products, including medical products?
- Does your job duty listing include the stressful elements of your job and how those may impact your overall health?
Keep records of things that can prove the full range of your job duties. Examples include travel logs, airline tickets, reimbursement reports, photos, calendars, records of meetings, or specifications on the products you sell. All of these items can help establish the full weight of your role.
3. Inability to work, but no drop in pay
Sales jobs are unique in the way they handle compensation. Sometimes, you may become unable to work or see your work suffering because of chronic illness but fail to see an immediate loss of income. You may be paid based on residuals or commissions from past sales. While you’ve currently cut back on your work, it will take time for your current income to reflect that reality.
I call this the “walking dead” scenario. You are like a zombie: going through the motions as you try to keep things going, but in reality, not doing productive work. In fact, I had a client go through just this situation. He did mostly inside sales and had some big accounts. By every account, he was completely disabled by depression. However, he was able to show up to the office a couple of times per week, so he continued to get paid based on his large account and residual sales.
The problem was, his relationship with the account was suffering. For the most part, he just hid in his office and didn’t do any work. Sure, he was there physically; but mentally, he wasn’t able to perform at the necessary level.
He eventually had to be hospitalized because of the toll this took on him. The problem was that he had missed deadlines for applying for long-term disability. By continuing to show up at the office, he made it more difficult for us to prove his case.
There are ways to prove disability even if your inability to work hasn’t caused an immediate drop in income. If you are in this situation, however, it is critical that you speak with a lawyer to make sure that you don’t miss deadlines or jeopardize your claim.
4. The risk of losing what you have built
Sales jobs are different from most jobs. You have built relationships with your clients. If you are away on sick leave, you can lose those clients. Taking a sick leave, even for a short time, can cost you more down the road than a typical employee in other types of jobs. That fear is what causes many sales reps to resist going on sick leave for far longer than they should.
Often, it means they work themselves to the point of a total mental breakdown.
I have seen these conditions so many times in sales representatives: that point at which they physically, mentally, and emotionally have nothing left by the time they’re “ready” to file a disability claim. In the meantime, they are worsening their physical conditions, eating away at their mental health, and displaying low levels of performance at work.
Sometimes, their work suffers so much that they are at a much higher risk of getting fired before they can make a disability claim. Getting fired, if it does not mean that you lose the right to make a disability claim altogether, can make the process much more difficult.
As a sales representative or agent, it is critical that you acknowledge your own health needs and apply for disability when you need it. https://www.resolutelegal.ca/beginners-guide-to-disability-insurance-claims/