What Happens After You File a Claim for Long-Term Disability Benefits?

Long-term disability (LTD) insurance can provide needed monetary resources if you suffer a prolonged injury or illness. However, the claims process can be complex. Understanding what happens after you file a long-term disability claim in British Columbia is important to avoid hassles and secure the necessary benefits.

Immediate Steps After Submitting a Long-Term Disability Claim

Long-term disability benefits can protect you and your family if you suffer an injury or illness that prevents you from working for longer than six months. Many employers in Canada provide employees with this type of insurance. You can seek LTD coverage once your short-term disability, employment sick leave, and Employment Insurance (EI) sickness benefits expire. You can also purchase long-term disability insurance privately.

LTD plans generally replace 60 to 70 percent of your income for up to two years, but each plan differs. You may be eligible for extended benefits if you cannot work after two years.

If you know that your medical condition will outlast your other benefits, you should file an LTD claim several weeks before your short-term disability ends. You should get confirmation of your claim receipt from your insurer for your records.

Depending on your insurance policy, you may have a 90 to 180-day waiting period, known as the “elimination period,” before you become eligible for LTD benefits. Your policy will dictate how long your insurance company has to send you its decision regarding your claim.

Assessment Process Explained

Insurance companies go through the following process when processing your long-term disability claims in British Columbia:

•  Initial review – Your insurance provider will review your initial claim. An adjuster will decide your eligibility based on various factors. Your insurer may contact you and ask for additional information.
•  Medical documentation evaluation – Ample medical documentation is essential for a successful LTD claim. Your insurer will use your medical records to decide if your condition is severe enough to prevent you from working for an extended time. Your provider may ask that you submit to a medical examination.
•  Assessment of treatment and rehabilitation plans – Your insurance company can periodically request an evaluation of your progress to determine if your injury or illness continues to interfere with your work capabilities.

What to Do If Your Claim is Denied

Many LTD applicants fail to secure benefits with their initial claim. Common reasons for denial (or discontinuation of benefits) include:

•  Lack of medical evidence
•  Presence of a pre-existing condition
•  Failure to communicate with the insurance provider
•  Refusal to attend a medical examination
•  Refusal to follow your doctor’s orders
•  Failure to participate in rehabilitation
•  Insurer error

If the insurance company denies your claim, you can appeal. It can help to have a legal representative to guide you through the process.

Contact Warnett Hallen LLP About Your Long-Term Disability Claim

A long-term disability lawyer from Warnett Hallen LLP can help you explore your options if you are struggling to receive the benefits you are entitled to. Contact us today for a free consultation.