You often don’t know what you’re missing until it’s gone. Sadly, many of us discover this truth when our health declines. What was once easy becomes laboured; what we once could do on autopilot now takes tremendous focus and concentration; our productivity is decimated; and, in the most serious cases of disability, we simply can no longer perform the same functions we could before.
A debilitating illness or disability profoundly affects us and our loved ones. If it prevents us from working, we lose the ability to provide for ourselves and those who depend on us. Sometimes this situation is short-lived and we recover quickly enough to return to work; other times recovery is painfully slow and we may not regain all of what we lost. In these cases, or in cases where a disability is permanent, we may never be able to return to the jobs we once had. Careers that were advancing are now cut short; jobs that we found satisfying no longer match what our bodies can do; and we must now find ways to live within our new reality.
Fortunately, many people qualify for short-term and/or long-term disability benefits through their employer’s policies or through privately held insurance. These benefits provide for income replacement, medical expenses, retraining programs, and other costs associated with their care. Unfortunately, insurers often don’t make accessing these benefits easy. Short-term and long-term disability payments are expensive for these companies and they’ll look for ways to avoid paying. They may deny claims, demand you return to work against a doctor’s advice, set deadlines that are exceptionally difficult to meet, delay payments by moving your file from adjuster to adjuster, blame the disabled for not following medical advice, offer inadequate retraining opportunities, or unreasonably insist you take a different job.
If you’re dealing with an insurer who is causing you grief as you apply for long-term disability benefits, you know they can and will throw all the resources they have at the file hoping you may give up in frustration. Choosing to partner with an Edmonton disability lawyer will help level the playing field and give you a fighting chance at accessing the benefits you deserve.
What Types Of Injuries Or Illnesses Can Lead To Disability?
In order to claim disability benefits, generally, a person does not have to prove that they are disabled to the point where they are fully incapacitated, unable to take care of themselves independently, or perform day-to-day functions. Rather, they must have an illness or condition that makes them unable to work in their regular role.
The bar for short-term disability leave is lower than for long-term disability. In either case, an assessment is usually made as to whether a person continues to be unfit to perform his or her “own occupation” or “any occupation” depending on the wording of policy.
Litco Law disability lawyers have worked on disability benefits cases covering a wide range of illnesses and injuries, including:
- Amyotrophic lateral sclerosis (ALS)
- Anxiety disorders
- Cardiac and breathing conditions
- Chronic fatigue
- Chronic pain
- Colitis and Crohn’s disease
- Diabetes (advanced)
- Depression and depressive disorders
- Multiple Sclerosis (MS)
- Neck or back pain, including herniated discs
- Nerve damage
- Parkinson’s disease
- Psychiatric conditions and mood disorders, including schizophrenia, bipolar disorder, and post-traumatic stress disorder
- Rheumatoid arthritis
- Somatic Pain disorder
- Thoracic outlet syndrome
- Vision issues
How Do Disability Benefits Work?
Many employers (and/or employees) pay into insurance programs that provide short-term and long-term disability benefits for employees who are off work due to injury or unexpected illness. The Canada Pension Plan (CPP) also offers some of these benefits. Short-term benefits usually last for up to 90 days and are provided through doctor’s notes or reports which explain the illness or injury and estimate when a return to work will be possible.
If recovery is not possible before short-term benefits are exhausted, the application process for long-term benefits begins. This is often where things get tricky – especially if the disability is permanent and a return to your job will likely never be possible. Specific insurance plans may require a person to be unable to hold any job for which they are qualified before benefits are granted. Other times, and not nearly as often, these plans start paying benefits if a person cannot perform the tasks required of their “own job.” If accommodation is possible, an employee may be expected to return to work.
Insurers will also no longer rely solely on your own doctor’s advice and reports to grant long-term disability benefits. They will often require a person to see a doctor chosen by an insurer to perform an independent evaluation. Since these doctors receive payment for their work on behalf of insurers who are hoping not to pay out benefits if possible, you may understandably question whether this evaluation is truly independent.
Reasons Insurers May Deny Long-Term Disability Claims
There are other ways an insurer may look for evidence with which to deny a claim. Before, during and even after the long-term disability application process an insurer may put surveillance on an applicant. Although this may feel intrusive and invasive, an insurer has a right to monitor an applicant’s public actions to determine whether they are misrepresenting the nature of their disability. This can even include social media activity.
Many people with disabilities or critical illnesses will tell you they have good days and bad days, and what they are capable of doing on a good day can be very different from what they can do on a bad day. Similarly, people with conditions such as depression are often encouraged to be active and social as a way to improve their mood. Insurer surveillance may use out of context photos or footage to suggest an applicant is not nearly as disabled as they claim.
In an effort to deny claims or to prevent an applicant a fair opportunity to apply, insurers may also:
- state they believe you are not disabled and fit to return to work;
- provide incomplete or unclear reasoning for denying a claim;
- suggest you have not properly followed your doctor’s instructions or sought out proper treatment;
- permit only a short appeal period for a denial; and
- say you missed deadlines or filed an incomplete application.
Critical Illness Policies
If you do not have benefits through your employment, you may have decided to purchase your own private critical illness insurance. Sometimes these policies are sold in high pressure situations where an insurance agent talks about all the coverage you’ll receive if you’re ever too sick to work, but who neglects to help you carefully fill out the application. As a result, you may misunderstand what you’re supposed to include and unintentionally not provide incomplete medical history.
Often it’s only when a person makes a claim on this policy that the insurer will review the application and request medical records to search for incomplete, incorrect or misleading information. Sometimes the mistakes made on the application will have no bearing on how the policy relates to the claimant’s critical illness, but they will still be used as a way to try to void the policy or otherwise escape payment.
When and Why Should I Contact A Disability Lawyer?
Many times people only contact an Edmonton disability lawyer when their disability claim has been denied.
However, once you have received a denial letter and taken the proper steps to appeal the decision, there is much we can do to help. Our trusted team of knowledgeable, experienced and skilled Edmonton disability lawyers are ready to handle all aspects of your case. We will determine the reasoning behind the insurer’s rejection of your claim and start to build a strong case designed to change their minds, or to persuade a judge that you’ve been treated unjustly. Using our extensive network of experts and specialists, we can schedule assessments or obtain opinions that can effectively counter what the insurer’s doctor may have found.
We understand and appreciate how overwhelming a denial of disability benefits can be. If your disability means you’re unable to work but your insurer is refusing to provide income replacement, you could be pushed into financial hardship or forced to compromise your health and well being by prematurely returning to work or trying to find another job. Thinking of adding a lawsuit against a big insurance company to your plate may seem like more than you can bear.
With Litco Law Edmonton disability lawyers as your staunch advocate, you won’t have to worry. We’re here for you as you take care of yourself and try your best to heal and we will take on all aspects of your claim so you can focus on other important areas of your life. We’ll always keep you informed, work in your best interest, and readily receive as much or as little input as you feel comfortable offering. By making this process as easy as possible for our clients, we reduce their stress and take a load off their minds.
Your initial consultation with us is free, and you’re under no obligation to pursue a claim with us. But, if you do, we won’t and don’t get paid unless and until we recover money for you. That means we take cases in which we’re confident we can make a difference by negotiating a fair and adequate settlement or winning a damages award in court.
What Our Peers And Clients Say About Litco Law
For more than 45 years, Litco Law has been advocating for Albertans who have suffered personal injuries and critical illnesses in their fight for fair compensation and the benefits they rightfully deserve. With a reputation for professionalism, community-mindedness, compassion, and expertise in this area of law, we have been voted by our peers as one of Canada’s Top Ten Boutique Personal Injury firms (Canadian Lawyer Magazine).
This national recognition is an honour, but what we value most is what our past clients tell us about how they’ve found their experience with us. Frequently, when our past clients refer their friends, family or acquaintances to us, we hear that we come highly recommended because these clients felt like members of our family and believed strongly that they mattered to us. Clients like Mick, David and Peggy say they never felt as though they were just a number in our system, but individuals whose well-being was important to our firm.
Let us demonstrate to you what these people already know – Litco Law Edmonton disability lawyers genuinely care about the people we are helping and we treat them with the respect, compassion and care they need and deserve.
Looking For a Disability Lawyer in Edmonton Contact Us.
We service the Edmonton and surrounding area, including the Parkland, Leduc, Strathcona, Sturgeon Counties. When you need a Disability Lawyer in Edmonton, think Litco Law Personal Injury Lawyers.