Policies may vary, but every policy typically has a qualifying period that must be met in order for benefits to be paid.
Toronto, Ontario (PRWEB) March 25, 2014
Employed persons may have access to long-term disability (a.k.a. LTD) benefits through their employer’s group benefits plan. LTD benefits provide an insured person with a monthly income replacement if that person is unable to work for a prolonged period of time as a result of injury or illness.
Policies may vary, but every policy typically has a qualifying period that must be met in order for benefits to be paid. The qualifying period is the duration of time a person remains off work due to the disabling condition, before benefits are paid. The qualifying period is usually in the vicinity of 6 months (120 days). Self-employed individuals can also purchase long-term disability policies.
There are terms that are important for insured persons to understand, as claims adjusters often refer to these terms in correspondence.
In order to be eligible to receive benefits, your insurer has to find that you meet the definition of total disability.
What does total disability mean?
In some policies, this means that a person is unable to perform his or her pre-disability occupation, in others this can mean that a person is unable to perform any occupation that he or she is reasonably suited for by education, training or experience. Another example of policy wording is that if because of disease or injury, there is no combination of duties the individual can perform that ordinarily took 60% of his or her time at work to complete.
Every insurance policy has clauses that set out what the test for disability is, and when the change of definition occurs. Generally, LTD policies contain an own occupation and any occupation feature.
Own occupation: This refers to insured’s ability to perform the duties of his or her occupation at the time of the disability.
Any occupation: This refers to any occupation that a person is reasonably suited for, or could become qualified for by education, training or experience.
Long-term disability policies use the “own occupation test” for the initial period of disability, which in most policies is 24 months (2 years). After this period is over, the test changes to any occupation, a stricter test. Long-term disability insurers encourage rehabilitation and do assist with vocational retraining, hence why part of the any occupation test is “could become qualified for”.
It is possible to experience a denial of long-term disability benefits at the outset of your claim because your insurer does not find there is evidence that meets the own occupation test, or a denial can happen when the change of definition is about to occur. Denials can also happen at any point in time when the insurer determines there is not enough medical evidence to substantiate an ongoing total disability.
Whatever reason for the denial, it is important to immediately contact a lawyer and file an appeal. The lawyers at Aaron Waxman and Associates are experienced at handling long-term disability claims and welcome your questions.
Aaron Waxman and Associates is a Toronto law firm whose practice is focused on long- term disability claims and other types of personal injury claims including motor vehicle accidents, slip and fall claims, traumatic brain injury claims, spinal cord injury claims, wrongful death claims, critical illness claims and CPP Disability claims.
We only help injured persons; we do not work for insurance companies.
We offer a free, no obligation initial consultation.
We can help you get your life back on track.
t: 416 661-4878