Most people arrive at the point of a disability denial after a long wait, many medical appointments, knowing full well that they just can’t do their job. Commonly, they have used up all their vacation time and have a doctor in their corner who fully supports their sick leave. Unfortunately, the insurance company doesn’t agree that you are entitled to short-term disability benefits.
Now, you’re in a fight to demonstrate to the insurance company that you are entitled to short-term disability benefits. Most people come to learn that those benefits they paid for every month (and hoped never to use) aren’t going to be readily available. An unfair denial by the insurance company is unfair, unprofessional, and inappropriate. However, complaining about the decision won’t change the outcome.
Below we will review the options available to you. This article intends to help you figure out what option is best for your situation. Once you’ve made your choice, you can proceed with a plan to get your much-needed disability benefits.
1. Go back to work (accept the decision and keep working)
It is possible that the decision to deny benefits may be the correct decision. We can’t say that every denial is without merit. There are cases where someone is hurt, or moderately impaired from doing their job, but the level of impairment does not prevent them from doing your job. Some people find it helps to take a step back from the paperwork and take a good hard look at their ability to carry out their work. Others ask a friend, family, or coworker for feedback. It’s often the case that those close to you have great insight on your abilities and struggles.
2. Go back to work (double-check your ability to do your job)
The insurance company says that you can do your job. They, however, don’t work in your environment every day. Some people go back to work and try their best to complete the daily demands of their job. This return to work effort may fail. If you can’t do your job and go off again, the insurance company will reconsider your right to disability benefits. They are now assessing you as someone who initially went off work and then gave their job a second chance (that didn’t work). This step may demonstrate to the insurance company that your claim for benefits should be approved.
3. Appeal the short-term disability denial decision
Denials can come in many forms. Be sure that you know what you’re appealing by requesting that the insurance company lay out their grounds for short-term disability denial in detail. Insist that the insurance company confirm what information they reviewed when making their decision. The steps for an appeal are usually provided in the denial letter. The obligation is usually on the applicant (you) to acquire new medical information for the insurance company’s review. The cost for obtaining new medical records and reports is yours to bear. To limit the cost of getting medical information, and improve the quality of your appeal, be sure that your appeal documents address each of the reasons for denial. Once your appeal documents are submitted the insurance company must reply with a decision. The decision will be to approve your claim or continue to deny your application. If the appeal is denied, move on to the next step (below).
4. Apply for Employment Insurance Sickness Benefit
If you can’t work, and you can’t get your insurance company to give you short-term disability, you should apply for employment insurance sickness benefits. Yes, this is another insurance benefit that is deductible from your paycheque. Despite some hesitance that you may have, you should apply for this benefit because it is a federal government program and completely separate from your work disability benefits provider. EI sickness benefits will also provide much needed financial relief. The benefit will provide 55% of your pre-disability weekly earnings for up to 15 weeks. The link to the Service Canada application can be found here. The application may take upwards of 1 hour to complete. You will also need your doctor to fill out an Attending Physician Statement as part of the application. Thankfully, many people have already spoken to their doctor about their inability to work. You will likely have an easier time getting the necessary paperwork from your doctor if he/she is familiar with your inability to work.
5. Apply for Long-Term Disability Benefits
The short-term benefits only last for 15 weeks. After 15 weeks your continued financial support will come from the long-term disability benefits policy. You can expect that the insurance company will deny your long-term disability benefits application if they remain unconvinced that you were entitled to short-term disability benefits. Nonetheless, be sure to apply. You can appeal the decision if need be.
If you have obtained short-term disability benefits, be sure that your benefits continue into the long term period. If your benefits are denied, be sure to get written confirmation from the insurance company. Your lawyer will want to review the denial letter to fully understand the insurance company’s rationale and determine the best legal strategy.
6. Appeal the Long-Term Disability Benefit Denial
In our experience, clients have very low rates of success in the appeal process because the process is run by the insurance company. Yes – the same insurance company that has just denied you the benefits! This process will ensure that your case lands in front of a new case manager, but the decision will usually be the same unless a blatant error was made. Of course, you must put your best foot forward when filing an appeal. Be sure to include any new medical information to support your right to benefits.
Avoid the appeal process if…
- You have no new medical information to provide, or
- You cannot afford to obtain the medical information
7. Start a lawsuit against the Insurance Company
Filing a lawsuit against the insurance company may seem like a big step to take. It is- but it may be your only option to get the benefits you deserve.
Filing a legal claim is serious, and it will require the insurance company to take a new look at their claim. The case manager will likely another person who only works exclusively on appeals and legal claims. The insurance company’s lawyer will also review the file and determine whether or not they may have made the wrong decision. The insurance company will now realize that you are serious about your right to compensation. The fact is, filing a legal claim may be the step which ultimately gets you your benefits.
You don’t need to take this step alone. You also don’t need to worry about having the money to have a disability lawyer represent you. There are lawyers who are willing to represent you on a no-win no-fee basis. This arrangement is a good one for the client because it puts a lawyer in their corner. That lawyer will also take a hard look at the case because he or she will only want to take it on if it has a good chance of being successful.
Do you want to talk about your options? Contact Jeff Mitchell to arrange for a free case review.