Personal Injury

Get familiar with LTD policy before making a claim: Hoffman

By Kirsten McMahon, Associate Editor

It’s very important that employees familiarize themselves with their employer’s long-term disability (LTD) policy in the event they need to make a claim, Toronto personal injury lawyer Jennifer Hoffman tells AdvocateDaily.com.

“Many people never even look at their employer's policy until it comes time to apply for benefits, says Hoffman, founder of Hoffman Law P.C. “They should get a copy and find out what the limitation periods are and any exclusions.”

LTD insurance is, for the most part, offered to employees as part of their employer's benefits package. If an employee is injured in a car accident or has been diagnosed with an illness that prevents them from being able to work, they can apply for benefits.

A person can also purchase LTD benefits privately, but premiums are quite expensive, so most people have them through their employer, she says.

While policies vary, in most cases, in order to be entitled to LTD benefits, a person must be disabled from performing their own occupation for the first two years after the date of disability, Hoffman says.

“Disability can be defined in different ways — it could be disability due to severe psychological distress, a cancer diagnosis, or injuries sustained from a car accident, for example,” she says. “The test you typically have to meet is whether you are disabled from performing the essential duties of your own occupation for the first 24 months following the accident or diagnosis. After that period of time, the test changes to whether you are disabled from performing the duties of any occupation for which you are reasonably qualified for by education, training and experience.”

In the event of a disability that would prevent you from doing your job, a policyholder should start gathering all medical evidence and submit it as quickly as possible, Hoffman says.

“Ensure that your treating physician or specialist is on board with you filing an LTD claim,” she says. “They’re involved in the process and will often need to fill out paperwork and submit medical documents to substantiate your claim.”

Every policy is different, but Hoffman says over the course of an employee's absence, it’s very likely they will be asked for medical records on an ongoing basis to show that they are still suffering from a disability.

“Certainly by the two-year mark, you’re definitely going to have to provide more evidence to show that you are unable to perform in any occupation,” she says. “You may have to go for a medical assessment and see the insurance company's medical assessors.”

Hoffman advises applicants to be as co-operative as possible with the insurance provider at all stages of a claim.

“They may make you jump through hoops before they give you a determination on your benefits," she says. "It’s frustrating, and you may have to collect more medical evidence and visit with to medical assessors who don’t seem to be on your side. But be co-operative and don’t give the insurer any excuse to deny you.

“As best as you can, you want to do everything to get approved early and receive your benefits as quickly as possible,” Hoffman adds.

She also recommends applicants apply for Canadian Pension Plan disability benefits at the same time as they apply for LTD benefits.

“Many people don’t know the insurance company is entitled to a deduction for any CPP benefits that are paid out, but if you failed to apply, many LTD carriers will make that deduction regardless,” Hoffman says. “If you apply for CPP and are denied, that’s a separate story.”

If your LTD benefits application is denied, she says it’s wise to seek legal advice as soon as possible.

“It’s a frustrating process for applicants to deal with at any given time let alone when you’re also dealing with illness or disability,” she says. “You definitely want a lawyer to review your file and go over your options as early as possible. An experienced personal injury lawyer will advise whether you can commence a lawsuit against the LTD carrier."

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