Are you struggling with addiction and had your LTD claim denied?

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Man in White Dress Shirt Holding Glass Bottle on Brown Wooden TableLong-Term Disability insurance provides you with payment of a portion of your income when you become disabled. It is important that you review your Long-Term Disability insurance policy so that you are aware of key terms like the definition of disability, the amount that you would be paid and for what period. If you wait to review your policy until you are disabled, then that will be too late. You need to ensure that your Long-Term Disability insurance policy will provide you and your family with adequate coverage if you become disabled.

In the case of addiction one of the important parts of the application process is that you should be in a rehabilitation program. This is key for insurance companies to consider you qualify for the disability. This is problematic as there are issues of access (number of spaces) and financial constraints to entering long term treatment programs.

I’ll outline how LTD works here. If you feel that you or a loved one have been unfairly denied this benefit but are struggling with addiction call us for help. We can help navigate the claim process

There are several ways that Long-Term Disability insurance can be paid for. The employer can pay, the employee may pay or the employee and employer may share the cost. The issue of who pays will have some significant impact on whether the Long-Term Disability insurance payments are taxed. If the employee pays the premiums for the Long-Term Disability Insurance, then any payments to the disabled employee under the Long-Term Disability insurance coverage are not taxable. If the employer pays for the premiums associated with the Long-Term Disability insurance plan then the Long-Term Disability insurance payments, when made to the disabled employee, are taxable. You should consult with your human resources department, and financial planner, to determine whether your benefits would be taxable, particularly under a Long-Term Disability insurance plan where contributions to the premium is made by both the employer and employee.

You will need to review your long term disability insurance policy to determine how long you have to wait to collect benefits. If your employer has a short term disability insurance plan you will usually be entitled to access short term disability insurance benefits under that plan after a short waiting period.

For long-term disability insurance benefits, you need to be off work for several months before you can access long-term disability insurance coverage. The amount of time you must wait before you access long term disability insurance benefits is called the "elimination" or "qualifying" period. A typical elimination or qualifying period can range from 90 to 180 days. It is important to read your long term disability insurance policy carefully to ascertain your elimination period. If you do not have access to a short term disability plan, you may also qualify for Employment Insurance or Sickness Benefits through the Government of Canada which can provide you with up to 15 weeks of sick benefits.

Generally, you will qualify for long term disability insurance benefits if you are not able to do all, or substantially all, of the elements of your current job. Many long term disability insurance policies indicate that in order to qualify for long term disability insurance benefits, you will have to prove that not only can you not do your own job, but at some point, usually 24 month later, you cannot do any job that you may be qualified to do by reason of your education, training or experience. You should carefully review your long term disability insurance policy so that you understand the terms and conditions that will apply to you if you become disabled.

Most long-term disability insurance policies cover you no matter what type of injury or illness prevents you from working. Some long-term disability insurance policies, however, exclude certain illnesses, while others exclude injuries or illnesses which would be covered through a Workplace Safety Insurance Board (WSIB) claim, if WSIB is available to you in your workplace.

Most long-term disability insurance policies provide a definition of total disability or completely disabled. Totally or completely disabled from working means that you are unable to carry out the normal functions of your usual job. It does not mean that you are completely physically unable to do any part of your job, but that your injury or illness is such that common sense requires you to stop working so you can focus on getting better.

Generally, most long-term disability Insurance policies state that for the first 24 months that you are entitled to claim long-term disability Insurance benefits, you cannot perform the essential duties of your own occupation. This is called the "Own Occupation Test." After that 24-month period, your eligibility for long-term disability insurance will be based on whether you are unable to perform any occupation for which you are reasonably qualified, or could become qualified for, by reason of education, training or experience. This is often referred to as the any occupation test.

There are many variations on when each of these tests apply. Some long-term disability insurance policies provide for an own occupation test until age 65. Some long-term disability insurance policies have an “any occupation test” that commences from the first day you are entitled to claim for long-term disability insurance. It is important for you to review your long-term disability insurance policy to find out what tests are applicable and when they apply. Some long-term disability insurers will provide you with vocational training to help you to find another job that is more suitable for you if your disability is ongoing and prevents you from returning to your pre-disability occupation.

Many long-term disability insurance policies contain provisions that allow the long-term disability insurance company to make you apply for benefits from another source, like the ones noted in the previous question. If you apply for other benefits, and are denied, they might also have the power to make you appeal the decision. If you are asked to apply for other benefits, or appeal a denial of benefits under another plan, ask the long-term disability insurance company representative to show you which part of the long-term disability insurance policy gives them the authority to force you to do this.

With most long-term disability insurance policies, what matters is when you became disabled. So long as you were actively employed at the time you became disabled, your termination should not affect your long-term disability insurance entitlement. However, any termination and/or severance payments, made according to legislation or the common law, may be deducted from your long-term disability insurance entitlement. The matter would become more complicated if you were not actively employed at the time of your termination, such as becoming disabled during a temporary layoff. Additionally, some long-term disability insurance companies can become more critical with your long-term disability insurance claim when they know that you do not have a job to return to.

If you apply for LTD benefits and your insurance company refuses to pay you should carefully read the letter from the long-term disability insurance company and find out why you are being denied benefits. It may be that the reason the long-term disability insurance company is not paying you long-term disability insurance benefits is because the long-term disability insurance company is waiting for some paperwork such as medical records. In many cases, the long-term disability insurance company will require documentation from your treating medical doctors before the long-term disability insurance company will make a determination. If that is the case, you should immediately make arrangements to contact your doctor and make sure that the long-term disability insurance company has everything it needs to process your claim.

It may be that the long-term disability insurance company is refusing to pay you due to a misunderstanding or because of some problem with your employer. In that case, you should also contact your employer immediately because the employer is often able to assist you in getting the long-term disability insurance company to fairly process your claim. If you have submitted all proper paperwork and supporting documentation and your family doctor supports your claim, but the long-term disability insurance company will still not consider making payments, you may need to consider speaking to a qualified long-term disability insurance lawyer. The long-term disability insurance lawyer will assess whether you should be receiving long-term disability insurance benefit

Has your claim been denied? Call the experienced firm of Deutschmann Personal Injury and Disability Law today 1(866) 414-4878 and remember the first consultation is always free.