Have you taken out disability insurance and your company refuses to pay you the benefits promised? You have to take steps to claim these benefits from your insurance company and the whole process seems too long and complex...
It is easy to convince oneself to give up their insurance claim and simply move on, especially when your insurance company requires you to comply with multiple medical assessments or when the paperwork seems endless.
In this case, it is important not to give up. After all, the insurance contract is an agreement that your insurer must respect in exchange for the price you pay! A disability insurance specialist can help you with your claim.
Insurance law expert , this professional can analyze your insurance policy for you and inform you of the different avenues of recourse available to you. JuriGo explains the role of the lawyer in your disability insurance claim!
What is disability insurance?
Disability insurance is a type of insurance that aims to ensure that you receive an income in the event that you become disabled and are unable to work, and therefore unable to support yourself.
Disability can result from a sudden event, such as an accident, or from a degenerative illness that leaves the affected person unable to support themselves.
Disability insurance benefits generally amount to 60 to 85% of the usual income of the disabled person. Anyone earning an employment income or self-employed can take out disability insurance. Some employees may even have such insurance in their group insurance program.
Disability insurance plans generally provide different types of protection for different types of disabilities, such as partial, total, temporary, or permanent disability. The two main types of disability insurance are as follows:
- Short-term disability insurance; and
- Long-term disability insurance.
It is therefore particularly important to refer to the definition of disability and the inability to perform one's job as well as the conditions and obligations provided in the insurance contract regarding medical exams and the claims process.
The waiting period: what is it?
If you read your disability insurance contract, you will see that it includes a waiting period. The waiting period means that from the beginning of your disability, you will have to wait for a certain period of time before your insurer starts compensating you.
The length of this waiting period will vary from one contract to another. In order to find out about the duration and conditions of the waiting period that apply to your case, you must refer to the insurance contract.
Short-Term Disability Insurance vs. Long-Term Disability Insurance
Short-Term Disability Insurance:
- This type of insurance comes into effect before long-term disability insurance;
- It generally provides a certain percentage of your usual income, normally between 60 and 85%;
- This insurance is valid for a determined period. Generally, this period is calculated in weeks;
- If you do not have short-term disability insurance, you may still be entitled to various protections offered by the government, such as disability benefits provided by employment insurance.
Long-term disability insurance:
- This type of insurance comes into effect when you are no longer covered by short-term disability insurance or employment insurance;
- You are then granted long-term compensation, which is calculated based on a certain percentage of your usual income. This calculation will be provided in the insurance contract;
- You will receive compensation for a maximum period determined by your contract. This period can be quite long, for example, up to the age of 65;
- Some contracts may provide for a waiver of premiums. This means that as long as you are disabled, you do not have to pay your insurer.
Group Insurance vs. Individual Insurance
Your disability insurance can also be either group or individual.
Group Insurance:
- Group insurance is offered to all members of a same group, such as all employees of the same company or all members of a certain professional association;
- In the vast majority of cases, this means that you are required to adhere to the terms of this insurance and therefore cannot choose your own protections.
Individual Insurance:
- This refers to cases where you purchase disability insurance for yourself, for example if you are a freelance worker;
- This type of insurance allows you to choose the protections that best suit your personal situation.
Some examples of disability cases
As an example, here are some disability cases that have already been recognized by insurers:
- Depression: Depression is a disabling disease, even if it has not always been recognized as such. Now, depression is taken much more seriously and many insurers recognize it as a disease that should be covered by disability insurance.
- Lyme disease: It is a disease transmitted to humans by ticks and can cause pain and redness. This disease takes several weeks to heal, so it is possible to be diagnosed by a treating physician in order to receive a work stoppage and, subsequently, to make a request to your insurer to receive disability insurance during the convalescence period.
Insurance claim: who decides if you are entitled to your benefits?
Most people seem to believe that it is doctors who decide whether your disability is covered by your insurance plan or not. This is not the case, it should be noted that the decision belongs to your insurer. The insurer will rely on your situation and your contract to make its decision.
That is why you may be faced with a dispute with your insurer when they do not recognize the validity of your initial claim or when they stop paying out compensation. Your insurer may require you to undergo a medical examination to confirm whether or not you are truly unable to work.
Medical evaluations in the claims process
In any case, the claims and review process will require medical follow-up from a treating physician. Your insurance company may even require you to undergo additional exams with specialist doctors. Therefore, you may need to obtain a complete medical file, which includes all clinical consultation notes.
These documents may be necessary for you to demonstrate that as a beneficiary, you have received all the information related to your medical condition. These documents also allow you to keep track of your medical file with your insurer.
Your insurer, according to what is provided in the insurance contract, may require you to undergo one or more medical assessments, in addition to the medical certificates from your own treating physician that you have already submitted.
If a medical expertise from your insurer concludes that you are fit to return to work, it will be important for you to obtain a counter-expertise. Thus, even if your treating physician has submitted several medical certificates, it would be relevant to obtain an independent medical expertise. A good independent medical expertise will have considerable probative force in a context of contestation of a decision by your insurer as well as in terms of your credibility.
Contesting a decision by your insurer
If you do not agree with the conclusions made by your insurance company regarding your disability, it is important that you act quickly to contest this decision. It is also important to note that you have a three-year deadline to file a claim against your insurer who refuses to indemnify you.
It is within the context of this dispute that your insurer may demand that you undergo a medical examination in order to evaluate your disability. On your part, you have every right to obtain a counter-expertise, which will be carried out according to certain specific rules and criteria.
Find a disability insurance specialist lawyer with JuriGo!
A dispute with your insurance company can cause a lot of stress and frustration, especially when it comes to benefits that you should be entitled to. That's why it's important not to give up and to seek help from a professional when this type of situation arises.
Indeed, some lawyers specialize in disability insurance, which means that they are more than familiar with disability insurance contracts and disputes over decisions made by insurers! For example, this lawyer can help you if:
- Your insurer has decided that your physical and/or mental condition does not make you disabled from occupying your job;
- Your insurer concludes that despite your physical and/or mental condition, you are not disabled from occupying any type of job or performing tasks for which you are reasonably qualified;
- Your insurer believes that the illness you are suffering from is not a serious illness according to its criteria;
- You failed to declare that you have a pre-existing condition or illness;
- The death of the policyholder is not due to an accidental cause.
So, you believe that your insurance company is in the wrong and refusing to respect the terms of your contract and pay you the benefits you are entitled to? It's time to seek the assistance of a disability insurance lawyer now!
Justly, JuriGo is here to refer you to one of its partner lawyers who are experts in disability insurance!
You just have to fill out the form at the bottom of the page and explain your situation to us, and we take care of the rest, all while ensuring a free and non-binding contact! So, what are you waiting for to assert your rights?