Short and Long-Term Disability Claims/Denials
When an injury or illness prevents you from working, short-term and long-term disability (STD and LTD) benefits can provide essential financial support. These benefits are meant to help cover your expenses during a time when your ability to earn an income is compromised. Unfortunately, many people find that their legitimate claims are denied by insurance companies, leaving them frustrated and unsure of what to do next.
If your disability claim has been denied the lawyers at Harvey Katz Law can be a valuable ally.
Understanding Short and Long-Term Disability Benefits
Short-Term Disability (STD)
STD benefits provide temporary income replacement, usually for a period of a few months to a few years, depending on your policy. These benefits are often offered through employer-sponsored plans or individual insurance policies, covering injuries, illnesses, or recovery periods after surgery or pregnancy.
Long-Term Disability (LTD)
LTD benefits, which typically begin after STD benefits are exhausted, can provide income for a much longer period—sometimes until you reach retirement age, and occasionally for the rest of your life. LTD benefits are especially important for individuals suffering from chronic conditions, serious injuries, or illnesses that require extended recovery or are permanently disabling.
When individuals in Canada receive LTD benefits through an insurance policy, they may also be eligible for Canada Pension Plan (CPP) Disability benefits. However, many are surprised to learn that the amount received from CPP Disability is often deducted from their LTD benefits.
Why Are Disability Claims Often Denied?
Insurance companies frequently deny disability claims, even when the claimant is clearly unable to work. Some of the most common reasons for denial include:
Lack of sufficient medical evidence
Insurers often argue that the medical documentation provided does not adequately demonstrate that the condition is disabling.
Failure to meet the policy’s definition of disability
Every disability policy defines "disability" differently. Insurance companies may claim that you don’t meet their specific criteria, which may include total disability or the inability to perform the duties of your job.
Pre-existing conditions:
If the insurer believes your injury or illness was caused by a pre-existing condition not covered by the policy, they may deny your claim.
Administrative or paperwork errors
Mistakes in filing, missing documentation, or missed deadlines can also result in denials.
Being denied disability benefits can be financially and emotionally devastating, especially when you’re already dealing with a serious medical condition. That’s where a personal injury lawyer can make a significant difference.
How Harvey Katz Law Can Help
1. Navigating the Complex Claims Process
The disability claims process is often confusing and filled with legal jargon, endless requests for medical records, and strict deadlines. Our lawyers are familiar with disability claims and will guide you through this process, ensuring that all necessary paperwork is filed correctly and on time. They will help you understand the nuances of your policy, such as its definition of "disability," coverage limitations, and appeal rights.
2. Gathering and Strengthening Medical Evidence
A key part of any disability claim is the medical evidence that demonstrates your inability to work. Insurance companies may argue that the documentation provided by your doctor is insufficient. The lawyers at Harvey Katz Law will help ensure that you gather comprehensive medical records, secure statements from treating physicians, and, if needed, arrange for additional evaluations from medical experts who can support your case. Our lawyers know what insurance companies look for and can help build a strong case to back up your claim.
3. Handling Denied Claims
If your STD or LTD claim has been denied, insurance companies provide the opportunity to appeal a denial, but the appeals process can be overwhelming. The lawyers at Harvey Katz Law are experienced in handling disability claim denials and can assist with:
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Requesting a detailed explanation of the denial: Insurers are required to provide the specific reasons why your claim was denied. We will analyze these reasons to find out where the weaknesses in the claim might be.
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Filing a formal appeal: We will draft and submit a thorough appeal on your behalf, ensuring that the necessary evidence is included and all legal requirements are met.
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Negotiating with the insurance company: If necessary, we will negotiate with insurers to reach a settlement before a claim goes to court and resolve your case on favorable terms without the need for litigation.
4. Filing a Statement of Claim if Necessary
If the insurance company still refuses to approve your disability benefits Harvey Katz Law will help you take the next step by filing a claim. Insurers have a legal obligation to act in good faith, and if they are unfairly denying your benefits, legal action may be the only way to recover the compensation you deserve. Our lawyers are experienced in litigating disability claims and know how to present your case in court.
The Importance of Acting Quickly
It is important to act quickly if your disability claim has been denied. Disability policies often have strict timelines, and missing these deadlines can result in forfeiting your rights to benefits altogether.
If you or someone you know has been denied disability benefits, the lawyers at Harvey Katz Law will help you understand your legal rights and take the necessary steps to ensure that you are protected both now and in the future.