Progressive Conditions and Long-Term Disability: How Do Benefits Work?
Living with a progressive medical condition can significantly impact your ability to work and maintain a steady income. Long-term disability or LTD benefits are designed to provide financial support for individuals who can no longer work due to health challenges like chronic illnesses, major health crises such as heart attacks and cancer, or past injuries. Typically, these benefits are available after other sources of coverage, like short-term disability (STD), have been exhausted. But what happens when your needs change?
Read on as we discuss types of progressive illnesses that may qualify for long-term disability, the importance of medical documentation and ongoing evaluations, how benefits can be adjusted as your condition changes over time, addressing insurer concerns about the long-term nature of your claim, and methods to ensure continued coverage and financial support.
Your insurance company may pressure you to return to work before you ready. Many of our clients are very proud of their careers and want to independently support themselves as soon as possible. You may wish to go back despite ongoing pain and other challenges. However, there is no requirement to follow an insurer’s recommendation. Instead, it is always best to follow the advice of your treating doctors and specialists.
Progressive Illnesses That May Qualify for Long-Term Disability in Alberta
Progressive conditions are those that worsen over time, often leading to increased disability and decreased functionality. Many such illnesses may qualify for long-term disability benefits. Common examples include (but are not limited to):
- Multiple sclerosis (MS)
- Parkinson’s disease
- Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease
- Chronic obstructive pulmonary disease (COPD)
- Rheumatoid arthritis
- Alzheimer’s disease
- Chronic back pain
- Cancer
- Ulcerative colitis
- HIV/AIDS
Click here for a list of other health conditions that could activate your LTD coverage. Our Alberta long-term disability lawyers can help to advance claims based on these conditions.
Qualifying for long-term disability benefits typically requires providing evidence that the condition significantly impairs your ability to perform the duties of a job. Diagnosis of a specific condition or illness is not always required to support your claim. Instead, eligibility is measured by your functionality in the workplace.
Each insurance policy has specific criteria and definitions of disability, so it’s essential to review your policy to understand your eligibility. If asked, your insurer should be able to explain your coverage in detail and in writing. Our staff can also examine your insurance policy.
The Importance of Medical Documentation and Ongoing Evaluations
Medical documentation is key to supporting your long-term disability claim. Insurers rely on detailed medical records to assess the severity and progression of your condition. This documentation often includes:
Diagnosis: A professional determination of the nature of your disease or disorder based on an examination of symptoms.
Medical history: Past records can establish your baseline state of health and ability before the onset of your illness.
Symptom details: A description of what your symptoms are, their severity and frequency. Both physical and mental symptoms may be relevant.
Functional assessments: The results of examinations by doctors, vocational experts, and other specialists to test your capacity to perform work-related tasks.
Treatment plans: Instructions from your healthcare team laying out your medication, treatment, rehabilitation, and other needs to maximize your recovery
Ongoing evaluations are essential to show that your condition is persistent and worsening. Regular follow-ups with your healthcare provider and keeping medical records up-to-date can help maintain the validity of your claim an provide evidence of continued disability.
Adjusting Your Benefits as Your Condition Changes Over Time
Progressive conditions can lead to fluctuating symptoms and varying degrees of disability. As your condition evolves, your LTD benefits may need to be adjusted to reflect your current level of functionality and ability to work. This process typically involves:
Re-evaluation of disability: Periodic reassessments by your healthcare provider to document changes in your condition.
Updated medical records: Submitting new medical records and reports to your insurer to support adjustments in your benefits. For example, a doctor may recommend hiring a caregiver or making accessibility modifications to your home so you can keep living there, though you did not have those needs previously.
Functional capacity evaluations (FCEs): Assessments conducted by an occupational or physical therapist to determine your ability to perform work-related tasks. They can also measure your ability to care for yourself and others.
Communication with insurer: Keeping open lines of communication with your insurance company to inform them of any significant changes in your condition.
These adjustments ensure that your benefits accurately reflect your needs and provide the necessary financial support as your condition progresses. Unfortunately, insurance companies don’t always do approve benefits, even with medical support from your treating doctors and health professionals.
Addressing Insurer Concerns About the Long-Term Nature of Your Claim
Insurers may have concerns about the long-term nature of your LTD claim, particularly if your condition is progressive. They may question the severity of your disability or seek to reduce or deny your benefits. To address these concerns:
Provide comprehensive evidence: Submit thorough and detailed medical documentation, including consistent records of ongoing evaluations and treatment plans.
Maintain consistent communication: Regularly update your insurer on your condition and any changes in your medical status. Insurers will typically ask for proof of your disability annually. Promptly respond to any requests for additional information or assessments.
Seek legal assistance: Consider working with a skilled disability lawyer who can help you navigate the claims process, respond to insurer concerns, an advocate on your behalf.
Document daily impact: Keep a journal of your daily experiences noting how your condition affects your ability to perform routine tasks and engage in activities. This can be a useful record of how your condition develops over time.
By proactively addressing insurer concerns and providing robust evidence of your disability, you can strengthen your claim and ensure continued access to long-term disability benefits.
Methods to Ensure Continued Coverage and Financial Support
Here are some steps you can take to help ensure continued coverage and maintain your long-term disability benefits:
Stay informed: Familiarize yourself with your insurance policy, including any requirements for ongoing eligibility, periodic reassessments, and potential benefit adjustments.
Engage in ongoing medical care: Regularly see your healthcare providers, follow recommended treatment plans, and attend all necessary evaluations. Consistent medical care demonstrates your commitment to managing your condition.
Give full effort at medical and functional capacity assessments: It is very important to make an honest effort at FCEs and independent medical examinations (IMEs).
Submit timely documentation: Adhere to deadlines for submitting medical records, functional assessments, and any other required documentation. Timely submission helps prevent delays or interruptions to your benefits.
Unfortunately, your health condition can make following these steps challenging. Thankfully, our legal team is available to support you and advocate on your behalf.
Discuss Your Progressive Medical Condition with Our Long-Term Disability Lawyers
Progressive medical conditions can have a major impact on your quality of life that increases as time passes. Although you may have long-term disability coverage, securing your benefits now and in the future may drain your time, energy, and other resources.
We want our clients to focus on their health while we represent their best interests. Our Calgary personal injury lawyers offers free initial consultations with no obligations. We can answer any questions you may have about your LTD insurance and progressive health issues.
To set up an appointment, call us on our 24-hour toll-free line at 1-888-494-7191 today. There will be no upfront costs to you. You only pay if we are successful in getting a settlement or an insurer to approve your long-term disability benefits.
