Disability Claims and LTD Claims

After being injured or diagnosed with a serious illness, the road to recovery can be long, painful, and debilitating. Coping with chronic illnesses, serious mental health disorders, and physical disabilities often requires all of an individual’s focus and efforts. Unfortunately, these types of disabling medical conditions can make it impossible for people to continue working in their chosen occupational field or, in many cases, in any area of employment.

Some employers offer their staff members group insurance plans that include coverage for long-term disability (LTD) benefits. LTD benefits may also be available to people through insurance policies they have purchased privately. LTD policies provide income replacement coverage for people who meet the terms of the policy for “totally disabled,” which generally means they are unable to work or mostly unable to work.

Most LTD benefits plans offer between 60-70% of a recipient’s regular wages. Depending on the terms of the insurance policy, this amount might be subject to a payment cap based on an individual’s earnings.

Even though LTD benefits do not provide recipients with the full amount of their normal salaries, they can be immeasurably helpful. Sustaining disabling injuries or developing a chronic illness can be expensive. Many people who need to access LTD benefits struggle to keep up with their regular household expenses, let alone the costs associated with their medical conditions.

Unfortunately, insurers do not always make it easy for qualifying applicants to receive the benefits they should be owed. Even if a claimant’s conditions meet their policy’s eligibility requirements for LTD benefits, insurance providers may find reasons to deny their claims, withhold their payments, or try dragging the process out for as long as they can to discourage applicants from trying to access the funds they deserve.

Insurance companies could also prematurely terminate a benefits recipient’s payments. Benefits are often wrongfully terminated after being paid to the recipient for two years. After this time, many insurance plans update their definition of “disability” from the “own occupation” test to the “any occupation” test. This makes it harder to qualify for benefits.

The “own occupation” disability test means that someone will be entitled to LTD benefits if they cannot perform their own job. The “any occupation” disability test means that someone will be entitled to LTD benefits if they cannot perform any job to which they are reasonably suited by education, training, or experience. Each insurance policy may vary slightly in terms of the exact terms of the test, so it is important to read your policy carefully.

It is important to note that LTD policies generally do not require that someone is unable to work at all in order for them to receive benefits. Most policies, for example, will reduce LTD payments by any income earned. It is important to seek legal advice on the specific terms of your policy to know how disabled you must be to receive benefits.

Employers pay monthly premiums to insurance companies so that their employees will be covered if they cannot work. Sadly, many insurance companies simply refuse to do the right thing by paying deserving people the benefits they need.

No one deserves to be given the runaround from their insurance company, especially people whose lives have been turned upside down by a serious injury or illness.Our lawyers have combined decades of experience helping unfairly treated benefits claimants stand up to their insurance providers. If your claim for LTD benefits was denied or if your payments were prematurely terminated even though you are still unable to return to work, contact us today for a free consultation.

Who Qualifies for LTD Benefits?

In general, people whose insurance plans include LTD coverage should qualify for these benefits if their diagnosed medical condition prevents them from completing tasks associated with their jobs. To receive LTD benefits, claimants often have to exhaust other benefits available to them, including short-term disability and employment insurance (EI).

Each insurance policy is subject to its own terms and conditions. It is important to understand the eligibility criteria of your own policy before submitting a claim for LTD benefits. The wording of these plans can be confusing and difficult to comprehend. If you are having difficulty interpreting the terms of your insurance policy, consider scheduling a free initial consultation with us and let us help you.

LTD policies do not only apply to physical injuries or illnesses. People with serious mental health disorders might qualify for LTD benefits. In fact, 30% of disability claims nationwide are attributed to mental health conditions.

Make sure to review your policy’s specific terms to ensure you qualify for LTD benefits. Some medical conditions that often meet insurance plans’ eligibility requirements include:

  • Heart disease
  • Back problems
  • Chronic pain or complex regional pain syndrome (CRPS)
  • Lupus or Lyme disease
  • Psoriatic arthritis or fibromyalgia
  • Paralysis
  • Depression
  • Bipolar mood disorder
  • Post-traumatic stress disorder (PTSD)
  • And more

Claimants must include various forms of supplementary evidence to prove the severity of their medical condition to their insurer. They must also demonstrate how their ailments prevent them from completing the tasks associated with their jobs.

However, even after supplying insurance companies with ample proof, the claim of an applicant who should qualify for LTD benefits may be denied. When this happens, claimants may feel frustrated, anxious, and unsure about their future financial security.

Legal Help For Disability and LTD Claims

After receiving a denial for an LTD benefits claim, people suffering from severe medical conditions may feel overwhelmed, frightened, and without hope. For many disabled Albertans, LTD benefits may be the only source of income keeping them and their families from financial disaster. Without access to these potentially life-changing benefits, seriously injured or ill insurance policyholders may be unable to continue supporting themselves and their loved ones.

The idea of taking on a large insurance provider in a legal battle may feel daunting. But we are here to help.

If you are eligible to appeal your claim’s denial, our legal team may be able to help you recover the compensation you are rightfully owed. This might include:

  • Previously denied benefits payments
  • Legal fees
  • Damages you have incurred as a result of your claim’s initial denial, like interest on loans
  • Punitive damages
  • Aggravated damages
  • And possibly more

We are familiar with the unfair tactics often used by insurance providers to try withholding money from deserving policyholders. At Preszler Injury Lawyers, we fight on behalf of our clients’ best interests so that they can finally get the fair treatment they should be owed.

To learn more about how Preszler Injury Lawyers may be able to assist you, schedule a free initial consultation with our legal team today.


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