The disability benefits application process is daunting. It’s terrifying to think of the possibility of having your disability claim denied. The reality is that disability claims are routinely denied due to insufficient medical evidence, no matter how legitimate the claimant’s disability is.
Here are tips for gathering strong, objective evidence to support your claim for short-term disability (STD) or long-term disability (LTD) benefits.
How important is medical evidence in the application process for disability benefits?
Medical evidence will make or break your disability claim. You have the burden of proving your ongoing illness or disability as part of the disability benefits application process. Insurance companies in Alberta and Saskatchewan are not required to conduct their own investigations of your ability to work and in many cases do a poor job of telling you what’s needed to prove your disability.
There are many reasons that disability claims are denied, but the most common reasons are lack of medical evidence and lack of evidence to support restrictions or limitations. In other words: the problem is not that you aren't disabled; it's that your medical evidence isn't considered good enough.
What evidence do you need to support your disability claim?
The insurance company requires evidence to explain your injury or illness. You must also provide evidence to support your restrictions and limitations and how they impact your ability to perform your job duties.
The required medical evidence will depend on the circumstances of your case and the terms of your disability insurance policy. For example, some policies contain a list of “acceptable medical sources.” That being said, these are the types of evidence you will likely need to support your disability claim:
Attending Physician's Statement, which should be filled out by the doctor most familiar with your medical condition. The statement form is where your doctor details your diagnosis, symptoms, treatment, prognosis, restrictions and limitations, and your ability to return to work.
Your treating doctor’s clinical notes.
Medical records from any hospitals, specialists, doctors, or other healthcare providers who have treated you.
Laboratory tests (e.g., urinalysis, biopsies, blood tests), x-rays, MRIs, CT scans, etc. that were performed to diagnose your illness or injury.
Statements from other sources like your employer, co-workers, and/or family members.
Keep in mind insurance companies put a lot of weight on medical records and physician’s statements. For that reason, it’s extremely important that you are always honest with treating physicians, specialists, and any other medical professionals. Don’t withhold information. Always report all symptoms and issues you are experiencing. It’s a great idea to keep a journal of daily symptoms to jog your memory when seeing healthcare professionals.
Why you should hire a disability claim lawyer
Calgary, Alberta’s Ludwar Law focuses on long-term disability claims across all of Alberta and Saskatchewan. Many of our clients come to us after having disability claims turned down by insurance companies due to lack of objective medical evidence to support their claim.
As the claimant, it’s your responsibility to ensure that all claim forms are filled out properly and that all necessary medical evidence is submitted with your disability benefits application.
That means you must contact your doctor and any other medical professional or hospital where you have received treatment to obtain their medical records. In our experience, healthcare providers and hospitals are not particularly responsive to requests for medical records. If you don’t have clinical records in time, it will delay your benefits claim, or worse—result in your claim being denied.
If you hire a long-term disability lawyer, it will ease the burden on you. An experienced long-term disability lawyer will tell you what evidence is essential to support your claim, handle the process of requesting medical records from your healthcare providers in a timely manner, and sift through the records to ensure they are accurate, relevant and complete. Your lawyer will also help you gather non-medical information from co-workers, friends and family, and ensure that your disability claim forms are correctly filled out. All of that increases your chances of being approved for disability benefits.
What is the difference between short-term and long-term disability benefits?
Short-term disability benefits typically provide income replacement for up to six months immediately following a serious illness or injury that leaves you unable to work. They can cover anywhere from 50% to 100% of your usual earnings, depending on your policy terms. If you have employer-paid sick leave, you will usually have to use up your paid sick time before applying for short-term disability benefits.
Long-term disability benefit coverage typically kicks in when your paid sick time, EI sickness benefits, or short-term disability period ends. Every LTD plan is different. Most LTD plans replace 60% to 70% of your usual income. Most policies provide coverage for up to two years if you are unable to perform the duties of your own occupation (i.e., the job you had before becoming disabled). After two years, you may still qualify for LTD benefits if you can prove you are unable to perform the duties of any occupation. If at that time you can prove you are disabled from any occupation, LTD benefits can continue for the benefit period set out in your insurance plan (for example, 3, 5, or 10 years; to age 65).
We’re here to help with your disability claim
Our firm is also here if you need a long term disability appeals lawyer. Saskatoon, Medicine Hat, Brooks, Lethbridge, Airdrie, Red Deer, Regina, Swift Current, Moose Jaw, and Calgary are just a few of the areas we serve in both Alberta and Saskatchewan. Our lawyers can help you get your rightful claims paid.