By Fiona Anderson.
Wouldn’t it be wonderful if the only reason we went to work each day was because we loved our job? The reality is that most of us are employed, at least in part, out of necessity. So, when an illness or injury prevents us from working, this can lead to significant financial stress.
Thankfully, many employers provide their employees with extended health benefits that include long-term disability (LTD) insurance. So, if the unfortunate happens and you find yourself unable to work, you will still have access to a source of income. The key is knowing what benefits you’re entitled to and how to access them. Your Human Resources department or manager should be able to point you in the right direction. For now, here are the basics:
While disability insurance policies differ, generally speaking, to be able to receive LTD benefits, a person must meet the insurance company’s definition of “totally disabled.” Totally disabled usually means that:
- For the first two years, the employee is unable to, due to illness or injury, carry out the essential duties of his or her regular occupation; and
- After these two years are up, the employee is unable to, due to illness or injury, work at any occupation which the employee is qualified for by training, education or experience.
To provide benefits, the insurance company needs to see that there is an illness or injury and then feel comfortable that this illness or injury prevents the employee from being able to work as set out above.
Dealing with the Insurer
If your claim for benefits is denied or your benefits are discontinued, the first thing to do is ask the insurance company for a copy of your file. This file provides crucial insight into the insurer’s thought process, containing detailed notes about why the claim was denied.
While the initial letter you receiving denying your benefits claim sets out the insurance company’s decision, it lacks detail, usually saying either that you do not meet the definition of totally disabled, or there is insufficient medical evidence to support your claim of total disability. With your file in hand, you will be able to see exactly why the insurance company came to this conclusion. For example, the file may list all the details of the your illness but question why that means you can’t work. A detailed medical report relating the illness to your duties may be what the insurance company needs to fill the gap.
In other words, don’t despair if you are denied benefits. Find out why by getting a copy of your file, and then try to provide what the insurance company thinks is missing.
It’s often just a matter of crossing the t’s and dotting the i’s.
Need help responding to a letter from your LTD insurer? Contact us!
NOT LEGAL ADVICE. Information made available on the Kent Employment Law website in any form is for information purposes only. It is not, and should not be taken as, legal advice. You should not rely on, or take or fail to take any action, based upon this information. Never disregard professional legal advice or delay in seeking legal advice because of something you have read on this website. One of our lawyers would be pleased to discuss any specific legal concerns you may have.