Introduction
If an accident or illness has made you incapable of working, disability insurance is supposed to protect you from financial losses and to provide you with peace of mind. You expect and rely on the fact that you will receive income replacement assistance if you become disabled from working.
Unfortunately, many individuals are improperly denied disability benefits because the disability insurer advises that their medical condition does not meet the policy definition of disability.
The Definition of Disability
Whether you are covered through group or private disability insurance, the insurance policy will contain the definition of disability that you are required to meet in order to be eligible for payment of disability benefits. This definition is not defined in any government legislation.
The definition of disability can vary and depends on the wording of the insurance policy that covers you. The definition of disability can include mental and physical conditions. Typically, the policy definition of disability falls into two categories:
1. Own Occupation
This definition considers you disabled if you are unable to perform the duties of the specific occupation that you were engaged in at the time that you became disabled.
2. Any Occupation
This is a stricter definition. You are considered disabled only if you cannot perform the duties of any occupation for which you are reasonably suited by education, training or experience. Disability benefits will likely be terminated if you have recovered sufficiently to work at a suitable occupation, or one for which you are reasonably fitted, regardless of whether or not this is the type of work that you were performing at the time of the onset of your disability.
Insurance policies often provide own occupation coverage for a limited period of time, generally for two years, after which the policy definition changes to any occupation coverage.
Residual Disability
Many insurance policies also provide for payment of a lower benefit during the period of time during which you are able to do some of your job, but are not yet able to work at your usual capacity. Residual disability can be defined either in terms of a reduction in the income that you are earning when you return to work following a period of disability, or by reference to the restriction in the job duties that you are able to perform.
Courts are reluctant to penalize employees who make genuine efforts to return to work. An unsuccessful attempt to return to work should not jeopardize your entitlement to payment of disability benefits. The Court will look at the specific duties of your occupation before the onset of your disability and will examine the tasks that you were able to complete during your attempt to return to work. An unsuccessful attempt to return to work may be evidence of your efforts to return to work, rather than proof that you have recovered and are no longer disabled.
Proof of Disability
In order to successfully pursue a legal action for disability benefits, you will need to provide supportive medical evidence that meets the policy definition of disability. Medical evidence may be obtained from your family doctor, your treating specialists and from the medical experts who are retained on your behalf by your lawyers.
If your disability benefits have been denied or terminated, and you have been unable to settle your case with your disability insurer, the Court will decide whether you meet the policy definition of disability, based on the facts of your case.
HOW WE HELP
At Bogoroch & Associates LLP, we understand the emotional and financial strain that an individual faces with the denial of a disability claim. Our experienced long term disability lawyers will guide you through the litigation process and will help you gather the evidence that you need to prove your case in a court of law. We will provide you with support, guidance and advocacy and will marshall the evidence necessary to obtain the compensation that you deserve.