Omar was a 25-year-old truck driver. He had just moved into his first home with his wife and new baby, ready to experience his happily ever after with his young family. As a truck driver, Omar was responsible for hauling heavy materials that would often be used in construction and paving. One day at the plant, Omar was instructed to go under his tanker carrying corrosive material and fix a broken line. While underneath his truck, Omar was unknowingly laying in a corrosive material, and he sustained severe burns to 20% of his body.
Omar’s injuries were serious, and he was no longer able to work. He had long-term disability insurance through his employer; however, his claim was being denied due to a suggestion that Omar was being careless while carrying out the request of his employer.
Omar hired Campisi to represent him. The investigation into the accident revealed that his employer did not have the proper procedures and practice in place to ensure the corrosive materials were handled safely. He will now receive a settlement in excess of seven figures, giving him some much needed financial help to help him through a very trying time in his life.
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Life is unpredictable, and accidents or injuries can occur at any time. When these unfortunate events result in long-term disabilities, individuals may face significant financial challenges, affecting their ability to work and maintain their livelihoods. Long-term disability insurance provides essential financial protection for those unable to work due to qualifying injuries or illnesses. In this article, we cover what you need to know about long-term disability insurance claims, including:
- Understanding Long-Term Disability Insurance Claims
- What Qualifies for Long-Term Disability Benefits in Ontario
- Important Steps to Take Following a Personal Injury
- How a Personal Injury Lawyer Can Help with Disability Claims
- The Legal Process of a Long-Term Disability Claim
Understanding Long-Term Disability Insurance Claims
Though these policies vary, long-term disability (LTD) insurance is designed to replace a percentage of an individual's pre-disability income if they become disabled and are unable to work for an extended period. The waiting period before benefits begin and how long someone has coverage varies from person to person as it depends on the terms of their insurance policy.
To make a long-term disability insurance claim, the injured person, or their legal team, must provide evidence of their disability, including medical records, diagnostic tests, and treatment plans. The insurance company will assess the claim's validity and determine if the person meets the criteria for long-term disability benefits.
What Qualifies for Long-Term Disability Benefits in Ontario
As mentioned above, the types of injuries and illnesses that qualify for long-term disability benefits will vary based on an individual’s specific insurance policy terms, however the severity of the condition also plays a key role. Though there are many different injuries that will qualify for LTD benefits, some injuries and conditions that commonly qualify include:
- Musculoskeletal Disorders
Severe back injuries, spinal cord injuries, and other musculoskeletal disorders that can lead to long-term disabilities and limit a person's ability to perform essential job tasks.
- Neurological Disorders
Traumatic brain injuries (TBI), multiple sclerosis (MS), Parkinson's disease, and other conditions that lead to cognitive impairments and physical limitations.
- Cardiovascular Disorders
Heart attacks, strokes, and other cardiovascular diseases that can result in long-term disabilities and prevent someone from getting and maintaining a job.
- Mental Health Conditions
Major depression, bipolar disorder, post-traumatic stress disorder (PTSD), and other severe mental health conditions can qualify for long-term disability benefits.
- Chronic Illnesses
Cancer, HIV/AIDS, and many autoimmune disorders can qualify someone for benefits as they often lead to long-term disabilities and require ongoing treatment, preventing them from working.
Important Steps to Take Following a Personal Injury
If someone sustains an injury that could lead to a long-term disability, taking immediate and appropriate action is crucial. Here are important steps to follow:
- Seek Medical Attention
Prioritize your health and seek immediate medical attention for proper diagnosis and treatment of your injuries.
- Document Everything
Keep a detailed record of the accident, including the location, date, time, and any factors that may have contributed to the incident. Take photographs of the scene if possible.
- Gather Witness Information
If there were witnesses to the accident, get their names and contact information. Their testimonies may be valuable in supporting your claim later.
- Notify Relevant Parties
If the injury occurred at a workplace or on someone else's property, inform the appropriate authorities like the employer or property owner.
- Report the Incident
File an incident report with the relevant authority or management as soon as possible ensuring there is an official record of the accident.
- Preserve Evidence
Keep any physical evidence related to the accident, such as damaged property or torn clothing, as it may be important for your claim.
- Consult with a Personal Injury Lawyer
Seeking legal advice from a qualified personal injury lawyer can help you understand your rights, navigate the claims process, and increase your chances of receiving fair compensation.
How a Personal Injury Lawyer Can Help with Disability Claims
Unfortunately, insurance companies sometimes deny valid long-term disability claims, leaving someone injured without the crucial financial support they need. In such situations, a personal injury lawyer can be helpful in the following ways:
- Reviewing the Denial
A skilled lawyer will review the reasons a claim was denied and determine if there are grounds for an appeal or further legal action.
- Gathering Evidence
Personal injury lawyers have experience in collecting and presenting evidence to support the injured person's case, including medical records, expert opinions, and witness statements.
- Negotiating with Insurers
Lawyers are great at negotiating with insurance companies to pursue fair settlements for their clients, avoiding long, drawn out legal battles when possible.
- Representing at Appeals
If the claim requires an appeal, a lawyer will handle the paperwork and represent the injured person's interests throughout the entire process.
- Pursuing Litigation
In cases where an insurance company continues to deny valid claims, a personal injury lawyer can file a lawsuit and bring them to court.
The Legal Process of a Long-Term Disability Claim
When applying for long-term disability benefits, or appealing a denial, the legal process typically involves the following seven steps:
- Initial Application
The person making the claim submits a long-term disability application (supplied by your insurance company) with all necessary documentation to the insurer, outlining the details of their disability and its impact on their ability to work.
- Insurance Company Evaluation
The insurer reviews the application, medical records, and any other supporting documents to assess the validity of the claim.
- Benefit Determination
Based on the evaluation, the insurer either approves or denies the claim. If approved, the injured person begins receiving benefits after the waiting period ends. If denied, they can appeal the decision.
- Appeals Process
If the claim is denied, the injured person, or their lawyer, can appeal the decision through the insurance company's internal appeals process. This typically involves providing additional evidence to support the claim.
- Legal Action
If the internal appeal is unsuccessful, they may decide to pursue legal action by filing a lawsuit against the insurance company.
This is the legal process where both parties exchange relevant information and evidence. Statements may also be taken from witnesses and experts. A trial may occur thereafter if the parties cannot reach a settlement.
- Settlement or Judgment
The case may conclude with a settlement agreement between the parties, or with a court judgment in favor of either the injured person or the insurer.
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Navigating long-term disability insurance claims and personal injury can be a complex and challenging process. Understanding your rights to benefits, and seeking professional, legal guidance with this complicated process can help you, or someone you love, move forward without the financial burden a personal injury can bring.
Let us help you focus on your recovery. Campisi is a personal injury law firm that represents injured individuals against insurance companies. Call us for a free consultation at 855-351-1115.
THE INFORMATION PROVIDED IN THIS ARTICLE ARE FOR GENERAL INFORMATIONAL PURPOSES ONLY AND DOES NOT CONSTITUTE LEGAL ADVICE. YOU SHOULD ALWAYS SEEK LEGAL ADVICE TO ENSURE THAT ALL OF YOUR RIGHTS ARE PROTECTED. THE NAMES USED IN THIS ARTICLE HAVE BEEN CHANGED TO PROTECT CLIENT CONFIDENTIALITY.
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