The Process of Filing a Long Term Disability Claim in Ontario

Filing a long-term disability (LTD) claim in Ontario can be a daunting and intricate process. To ensure you secure the benefits you are entitled to, it is crucial to understand each step, gather the necessary documentation, and be prepared for common challenges. This guide will provide a step-by-step overview of how to file an LTD claim, highlight key documentation and forms, discuss potential obstacles, and explain the expected timelines. 

Throughout the process, a long-term disability lawyer can be an invaluable ally, ensuring your claim is handled efficiently and effectively.

Step-by-Step Guide on How to File a Claim

Review Your Insurance Policy

  • Understand the specific terms, conditions, and definitions outlined in your LTD policy.
  • Identify the waiting period and any exclusions or limitations that may apply.

Notify Your Employer and Insurer

  • Inform your employer and insurance provider of your intention to file a claim as soon as possible.
  • Request the necessary claim forms from your employer.
  • You should be given two forms – A Claimant Statement form and the Attending Physician’s Statement form

Complete the Claim Forms

  • Fill out the claimant statement (sometimes called the employee statement), which includes personal information, details of your disability, and how it affects your ability to work.
  • Ensure accuracy and completeness to avoid delays in processing.

Have your Doctor Complete the Attending Physicians Form

  • Bring the Attending Physician’s Statement form to your primary doctor. 
  • For example, it could be your family doctor, psychiatrist, physiatrist or any other treating specialist. 
  • Ask them to fill it out for you. There may be a charge associated with it. 

Gather Medical Evidence

  • Obtain a detailed report from your treating physician(s) outlining your diagnosis, treatment plan, and prognosis.
  • Include any relevant test results, medical records, and specialist reports.

Submit the Employer Statement

  • Your employer must complete an employer statement, providing information about your job duties, work hours, and salary.
  • Ensure your employer submits this form promptly to avoid delays.

Provide Additional Documentation

  • Include any other required documents, such as any doctor’s notes, proof of earnings, direct deposit information and authorization forms allowing the insurer to obtain medical information.

Submit Your Claim

  • Send your completed claim forms and supporting documentation to your insurance provider.
  • Keep copies of all documents for your records.

Necessary Documentation and Forms

  • Claimant Statement: Filled out by the individual filing the claim, detailing personal information and the nature of the disability.
  • Attending Physician’s Statement: Completed by your doctor, providing medical evidence to support your claim.
  • Employer Statement: Filled out by your employer, detailing your job duties and employment status.
  • Additional Documentation: May include medical records, diagnostic test results, proof of earnings, and any other relevant information requested by the insurer.

Common Challenges and How to Overcome Them

Incomplete or Inaccurate Forms

  • Double-check all forms for completeness and accuracy before submission.
  • Seek assistance from a long-term disability lawyer to ensure all documentation is correctly filled out.

Insufficient Medical Evidence

  • Work closely with your healthcare providers to gather comprehensive medical evidence.
  • A lawyer can help identify and obtain additional necessary medical documentation.

Delays in Processing

  • Follow up regularly with your insurer to track the progress of your claim.
  • A lawyer can expedite the process by addressing any delays or issues directly with the insurer.

Denial of Claims

  • If your claim is denied, carefully review the denial letter to understand the reasons.
  • A long-term disability lawyer can assist in preparing a strong appeal and represent you in hearings if needed.
  • If you’re confused, a long-term disability lawyer can review the denial letter with you. 

Timelines and What to Expect During the Process

  • Initial Submission: After submitting your claim, the insurer typically acknowledges receipt within a few weeks.
  • Review Period: The insurer reviews your claim, which can take several weeks to a few months.
  • Decision Notification: You will receive a decision letter indicating whether your claim has been approved or denied.
  • Appeal Process: If denied, you have a limited time to file an appeal. The appeal process can take several months and may involve additional medical evaluations and documentation.

An LTD Lawyer Can Help You Navigate This Process

Navigating the process of filing a long-term disability claim in Ontario can be complex and challenging. Ensuring that all forms are accurately completed, gathering comprehensive medical evidence, and addressing any obstacles promptly are critical steps to securing the benefits you deserve. However, this process can be overwhelming, and the expertise of a long-term disability lawyer can significantly improve your chances of a successful claim.

At Unified LLP, our experienced long-term disability lawyers are dedicated to guiding you through every step of the claims process. We understand the intricacies of LTD claims and are committed to advocating for your rights. 

Contact our long term disability lawyer Toronto team today for a consultation and let us help you secure the financial support you need during this challenging time.