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I Suffer from Chronic Pain and Was Denied Long-Term Disability Benefits

You were diagnosed with fibromyalgia and are in a lot of pain. Since the condition is preventing you from going back to work, you applied for long-term disability (LTD) benefits. But your request was denied. What do you do now?

The reality is that many people are facing the same struggle; you’re not alone. According to recent estimates, 6 million people in Canada (19% of the population) struggle with a form of chronic pain. The pain can result from any number of circumstances and can be incredibly debilitating, preventing you from working and living your life to its fullest. But, since the condition is often hard to see or define, sufferers not only feel misunderstood, they are often denied LTD benefits.

Chronic pain

Chronic pain – defined as pain that lasts more than 6 months – not only affects you physically, it can have a significant impact on your mental and emotional wellbeing. In fact, many sufferers experience depression too.

Chronic pain encompasses a range of symptoms and conditions including:

  • ​Fibromyalgia
  • Various types of arthritis
  • Chronic fatigue syndrome
  • Myofascial Pain Syndrome

Invisible condition

Since chronic pain doesn’t often show up on medical scans and is seen as largely subjective in nature, it’s often referred to as an “invisible” illness. The lack of objective evidence is often a challenge when it comes to making an LTD request. And it’s not uncommon for insurance companies to deny those requests as a result.

Proper treatment and documentation

Of course, every sufferer of chronic pain knows the symptoms are real. They just need to find the medical specialists who understand the condition well and who can support them on their road to recovery or treatment. They must then accurately and fully report their symptoms to their doctor so that they can be documented properly in their medical files.

Since an insurer cannot see any objective evidence of injury, that documentation becomes exceptionally important. Asking for treatment and then following a treatment plan is equally crucial to a claim. All these elements help establish the credibility of the person suffering from chronic pain and making an LTD application.

 

Finding legal support

Though fibromyalgia and other chronic pain conditions are more widely understood today than they were in the past, challenges remain when applying for LTD benefits. Many still find themselves struggling to convince insurers that their pain is real. Others face difficulty navigating the complex application (and re-application) process.

But we’re here to help. The disability lawyers at Auger Hollingsworth has helped many clients successfully apply for long-term disability benefits when they’ve been denied or terminated prematurely. If you want to discuss how we can help you secure the compensation you deserve, call us at (613) 233 4539 or email us at [email protected] today. Or, to learn more visit our Long Term Disability Insurance Denials Page.

What’s the Difference Between Short-Term and Long-Term Disability?

If you’ve been injured or are suffering from an illness, you may find it hard to meet the responsibilities that your job requires. Disability benefits could provide you with some income replacement and can help you pay for medical expenses on your road to recovery.

Thankfully, many employers offer group disability insurance plans. But few of us spend time reading through the policies or can understand the complexities of what they provide. For starters, does your employer offer both short-term and long-term disability? To better understand the distinction, let’s have a closer look.

Short-term disability insurance

Once an employee has used up their sick days but still cannot return to work, they will often look for short-term disability (STD) benefits to cover their income. STD insurance usually lasts for up to six months, though some benefits could last up to a year.

STD benefits typically represent 70% of an employee’s regular income. But not every employer offers them in the group policy. If a company plan doesn’t provide STD benefits, employees must instead turn to Employment Insurance (EI).

Of course, the total amount, length of coverage, exceptions and conditions of those disability benefits are all contingent on the specifics outlined in the group plan.

Long-term disability insurance

Once STD is complete, the next step for anyone continuing to struggle with a disability is to apply for long-term disability (LTD) insurance. LTD benefits will technically provide a percentage of an employee’s earnings for up to two years.

After those 24 months are up, employees must prove that not only are they unable to work at their specific job, they can’t work at “any occupation” for which they’re otherwise suited. It’s an important determination to prove they’re still eligible for benefits.

Each policy will uniquely determine what “disability” means and how to meet their definition. But if an applicant can succeed at demonstrating “total disability”, it will be a lot easier to attain LTD benefits.

A lawyer can help

The process of applying for STD and LTD benefits is not an easy one. Policies are complex and applying for benefits while recovering from an injury or illness can be difficult. But if you work with an experienced disability lawyer, that burden eases significantly. A skilled and knowledgeable lawyer can help you understand your policy and your rights. And if you’ve been denied benefits, they can help you make a strong claim with a greater chance of getting approved.

The team at Auger Hollingsworth has helped many clients successfully dispute benefit denials and reinstate long-term disability benefits. If you want to discuss how we can help you secure the compensation you deserve, call us at (613) 233 4529 or email us at [email protected] today.

What to Keep in Mind When Making an LTD Claim

Were you injured in an accident or are you suffering from an illness that’s making it impossible to work? Are you worried about how you’re going to support yourself and/or your family if you can’t work for an extended period of time? Are you trying to figure out how to navigate the complexities of long-term disability claims and what your next steps should be?

Here’s the thing: the process is not easy. But if you follow these simple steps, you will have a greater chance of success.

Get your doctor on board

Before you apply for any benefits, it’s important that you’ve spoken to your doctor, that they understand what you’re going through, believe you are suffering and support your claim. Because without your medical practitioner signing onto your disability claim, you will face much greater challenges ahead.

What’s more, your employer won’t even approve your sick leave as a first step if you aren’t able to get your physician on the same page.

Treatment plan

Don’t forget to speak with your doctor about treatment and setting up a treatment plan for your specific disability. You will have to demonstrate that you are seeking and receiving treatment that is right for you and are under the care of a specialist that understands your condition well.

If you need medication, you should take it regularly as you’ll have to prove that you are compliant with your medication once you make your claim. And if the treatment becomes unaffordable, try to find OHIP-funded ways to support the continued treatment as it’s crucial to your LTD claim.

Understand and fill out the forms properly

We can’t stress this one enough. It’s vital that you start gathering all the application forms for disability benefits as soon as possible. Read everything with a fine-tooth comb, to make sure you are providing exactly what the form requires.

Take extra care in how you fill out the forms, ensuring you do so correctly. Typically, the application includes a medical report form that your doctor must fill out. And there’s a form your employer too.

Collect all supporting information and documents including all appointments, reports and notes taken. The responsibility to fill out these forms and gather the documentation rests primarily on your shoulders. So review everything for accuracy and consistency. Did your doctor forget to mention a specific treatment or ailment? Did your employer correctly indicate the duties you are responsible for? Correct any information that’s mistaken or not updated.

Submit and wait

Process and send in the information on time, according to any deadlines and requests. And then the waiting game begins.

We can help

The LTD litigation process is complex and frustrating. But a lawyer with experience in long-term disability and personal injury law can help you navigate it all with confidence and efficiency. After all, the last thing you need to worry about when focused on your recovery is filling out forms and fighting for your rights to benefits.

The team at Auger Hollingsworth is focused on helping our clients receive the compensation and justice they deserve. Over the years, we’ve helped many succeed in their claims for long-term disability benefits after they’ve been denied or terminated prematurely. Our track record, client satisfaction and years of experience, contribute to our respected reputation as one of the hardest-working and effective legal teams in the country.

If you want to discuss how we can help you secure the compensation you deserve, call us at (613) 233-4529 or email us today. Or, to learn more, visit our Long Term Disability Insurance Denials Page.

Do I Need Individual Disability Insurance If I’m Covered By My Group Plan?

Many employees are concerned over what would happen to them and their families should they become hurt or sick and unable to work. It’s a valid concern, to be sure. Keep in mind, according to a 2017 report by the Canadian Survey on Disabilities, one in five Canadians (or 6.2 million) aged 15 and older had one or more disabilities that limited them in their daily activities.

The good news is most employers include short and/or long-term disability insurance as part of their benefits package. But the extent and particulars of the coverage offered depends on the specific policy your employer has chosen. The question then becomes: is that coverage enough or do I need to invest in an individual disability insurance plan too?

Group insurance plans

As we’ve discussed earlier (include link to the “demystifying LTD insurance blog), disability insurance plans allow an employee to receive income replacement to help cover their costs for when they can’t work. The amount they receive is typically a percentage of their income, though specifics and other details depend on the policy.

Payments for the premiums are often covered by an employee through their paychecks, though the employer may pay all or part of the premiums itself.

Individual disability insurance

When you explore the fine details of your group insurance plan, you may see that it doesn’t provide the full coverage that you’d want should a disability arise. Or you may be self-employed and not covered at all. In either case, it’s worth looking into purchasing an individual disability plan to better safeguard you and your loved ones against potential illness or injury.

While costlier than group insurance plans, the good thing about individual policies is that you can make a more informed and personal choice on the monthly benefits you receive. They’re also known to offer more features and to be more flexible. For example, when determining whether you’re eligible for coverage, individual plans often allow you to demonstrate “partial disability” as a condition for receiving benefits while most group plans require you to demonstrate “total disability”.

Contact us

At Auger Hollingsworth, our priority is helping you receive the compensation and justice you deserve. Over the years, our team has helped hundreds of clients succeed in their claims for long-term disability benefits after they’ve been denied or terminated prematurely. Our track record, client satisfaction and years of experience, contribute to our respected reputation as one of the hardest-working and effective legal teams in the country.

If you want to discuss your long-term disability benefits and how we can help you secure the compensation you deserve, call us at (613) 233 4539 or email us [email protected] today. Or, to learn more, visit our Long Term Disability Insurance Denials Page.

De-Mystifying Long-Term Disability

When you’re ill or hurt and can’t work, disability benefits can prove essential. After all, the last thing you want to worry about when focused on getting better is how you’re going to support yourself and your family. The financial assistance allows you to prioritize one thing and one thing only: recovery.

As simple as that concept may sound, the world of long-term disability insurance is a complex one and can become even more confusing when you’re struggling to make sense of an illness. To provide some clarity to the disability landscape and language, we offer a few definitions and context, with more to follow in this ongoing blog series.

 

Long vs short term disability

The amount and length of coverage that is available to you depends on your disability insurance plan, whether short or long-term. Generally speaking, however, this is what each policy provides:

Short-term disability insurance

Short-term disability (STD) insurance covers the expenses you may incur for a short period of time, once your sick leave is completed if you’re employed. Short-term disability benefits usually continue for 6 months, although they could last as long as a year. And they typically cover 70% of an employee’s regular earnings. Most employers cover these benefits with their group policy, but some employees also rely on Employment Insurance (EI) disability benefits.

Long-term disability insurance

Long-term disability (LTD) coverage begins after STD or EI benefits run out. In these cases, the disability has made it impossible for the individual to return to work. Every policy is different but LTD benefits often cover income replacement as well as medical treatment and rehabilitation. LTD benefits extend beyond the short-term time period, usually lasting up to two years if a person is deemed unable to work at their job or any job (see the definition of “any occupation” below). What’s more, if after that two-year period, someone is still incapable of returning to work, they may continue to receive benefits until they turn 65.

Keep in mind, however, that the amount of LTD insurance benefits you receive will be reduced by other sources of disability income, such as Canada Pension Plan (CPP) disability benefits or Workplace Safety and Insurance benefits (WSIB).

 

Eligibility

To be eligible for LTD insurance, you must either be employed by a company that has invested in a group insurance policy or have bought an insurance policy on your own. Every plan has specific disability requirements that will determine whether you qualify for benefits when you’ve fallen ill or have been in an accident that renders you unable to work. So best to read the fine print.

 

Conditions covered by LTD

A range of medical conditions are technically covered by LTD insurance. Some conditions, like a brain injury, broken bones and cancer, maybe mostly physical in nature. Other conditions can be emotional or mental, such as depression or anxiety (we will explore these more extensively in part 2 of this series). In short, so long as a condition causes you to experience “total disability” as defined by your policy, and an inability to perform your duties at work or elsewhere, you may qualify for long-term disability.

 

Pre-Existing Conditions

The majority of long-term disability plans will exclude pre-existing conditions. Those conditions can lead to you being denied LTD insurance despite otherwise qualifying due to your disability. What that means exactly depends on your specific plan, but pre-existing conditions generally include any physical, mental, or emotional condition that prompted you to see a medical professional for treatment shortly before you obtained coverage. Common pre-existing conditions include cancer, asthma, heart disease, arthritis, depression, and anxiety.

 

The Qualifying Period

Whether called a waiting period, elimination period or qualifying period, the term refers to the amount of time you must wait between first becoming disabled and when you’re eligible for long-term disability benefits. The exact length of these periods depends on your policy, but they typically range between three to six months. During the waiting period, an applicant must be unable to work and continuously disabled by their condition. They usually rely on short-term disability benefits and sick days as they await the response from their insurer.

 

Own vs Any Occupation

Within your disability insurance policy, your insurer may distinguish between any-occupation and own-occupation coverage. When first applying for benefits, an applicant only needs to demonstrate that they’re incapable of performing his or her “own occupation”, that they’re unable to work at a current or most recent occupation.

After some time, however, they may need to demonstrate they can’t perform “any occupation”. Under any-occupation coverage, if you can’t work at your own job but can work at another one – even if it requires less responsibility or pay – you aren’t considered disabled enough to receive benefits.

 

We can help

The lawyers at Auger Hollingsworth have helped many clients attain long-term disability benefits after they’ve been denied or terminated prematurely. Our successful track record, client satisfaction and years of experience, contribute to our respected reputation as one of the hardest-working teams in the country.

If you want to us to help demystify other complexities of the LTD world, or to discuss your long-term disability benefits and how we can help you secure the compensation you deserve, call us at (613) 233 4529 or email us at [email protected] Or, to learn more, visit our Long Term Disability Insurance Denials Page.

Is My Depression Considered a Disability?

Every year 1 in 5 people in Canada will personally experience a mental health problem or illness, according to the Canadian Mental Health Association.

Depression and other mental health issues not only affect our personal lives, they affect our professional lives too. In fact, a recent study found that mental health problems and illnesses were a primary reason for missing work, with 78% of respondents reporting they missed work due to mental health concerns. Of those, 34% reported missing work for two or more months.

It’s perhaps not surprising, that mental health accounts for 70 percent of disability costs in the workplace, while one-third of short and long-term disability claims are related to mental health problems.

 

Stigma, fear remains strong

Despite the high rate of depression, there remains a stigma attached to the condition. People tend to avoid discussing their pain for fear of being seen as “weak” or of losing their jobs. That unfortunate reality prevents many from applying for benefits for depression and other mental health issues when their condition is very real indeed.

In fact, mental health issues can impact people as significantly as physical conditions, if not more so. That’s why the Ontario Human Rights Code protects people suffering in that way against discrimination and harassment under the grounds of “disability”.

 

But will I receive benefits?

When suffering from depression and/or anxiety, taking some time off work is often recommended and even necessary. In those situations, short-term or long-term disability benefits can play a vital role, just as they would if one were in a car accident and unable to work.

While many employees will be covered by the company policy in these circumstances, be sure to check the specific definition of disability in your work policy to confirm your eligibility, and whether you’d be covered for short-term or long-term disability benefits.

Assuming you’re covered, for an application to succeed, you have to demonstrate that your symptoms are serious enough to prevent you from performing at your job (or any job, depending on the policy).If your depression is accompanied by physical symptoms – e.g. digestive issues, fatigue – make sure to mention those, as they are easier to document and better understood by insurers.

 

Things to consider when making a claim

Even if depression is considered a disability under your policy, you may face additional challenges in getting a claim approved. That reality can be attributed to the subjective nature of mental illness and the fact that insurers are still learning about the condition. To be sure, we’re a few steps ahead than a decade ago in terms of our understanding of mental illness, but there’s still a long way to go.

In the meantime, there are some steps you can take to help bolster your claim.

  1. Make sure to see your doctor regularly and don’t miss any appointments.
  2. Take your prescription medications and ensure they are monitored.
  3. Get a referral to a psychiatrist for a consultation. Try to get that appointment as soon as possible.
  4. If you feel you’re not getting the care you deserve, get a second, or a third opinion. Make sure you have the standard of care that insurers will regard as optimum for you and your condition, and that you’ve received the necessary treatments.
  5. Make sure all your medical appointments and treatments are well-documented.

 

Speak to a lawyer

A lawyer can help determine your eligibility for benefits, explain your options and compile the evidence you need to make a successful claim.

The disability lawyers at Auger Hollingsworth have helped many clients attain long-term disability benefits after they’ve been denied or terminated. If you want to us to help demystify other complexities of the LTD world, or to discuss your long-term disability benefits and how we can help you secure the compensation you deserve, call us at (613) 233 -4529 or email us at [email protected]

Ottawa Lawyer Brenda Hollingsworth – A Panelist at the University of Ottawa

On October 22 2019, Ottawa lawyer Brenda Hollingsworth was pleased to serve as a panellist on a presentation to law students at the University of Ottawa.  The panel was sponsored by the Ontario Bar Association.  Kelly McDermott from Durham Region and local family law lawyer Jonathan Richardson rounded out the presenters.

The topic was looking for opportunities for law students to article and practice that are not necessarily on the beaten track.  It is so easy for law students to get caught up in the march to Bay Street that they miss interesting and potentially fulfilling opportunities right under their nose.

The panel touched on resume etiquette, answering tough questions during an interview, appropriate preparation for an interview and planning one’s career.  The many advantages and benefits available to students who join the Ontario Bar Association (which is FREE for students) were also reviewed.

 

Photo of panel of lawyers

OBA members describe different career paths to University of Ottawa students.

The students had meaningful questions.  When it comes to getting a placement after law school, the more you know, the better your chances.

 

Brain Injury Association of the Ottawa Valley Fundraiser

Auger Hollingsworth was a proud sponsor of the Brain Injury Association of the Ottawa Valley Fundraiser on October 23rd.  The event was held at Bayview Yards — a very cool venue.

The Brain Injury Association of the Ottawa Valley is a vital organization that offers education, information, hope and support to persons with brain injuries, their family members, friends, caregivers and professionals in the Ottawa Valley region.  This annual event — the 13th of its kind — is key to ensuring it can provide support and advocacy those who need it.  Our firm was proud to be part of this great event.

Group Photo at BIAOV event

l-r: Jessica Kraft, Yoni Aroosi, Brenda Hollingsworth, Bianca Bielecki, Jessica Byles

Another amazing thank you!

There is nothing we like better at Auger Hollingsworth Personal Injury lawyers than handing over a settlement cheque and getting a thank you note from a satisfied client.  We are happy to have received this note today from a client in Eastern Ontario.

Thank you From C.B.

“Thank you everyone at Auger Hollingsworth.  Everything worked out exactly as you said it would. Will definitely recommend your services.”

The lawyer who handled this case is Dawn Baglole.  Dawn is our most senior associate lawyer.  She has handled all types of injury cases including slip and fall and car accidents.  She also represents clients with serious injuries who are dealing with their own accident benefit insurer.

Dawn Baglole Photo

Lawyer Dawn Baglole

 

For more information on how our lawyers can help you with your injury case, please contact our firm.  Call us at 613 233-4529.  We are happy to help.

A Client Pays a Compliment!

One of the best things about being a personal injury lawyer at Auger Hollingsworth is the opportunity to help clients get the compensation they need to get on with life after an injury.  This week a client who received a settlement after a slip and fall sent our associate lawyer Charles Genest this kind note:

Thank you Charles

“This settlement will ensure that I get the physio and home care I need to make a recovery that will allow me to live a “normal” life.  Your kindness,  thoughtfulness and hard work is a testament to who you are!  Brenda is very fortunate to have you on her team!”

Charles Genest

Photo of personal injury lawyer Charles Genest

[Note from Brenda:  It’s true!  I am very lucky to have Charles at the firm.  I can truly rely on him to provide the very best service to our injured clients.]

Charles Genest recently celebrated the completion of his 5th year at Auger Hollingsworth.  Fully bilingual, he practises out of our office on Lancaster.  Charles handles serious motor vehicle collision cases, slip or trip and fall cases and long term disability denials.

Of particular note, Charles attended Harvard University’s Program on Negotiation in 2017, which helped hone his skills in achieving excellent out of court settlements both at mediation and through direct negotiation.

If you would like to meet with Charles about handling an Ontario personal injury case on your behalf, contact the firm at 613 233-4529.

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