We understand that as medical conditions develop or worsen, an individual’s mobility can drastically change. We hear from clients every day who are unsure of what steps they can take either before filing a long term disability claim or after they have been denied. Below, we have compiled several common questions that are available on the Ask A Lawyer section of our website.
Mobility Questions & Answers
If I have a Private Policy, am I entitled to disability benefits if I work at a different occupation?
The policy wording is crucial. Many private policies are sold as paying out benefits if you cannot work in your chosen profession. Yet, amendments to these policies over time have dramatically affected how they apply in practice. In short, if you are able to work at a different occupation, you might still be entitled to disability benefits. Even so, the policy must be carefully reviewed.
My insurance company forced me to return to work even though I am disabled. I am struggling and cannot continue working. Do I have to submit a new claim?
The question of whether a new claim must be submitted if you cannot continue will usually depend on the “Recurrent Disability” provision in the policy, or the clause in the policy that deals with the impact an attempt at returning to work will have on future entitlement in the event that the return attempt fails. You should carefully review the policy terms in your specific case to see how this works in your particular circumstances.
I was diagnosed with arthritis in my early 20s. I am now 38 and I started a new job ten months ago. Recently my arthritis pain became so severe that I could not work, so I applied for disability insurance through my new group plan. They denied my claim because my arthritis is a pre-existing condition. Can they do this?
If you are working in a relatively new job, and your coverage has been in place for less than one year (in most cases), there is usually a pre-existing exclusion for long-term disability benefits that is part of the policy. This allows the insurance company to investigate whether your current disabling condition was something you were already consulting with health care providers about or receiving treatment for in the defined period of time. These cases can be quite complex and it is sometimes possible to dispute the insurance company’s denial based on a pre-existing exclusion. You should consult an experienced disability lawyer to see whether you have a case.
My co-workers have told me that back conditions do not qualify as disabilities under our long-term disability benefit plan with Manulife. Is this true?
Never rely on what a co-worker or what you have heard when it comes to disability benefits. Some policies do have restrictions regarding what types of disabilities or medical conditions are covered or excluded, however, most group policies do not specifically exclude “back conditions” from coverage for disability benefits. If in doubt, submit the claim and let the insurance company process your claim. Rest assured if they intend to deny your claim because such conditions are not covered under their policy, they will tell you that but do not simply accept what someone tells you without getting written proof.
Do AD&D policies cover loss of vision?
Very often AD&D coverage or policies will provide a lump-sum payment in a specified amount for loss of vision. The loss of vision has to occur as the result of an “accident” which may not always have the most obvious meaning that most people think of when they consider what an accident is, but the loss has to be caused by accidental means. In order to determine whether loss of vision is covered, you need to review carefully the schedule of covered losses that form part of the policy.
Has your long-term disability claim been denied?Contact Share Lawyers and put our experience to work for you. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.
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