Short Term Disability Claims – How to Start a Claim
Short-Term Disability (“STD”) benefits are paid to employees who become disabled and unable to work due to an illness or an injury. They are sometimes called Weekly-Indemnity Benefits. While STD policies differ from each other, in most cases the test for eligibility is whether you are capable of performing your usual job duties.
The normal process of applying for STD benefits involves completing a series of forms. The necessary forms are supplied by your employer or the insurance company managing short-term disability claims.
The employee completes a form often called a Claimant’s Statement which asks a series of questions about the nature of your disability and how it affects your ability to work. The Claimant’s Statement will also ask for a list of your doctors and information about the treatment of your condition.
Your doctor will also be required to complete a form which is often called the Attending Physician’s Statement. This form asks your doctor to answer questions about your diagnosis, treatment, severity of your condition and the impact of your disability on your work function. It is very important that when your doctor completes the form they do so as thoroughly as possible or your claim may be denied on the basis of insufficient information. It is also recommended that your doctor attach key medical records to the form that will help confirm your total disability.
Once the forms have been completed and submitted, you will be contacted by a representative of the insurance company or assessment company hired to evaluate your claim. They may want to set up a telephone call to ask you questions about your disability, your job duties and treatment. They may also ask you to supply them with additional medical records such as your doctor’s chart entries from your medical appointments.
Short Term Disability Claims – Who makes the Decision?
The vast majority of employers do not decide disability claims themselves. Firstly, they likely do not have the specialized knowledge or training required in order to evaluate medical conditions and their impact on function. More importantly, they would be accessing your personal medical information – something that an employer is not entitled to for privacy reasons.
Most employers will hire either an insurance company like Sun Life, Manulife or Canada Life to evaluate STD claims. Sometime employers will hire assessment companies like Sedgwick or Morneau Shepell (now LifeWorks) to perform the evaluation.
It is important to note that in the majority of cases, the STD benefit is an employer-paid benefit. Thus, even though the claim is being managed by a third-party insurance company, the employer is still legally
responsible to pay the claim. If a STD claim is denied and legal action is required, in most cases it will be necessary to sue the employer in court even though they may not have had any part in making the decision to deny your claim.
Short Term Disability Claims – What if My Claim is Denied?
STD claims can be denied for several reasons. The insurance company or assessment company may say that there is insufficient medical evidence to establish that you are disabled. They may claim that your condition does not prevent you from carrying out your job duties or that you have not been getting appropriate treatment.
Usually the first course action is to submit an appeal. Sometimes claimants will appeal by typing up arguments and sending them to the insurance company. It is very rare for this type of appeal to work and often the insurance company will find a way of using your own words against you. For example, they may that argue that your ability to put together arguments in an appeal letter proves that you have the capacity to work. Thus, the best course of action is to appeal by submitting a support letter from your doctor(s).
Often your doctor will not know what information should be included in a support letter. This will vary from person to person, but at a minimum the doctor should provide an explanation why in their opinion you are not able to perform the key parts of your occupation. You can assist your doctor by making sure they understand the two or three most critical tasks of your job. Your doctor can then explain why your symptoms prevent you from carrying out those critical duties. The support letter should also include information about your current and upcoming medical treatment.
Long Term Disability Claims – What if My Claim is Denied?
LTD claims can be denied for several reasons. The insurance company might allege that there is insufficient medical evidence to prove that you are disabled. They might argue that there is no “objective medical evidence”, meaning there is not an x-ray or MRI that confirms your symptoms. They may also claim that your symptoms do not prevent you from performing your job tasks or that you have not been getting appropriate treatment. For additional information on why claims are denied, see my blog.
A denial by the insurance company is not necessarily final and you will have the option to submit an appeal. Sometimes individuals will appeal by typing up arguments about why the insurance company has made the wrong decision. It is very rare for this type of appeal to be successful and often the insurance company will use your own words against you. For example, they may that argue that your ability to put together arguments in an appeal letter proves that you have the capacity to work.
Appeals have a very low probability of success in my experience. However, the appeals that I have seen be successful involve submitting new important medical information that might persuade the insurance company to reverse their decision. For example, new test results or a recent specialist report that confirms your total disability. Another example is a support letter from your doctor or treatment provider.
Often your doctor will not know what information should be included in a support letter. This will vary from person to person, but at a minimum the doctor should provide an explanation why in their opinion you are not able to perform the critical parts of your occupation. You can assist your doctor by making sure they understand the two or three most important tasks of your job. Your doctor can then explain why your symptoms prevent you from carrying out those critical duties. The support letter should also include information about your current and upcoming medical treatment.
Short Term Disability Claims – When Should I Call a Disability Lawyer?
You may call me at any time during the STD claim. If you have questions or difficulties with applying for benefits I can assist you with navigating through that process. Certainly if your short-term disability claim is denied or prematurely terminated then I can advise you on how best to submit an appeal – including helping your doctor understand the optimal information to be included in a support letter.
If your appeal is rejected, then I can provide you with advice with respect to legal action, including the steps involved and the potential outcomes. As always, there is no charge to speak with me about your case.
Call me for a free confidential consultation at 416-630-8880. Alternatively, please feel free to email me at info@disabledlaw.ca
Mark Yazdani
Short-Term Disability Lawyer
