Disability insurance pays monthly benefits to covered workers who become unable to perform the duties of their job for medical reasons.
Unfortunately, the process of filing a claim for disability benefits can be confusing, frustrating, and time-consuming, especially if you don't know what to expect.
While many of us understand the importance of life insurance, the truth is that insurance against an accident or disease that prevents you from working is arguably even more important. A typical 30-year-old has a four times greater chance of becoming disabled than he does of dying before age 65. A full one in six Canadians will be disabled for three months or more before the age of 50.
Here is the basic information you need to know when filing a disability insurance claim in Canada:
What You Need To Do
Make sure you understand the claims process and obtain all the necessary forms from your insurance advisor/agent. Yourinsurance agent can advise you and help you make sure the papers are filled out correctly before you submit them.
Make sure you file your claim promptly as there may be implications if you don’t submit your claim within a certain amount of time after you become disabled. This time frame will be specified in your policy. Keep your insurance policy handy and in a safe place because a relative or adviser may need to access this document to act on your behalf.
If you can't find your policy at the time you wish to file a claim then contact your insurance agent immediately and he or she will work to provide a replacement as soon as possible.
The Role of Your Doctor
Your medical records and the opinions of your doctor are two of the most important components of your disability case.
Your doctor will complete their respective component of your claim form, which will ask for a professional diagnosis of your disability. Moreover, your doctor may be called upon by the insurance company to submit additional relevant medical records to further substantiate your claim.
Importantly, ask your doctor to write a detailed report regarding your medical history and your current limitations. Do not simply rely on the insurance company's forms. Be sure your doctor does not simply write that you're "disabled," as this is a legal term, not a medical one.
The Role of the Insurance Company
The insurance company will evaluate your claim based on the provisions of your plan. Be sure to familiarize yourself with the answers to the following questions:
How does your plan define "disability"?
Is there medical evidence to support that you are disabled according to the terms of your plan?
Are you unable to perform your regular occupation, or are you unable to perform any form of gainful employment for which your education, training and experience may have prepared you? Does your policy distinguish between the two?
Once your claim is filed and is under evaluation, the insurer will appoint a primary point of contact such that you may communicate about the status of your file.
Your Right To Appeal
If your claim is not accepted or if your benefits are terminated, you have the right to appeal this decision if you don’t agree with it. Check the provisions of your plan to find out if there is a time limit to appeal, and make sure you know who and where, in the insurance company, to send your appeal information.
If your appeal is turned down and you believe the decision is unjust, you may wish to contact the OmbudService for Life and Health Insurance to discuss your case.