Accountant Disability Claim Denied? We Can Help

Types of Disability Insurance

Group Disability Insurance

If you work for the government or an accounting firm, you will likely have coverage for long term disability benefits through your employer’s group benefits package. Your long term disability benefits will be based on a percentage of your pre-disability earnings and may have indexation to protect against increases in the cost of living.

If your employer has paid any portion of the premiums for your long term disability benefits, they will be taxable income in your hands. Most group long term disability policies pay benefits if you are disabled from your own occupation for an initial period of time and only if you are disabled from any other occupation thereafter.

Individual Disability Insurance

Many professionals opt to purchase a private disability policy which may provide better income protection. Typical features of private disability income policies include:

• The definition of disability is known as “own occupation” meaning that even if you can perform a less demanding occupation, if you cannot work as an accountant, you are entitled to benefits
• Partial disability benefits will provide payment of a disability benefit if you are prevented from performing your job duties a portion of the time
• Residual disability benefits are payable if you suffer a loss of income at a certain level despite the fact that you can work in some capacity
• Business overhead coverage to cover expenses when your income is reduced
• The policy may include an option to add cost of living protection as a rider to the contract
• Lifetime coverage may be available

Health Issues Accountants May Develop

As an accountant, you may be come disabled from working by any number of physical or mental diagnoses including:

• Physical medical conditions including carpal tunnel syndrome and other repetitive strain injuries, shoulder and neck strain, rheumatoid arthritis, trigger finger, tendinitis, and joint pain
• Substance abuse disorder
• Mental health diagnoses including anxiety disorders, depression, PTSD and bipolar disorder
• Chronic pain, chronic fatigue syndrome and fibromyalgia
• Autoimmune conditions such as irritable bowel disease, multiple sclerosis and Parkinson’s disease
• Fatigue, neuralgia or cognitive difficulties secondary to cancer treatment

The Claim Process

Disability Insurance Claim Tips

To apply for disability benefits, you will need to submit a claim which includes either 2 or 3 statements depending on whether you are applying for group long term disability benefits or under a private insurance policy:

1. A claimant statement
2. An employer or occupation statement
3. An attending physician report

The claimant statement provides personal information such as your age, date of birth, your work history and education. It also requires you to provide a detailed description of the symptoms that you suffer as a result of your medical condition and the reason that you cannot perform the substantial duties of your profession.

An employer statement provides a description of your own occupation including your current income at the time of disability and details of your benefit amount. This statement is required if you have long term disability benefits through a group insurance policy – for instance if you work for an organization or a law firm. An employer statement is also required if you own a private policy but work for an employer. If you are self employed, you may only be required to submit an statement which sets our the duties and tasks that you complete on a daily basis, and financial documents showing actual earnings.

All long term disability claims must be supported by a report completed by the treating doctor. The doctor will need to provide their observations of your condition and symptoms, your treatment and the doctor’s opinion about your level of function and restriction from your occupational duties. It is wise to submit detailed supportive medical records along with the initial claim.

The Claims Adjudication Process

Your long term disability will be assigned to a case manager. Case managers review all the documents you have a submitted with the intention of determining if the relevant medical documentation supports an inability to perform the material and substantial duties of your own occupation. If the case manager concludes that your are entitled to receive disability benefits, you will receive a letter admitting your disability claim. Your monthly benefits begin after the end of the elimination period (or waiting period). If your insurance provider denies your claim, the reason for the decision should be set out in a denial letter.

Appealing Denied Disability Benefits

Most insurance companies offer an review process to request reconsideration of their decision. While disability companies refer to their internal reconsideration as an appeal, it is important to understand that there is rarely a robust review of the claims decision. If you have new information to submit which includes medical records or financial documents that the insurer has not previously reviewed, an appeal may be successful.

While appeals are rarely successful, it’s important to review your long term disability claim with the help of a law firm with expert knowledge of disability law. The disability insurance policy may require you to submit an appeal before you can start a lawsuit. We provide clients with free consultations to review their options and can assist you by reviewing your claim forms, gathering the medical evidence and submitting a persuasive appeal on your behalf.

Reasons for Accountant Disability Claim Denials

Common reasons that accountants’ claims for LTD benefits are denied include:

• The insurance company suggests that you can work in some other occupation – for instance, a forensic accountant may be advised that they are not disabled and can find work preparing tax returns
• Insufficient medical records supporting disability
• The insurer fails to understand the true nature of the duties or hours required by the accountant’s area of practice
• Medical condition causing the disability is alleged to be pre-existing and excluded from coverage
• The insurer arranges an independent medical examination which refutes the treatment providers’ opinion of disability

Benefits of Working with Our Experienced Disability Lawyers

We can assist you at any point of your disability insurance claim including:

• Reviewing your application forms to highlight areas which need more information
• Assist you in dealing with your insurance company if your claim is accepted but you are being required to attend an independent medical examination or participate in a premature return to work program
• Submit a detailed appeal on your behalf to persuade the insurer to overturn your denied disability claim
• Start a lawsuit to enforced your rights
• Negotiate an acceptable lump sum settlement or for ongoing benefits
• Proceed to trial to obtain a court award if a negotiated resolution is not possible

There is no risk in finding out your options by getting advice from someone with legal expertise in battling insurance companies. If you are going to be off work for an extended period, you need help obtaining the financial security that you expected from your disability coverage. Book a free consultation with one of the disability experts at Burn Tucker Lachaine. We can take most cases on a contingency fee basis and, if not, can arrange an appropriate hourly rate retainer.