Lawyers working in government or for law firms are usually covered by long term disability policies which are offered as part of your employer’s group benefits package. It’s important to review all of the coverage you have to determine when and how to apply for benefits.
Understanding Disability Claims
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:
- A claimant statement
- An employer statement
- 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 ways that you are limited from performing at your pre-disability level.
An employer statement provides a description of your own occupation including your income at the time of disability and details of your coverage. 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 occupation statement which sets our the duties and tasks that you complete on a daily basis, and financial information.
All 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.
The Claims Decision
Your disability claim will be assigned to a claims adjudicator who will review your application and focus on whether your claim supports an inability to work in your profession as a lawyer. The medical documentation needs to be detailed and provide information about day to day functioning. If there are test results or specialist reports, they should be attached to the initial claim.
The insurance provider may require additional information from your doctor or your employer before making a decision. Most long term disability claims will require a telephone call or functional telephone interview where you will be asked detailed questions about how you spend your day, what treatment you have tried and if you have an upcoming specialist appointments or changes in treatment. The insurer’s decision will be communicated in writing in the form of a letter admitting disability or a denial letter. Occasionally insurers call to advise you of their decision.
Disability Benefits: What You’re Entitled To
The disability benefit details will be set out in the policy. For instance, if you are covered by a group insurance policy, you may be entitled to a percentage of your income (e.g. 60%) to a maximum benefit amount per month (e.g. $4,500). In addition, you may have been entitled to apply for excess coverage beyond the maximum benefit amount within a certain time after you became covered. Requests for additional coverage usually require an form which answers medical questions and provides a health history.
If you paid all of the premiums for your disability benefits, the replacement income will not be reportable for income tax purposes. The policy will indicate whether there is an indexation provision for the cost of living. The benefits may be payable to age 65 if you remain entitled to benefits under the policy. Some private disability income policies have lifetime benefits.
Common Reasons for Disability Claim Denials for Lawyers
Long term disability claims are denied for many reasons including:
- The claim is supported by insufficient medical evidence
- The insurance company accepts that you have symptoms but disagrees that your illness or injury is so severe that it causes you to be totally disabled
- The insurer may have arranged an independent medical examination which differs from the opinion of your own doctor
- The insurer accepts that you cannot perform your occupation at your firm but suggests that you can perform the same role in a less demanding environment or setting
The Role of a Disability Lawyer
If you receive a denial letter, it’s important to schedule a free consultation with a firm which is knowledgeable about disability law. We can review your legal options and assist at any time of the claims process including:
- Assisting with a review of the initial application forms
- Reviewing the denial letter and advising about your legal options
- Drafting and handling a challenge of the denial through the insurer’s internal appeal process
- Starting a lawsuit to enforce your rights
- Negotiating a fair settlement of your LTD claim whether on a lump sum or monthly disability income payment basis
- If resolution is not possible, proceeding to trial to enforce your rights
Our Experienced Lawyers Can Challenge Unfair Disability Insurance Claim Denials
Long term disability benefits are intended to provide replacement income when you are unable to work in your own occupation. We know that legal fees are an unexpected expense at a time when your income is already reduced by your illness. We provide free consultations so that we can discuss your file and consider your options. Most files can be approached on a contingency basis and we are able to approach cases on an hourly retainer rate if that is your preference.
March 6, 2025 
