Luckily you have insurance that will cover you. But then comes the paperwork. And if the insurance provider denies the claim, it can make an already bad situation a whole lot more stressful.
Most people simply aren’t well versed enough in their rights and responsibilities when it comes to insurance disability claims. The first thing to realize is that no matter what your income level, or whether or not you are insured, there are options if you have suffered an accident or illness that has left you unable to work. The Ontario Disability Support Program (ODSP) provides income support to those with serious health problems and no or low income. You may also have paid into the Canada Pension Plan (CPP) over the years, or your employer may have a group benefit plan in place for just such an eventuality.
But what if you thought you were covered through insurance, but had your claim denied? Luckily, there is still recourse. Remember, it is in the best interest of your insurance provider’s bottom line to pay as little as possible. This means that they may take advantage of loopholes or technicalities to avoid paying out the insurance benefits that you need.
In order to gain access to the insurance funds that you need, a law suit may be necessary. To begin this process, you must first issue a Statement of Claim at court, which is a short summary of the facts of your case and specifically outlines what you are demanding from the insurance company. These items may include reinstatement of your policy benefits, back payments for unpaid funds to date, legal expenses and possibly additional damages for mental hardship. The insurance company would then file a Statement of Defence, explaining why they believe that they were justified in denying or stopping payments of your disability claim. Each side will then exchange information and you will likely undergo questioning about your health, life and daily activities. Finally, the parties may require medical examinations to assess the level of your disability and to determine whether you may be entitled to the benefits that you seek.
The litigation process can be stressful, time consuming and emotionally and physically draining. Many choose to navigate the legal system with the aid of an experienced disability claim lawyer, who can guide them through the process, take care of the complicated paperwork, and protect them from intrusive, misleading or inappropriate questioning.