Markham & Toronto Disability Lawyers Helping Clients With LTD Claim Applications

It is never too soon to reach out to us for help. As a law firm dedicated to litigating LTD claims disputes, we understand all too well that the best outcome for our clients is never having to litigate. Seeking assistance from Mulqueen Disability Law early on can greatly help improve your chances of a quick approval of your LTD claim or appeal.

Proving you are disabled should not be difficult

We are mindful that our clients have suffered enough. With certifications in Trauma Informed practice and Mental Health First Aid, Mulqueen Disability Law takes clients’ mental health seriously. If you need help with an LTD application, you can feel safe contacting us. If you are not ready or still feel anxious about reaching out to us, below we have shared our “tried and true” list of Practical Tips for Applying for LTD.

Practical tips for applying for LTD

Our clients have suffered enough. Certified as a Trauma Informed Service Provider and in Mental Health First Aid, Mulqueen Disability Law takes clients’ mental health seriously. If you need help with an LTD application, you can feel safe contacting us. In the meantime, we are happy to share our “tried and true” list of Practical Tips for Applying for LTD.

Good timing and lots of details

  • If in doubt, apply for LTD and do so at least a month or two before the end of your short-term disability or sick leave period.  The future is unknown and even if you are optimistic about your recovery, it is best to apply in case things do not go as planned.
  • Your insurance policy has deadlines for applying for LTD. You should not wait too long or your claim could be denied on the basis that you submitted it too late. You also do not want to be waiting too long for a decision, without any income.
  • When you are completing your Claimant’s Statement/Plan Member’s Statement, provide detailed and accurate information. You can even add a page to ensure that you have provided the information the insurance company will need to fully understand and properly assess your claim. More is more at this early stage.

Choose doctors wisely and give some direction

  • Ask your family doctor to complete the Attending Physician’s Statement (APS) for every condition that impacts your functioning and your ability to work.
  • Submit an additional APS for psychological conditions, which can be completed by a psychologist or psychiatrist or other specialist.
  • Include reports/notes from other specialists for other conditions. Your family doctor should have all of your specialist’s consultation reports and you can ask that they attach those reports and their records to the APS.
  • Make an appointment with your doctor specifically for the purpose of discussing your LTD claim.
  • Explain the physical and cognitive demands of your job to your doctor. It’s helpful for them to fully understand why you are unable to do your job.
  • Remind your doctor to attach records, consultation reports, test results, etc.
  • Provide your doctor with a completed copy of your Claimant’s Statement/Member’s Statement for their reference.
  • Ask your doctor to add a short report explaining how your condition(s) prevent/limit you from doing your “activities of daily living” and the “the duties of your occupation”.
  • Ask for a copy of the completed APS and any additional documents submitted. If your claim is later denied, it will be helpful for us to have these documents readily available to start your court case or appeal the decision.

Referrals help – Be proactive

  • The insurance company may make assumptions about the severity of your condition based on who is treating you. For example, in mental illness claims, the insurance company will expect that you are receiving talk therapy (like CBT); medication; and that you have seen or have been referred to a psychiatrist.
  • Ask your doctors for referrals to specialists for the purpose of investigations, diagnosis, and treatment (if appropriate). You may need to advocate for yourself and be proactive in getting the necessary referrals. Even if you have not seen the specialist when your claim is being assessed, the fact that a referral has been made will suggest to the insurance company that your condition is severe.
  • Advise the insurance company of pending referrals on your claim form or in your telephone interview.  You can also remind your doctor to add that information to the APS.

Treatment is critical

  • The insurance company may make assumptions about the severity of your condition based on your treatment, such as what medications and dosages have been prescribed and changes to your medications; the frequency of appointments with your treatment providers; the nature of your treatment; and the qualifications of your treatment provider.  Treatment from a medical doctor will be more important in supporting your claim (in most cases) than treatment by an alternative or paramedical treatment provider (like a naturopath or acupuncture).
  • Insurance companies will not pay your benefits if you are not receiving “reasonable and customary treatment” or “appropriate treatment” as defined in your policy.
  • Follow your doctors’ and treatment providers’ recommendations (therapy and/or medication, etc.) and try not to miss any appointments. If you need to miss an appointment because you are unwell, be sure to make that clear when you cancel to ensure that the insurance company does not claim that you are not motivated to recover or that you are non-compliant.
  • If some form of treatment has been discussed or recommended but you are reluctant to proceed with it; or if you will want to try other treatment first; or if there is some other very legitimate reason why you are not proceeding with recommended treatment, be sure to have that discussion with your doctor and ask that they make a note detailing why you are not proceeding with that treatment. For example, some clients prefer to wait to take medication for depression/anxiety until they have tried talk therapy. Others may have tried medication and the side-effects were severe or interacted with other medications. If there is a family history of addiction, clients may also be reluctant to take any medication.
  • Seek out all forms of treatment–even alternative treatment if appropriate. Insurance companies will want to see that you are receiving medically supported treatment but other alternative treatments will still demonstrate your motivation and efforts to find relief from your symptoms and regain your functionality.
  • Complying with treatment recommendations adds to your credibility by demonstrating that you are doing everything possible to recover from your condition.

Telephone interview/questionnaire – More is more

  • The purpose of this initial telephone call with your insurance case manager (or disability claims analyst) is to clarify the information you and your doctors provided in the claims forms and medical documentation. The insurance company will also be on alert for any inconsistencies in your reporting to them as compared to what your treatment providers have said. The call could take anywhere from 30 minutes to an hour and a half.
  • They will ask not only about your condition and symptoms but also details about your daily activities. It is important that when you tell them what you can and can not do, you provide context for the activities. For example, you may have a “good day” or a “good moment” during a day when you leave your home to buy groceries or do other things, but the activity may be so exhausting that you require a few days or longer to regain your energy.
  • Be truthful. Listen to the questions carefully and provide complete and accurate answers. Do not guess, if you are not sure of the answer, particularly when it comes to questions about when you think you will be able to return to work. You do not want the insurance company to believe that you will return to work by a particular date if your recovery and prognosis is still unknown.
  • You can ask for the initial interview call to be scheduled for a time convenient to you or that it be done in writing. If you have severe anxiety, an unexpected call from the insurance company can be triggering and you may suffer an aggravation in your symptoms or you may forget to provide or explain important information.  If requested, your insurance company may also agree to provide you with a lengthy questionnaire that you will be able to answer in writing and return to them by a certain date. 
  • To ensure consistency in your answers and the other information provided in support of your claim, we recommend having a copy of everything that was submitted to the insurance company, in front of you and reviewing it in advance of the call, if you feel up to it. The call is not meant to be a test of your memory and you may feel less anxious having something to refer to when answering questions.
  • Do not be interrupted. If you are not finished answering a question, you may stop the interviewer from moving on to the next question and provide more details. After the call you can also email any additional information that you forgot to mention or correct anything that you may have misstated.
  • Remember to focus your answers on how your conditions and symptoms prevent you from working in your occupation and impact your daily functioning. The interplay between your conditions is also very important to explain. For example, if stress causes your pain to worsen and increased pain causes you more anxiety and depression, be sure to explain that interplay to them.

Additional requests for information

  • Following the interview, you may want to advise your doctors that the insurance company will likely be requesting more information (usually copies of records and possibly a short report) and ask that your doctors respond as soon as possible to avoid delay in assessing your claim.
  • If you have not seen your treatment providers in a while, now would be a good time to make follow up appointments to ensure that the most current information about your condition, treatment, functioning and prognosis is provided to the insurance company, when it is requested.

Contact Mulqueen Disability Law in Markham & Toronto for skilled assistance with your LTD claim application

By helping you with your application, Mulqueen Disability Law will know your claim inside and out. If it is approved, we will celebrate with you and be proud to have played a role in the positive outcome. 

However, if your claim is later denied, we will be able to start your litigation or appeal right away, saving you time and money. Courtney Mulqueen has over two decades of experience litigating complex long-term disability disputes and has unparalleled insight into the insurance industry after representing major life and health insurance companies for several years before switching sides.Based in Markham with meeting availability in Toronto, Mulqueen Disability Law advocates for disabled clients across Ontario. We also offer our services virtually for those clients who have difficulty meeting us in person. To discuss your LTD application with a member of our responsive, trauma-informed team, please contact us online or by phone at 416-900-0368 (or toll-free at 833-363-3LAW [3529]).