The Important Role Of Doctors In Obtaining Long-Term Disability Benefits

All long-term disability policies require a medical report to be approved.  For many people the obvious choice for a medical report is their family doctor as these doctors often have a long history with their patients and are familiar with their physical and mental health history, which is often important in long-term disability applications.  Most family doctors are passionate about caring for their patients and want to help their patients when they can and gladly assist their patients in applying for long-term disability benefits if it will help them at the end of the day.

However, your long-term disability application isn’t about what is good for you or what you or your doctor would like, it’s about the insurance company’s obligations under the terms of your insurance policy.  It is a strictly contractual relationship, and you can be sure that the insurance company won’t provide you any benefits they are not obligated to under the terms of the contract.  Even then they are obligated to provide benefits insurance companies will often attempt to skirt their obligations and pay nothing at all.

This is why it is important that your doctor understands that not only is their opinion on your disability important, but also what the insurance company need to be told to force them to pay your long-term disability benefits.

What If I Don’t Have A Doctor?

Applying for long-term disability benefits can be difficult enough, with approximately more than half of all long-term disability applications in Canada being denied, but the citizens of British Columbia have it worse than most as a staggering number of British Columbians are without a family doctor in the first instance.  As more and more family doctors are getting out of the practice altogether, whether due to burn out or low pay, most medical care outside of the emergency context is being accessed by walk-in clinics.  Often more than one walk-in clinic as most people will choose whichever clinic has the shortest wait time.  What this results in is not only a lack in continuity in care, but also with people’s medical records scattered about various clinics, with most people not knowing how to access their health records should the need arise, as it would in an application for long-term disability.

If you are looking for a family doctor there are some websites that can assist including:

Unfortunately, even with these resources finding a family doctor willing to take on new patients is becoming increasingly more difficult every day.  If you can’t find a family doctor willing to take you on then we recommend attending the same walk-in clinic for all your medical care, so at least your records will be at one clinic.

Defining Long-Term Disability Matters

As discussed above, the relationship between an insurer and the insured is a contractual one.  As such, the most important thing you can do to ensure you application for long-term disability is accepted is to make sure you understand what the contract between you and your insurance company is.  Not every long-term disability policy is the same and it is vitally important that you and your doctor understand what the definition of disabled is under your policy before you apply for long-term disability benefits.  Being disabled is one thing.  Meeting the definition of disabled under your insurance policy is another.

The most common definition of disabilities in long-term insurance policies is that an individual is
“unable to complete the essential duties of their job because of an illness or injury”.  However, this isn’t always the case.  Sometimes there is a threshold of what percentage of their regular duties can’t perform.  Other policies will require a lower percentage of earnings.  Whatever the definition for disability is for your contract of insurance will be in your policy and it is important you and your doctor understand what it is before you put in your long-term disability application.

A Change in Long-Term Disability Definition

Just as important for you and your doctor as knowing what the definition of disabled is under your long-term disability policy, is understanding that the definition can change.  Most long-term disability policies require you to be unable to complete the essential duties of your job because of an illness or injury for the first two years of your long-term disability benefits.  Often policies will have a clause that provides for a change in definition as to what is required to be considered disabled under the terms of the policy, and usually the change is from being unable to complete the essential duties of your job to being unable to complete the essential duties of any job.  This is often called a change from an own occupation (or own occ) definition of disability to an any occupation (or any occ) definition of disability.

It is important for you and your doctor to be aware of changes of definitions in your policy as a medical report stating you are still unable to complete the essential duties of your job could result in a termination of long-term disability benefits.

If you have a long-term disability claim that has been denied contact the lawyers at Taylor & Blair LLP today, as there are time frames in which you have to take action.