Disability Claims in Ontario: Navigating the Complex Process

November 21, 2024, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Applying for disability benefits can be a daunting task, especially when you're already dealing with health challenges. In Ontario, the process of filing a disability claim involves several steps and requires careful attention to detail. This guide will walk you through the process, highlight common pitfalls, and provide tips for building a strong claim.

Types of Disability Benefits in Ontario

Before diving into the claims process, it's important to understand the different types of disability benefits available:

Short-term disability (STD): These benefits typically cover the first few months of disability, usually up to 6 months.

Long-term disability (LTD): These benefits kick in after STD benefits end and can last for several years or until retirement age, depending on the policy.

Canada Pension Plan (CPP) disability benefits: This is a federal program for those who have made sufficient CPP contributions and have a severe and prolonged disability.

Workplace Safety and Insurance Board (WSIB) benefits: These are for workers who have been injured or become ill due to their job.

The Claims Process

Step 1: Notify Your Employer and Insurance Provider

As soon as you realize you may need to file a disability claim, inform your employer and insurance provider. They will provide you with the necessary forms and information about the process.

Step 2: Gather Documentation

You'll need to collect several documents to support your claim:

• Medical records detailing your condition and treatment
• Doctor's notes and assessments
• Employment information, including job description and salary details
• Any relevant accident reports (if applicable)

Step 3: Complete the Claim Forms

You'll typically need to fill out three main forms:

• Employee Statement: This form asks for your personal information, details about your condition, and how it affects your ability to work.

• Employer Statement: Your employer will need to provide information about your job duties, salary, and any accommodations that have been made.

• Attending Physician's Statement: Your doctor will need to complete this form, providing medical evidence to support your claim.

Ensure all forms are filled out completely and accurately. Any missing or incorrect information can lead to delays or denials.

Step 4: Submit Your Claim

Once all forms and supporting documents are ready, submit them to your insurance provider. Keep copies of everything you send for your records.

Step 5: Follow Up

After submitting your claim, stay in touch with your insurance provider. They may require additional information or clarification. Respond promptly to any requests to avoid delays in processing your claim.

Common Reasons for Claim Denials

Understanding why claims are often denied can help you avoid these pitfalls:

1. Insufficient medical evidence: This is one of the most common reasons for denial. Ensure your medical documentation clearly outlines your condition, its severity, and how it impacts your ability to work.
2. Missed deadlines: Be aware of all deadlines associated with your claim and meet them. If you need an extension, request it in writing before the deadline.
3. Pre-existing conditions: Some policies have exclusions for pre-existing conditions. Review your policy carefully and discuss any potential issues with your doctor.
4. Inconsistencies in information: Ensure all information provided is consistent across all forms and documents.
5. Not meeting the definition of disability: Each policy has its own definition of disability. Make sure you understand this definition and that your claim clearly demonstrates how you meet it.

Building a Strong Disability Claim - You Need An Experienced Personal INjury Lawyer from Our Team on Your Side

To increase your chances of approval:

• Seek regular medical treatment: Consistent medical care demonstrates the ongoing nature of your condition.
• Hire an experienced lawyer. Our team at Deutschmann Law is here to help you get the care you deserve and the settlement you’ll need to help you recover.

Call us. There's no charge for the initial consultation.

About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us at 1-519-742-7774.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.