4 reasons insurance providers might deny disability benefits

If you are seriously sick or hurt and cannot work because of your condition, you can file a claim seeking long-term disability benefits. While they cannot completely fix the situation, these benefits can help you support yourself and your family during a difficult time.

Because of this, it can be incredibly upsetting if your insurance provider denies your claim. They may do this for the following reasons:

  1. You missed a deadline: Depending on your policy and provider, there can be deadlines you must meet with regard to filing a long-term disability claim. If you miss a deadline, they could delay or completely deny your benefits.
  2. They deemed the claim invalid: Insurance companies will investigate a person’s claim, which could mean following you to take photos or videos. If the information they collect contradicts what you have said in your application, your benefits can be in jeopardy.
  3. They believed your condition does not prevent you from working: Insurance providers vary in their definitions of disability. And if they do not think you meet their definition, they may deny a claim. Thus, it is essential that you be honest and forthcoming with all the details of your condition.
  4. There was insufficient information: Applications that are missing medical documentation, personal information and other pertinent details may not be successful. Further, some policies require applicants to see an approved physician for an assessment. If you do not do this, the company can deny a claim.

If your insurance provider denies your application for these or any other reasons, do not lose hope. You can request a review and pursue an appeal if you disagree with an insurer’s decision.

It is crucial to understand your rights and options when it comes to pursuing long-term disability benefits. These financial remedies can be vital to your life and well-being when you are coping with a serious injury or illness.

Requesting workplace accommodations after disability leave

After being on short- or long-term disability, people returning to work can face obstacles they might not have experienced before their leave. One significant challenge can be returning to a job with conditions that make it difficult or impossible to participate in the workplace fully.

Under these circumstances, an employee can request accommodations that allow them to work. 

What makes an accommodation reasonable?

Under Ontario’s Human Rights Code, employers have a duty to provide accommodations that ensure employees with disabilities have equal access and benefits as other workers. However, one condition is that the accommodation must be appropriate. 

To be reasonable or appropriate, an accommodation must not be highly disruptive to other employees or fundamentally change the nature of the person’s job. Further, it must not put an undue hardship on an employer in the form of substantial expense or resources.

Some examples of an appropriate accommodation include:

  • Ergonomic equipment
  • Adjusted work schedule
  • Accessibility equipment
  • More frequent breaks
  • Additional support

These measures can enable a person to perform the essential functions of their job while preserving their dignity and allowing them to participate fully.

Requesting an accommodation

If you are returning to work and could benefit from an accommodation, you can submit your request to your employer. If you are unsure of what an accommodation might specifically look like, you might discuss the options with your supervisor. You can also consult your physicians or a lawyer to discuss possible solutions.

Keep in mind that any accommodation an employer provides should respect an individual’s dignity and promote integration.

It is also crucial to recognize that an accommodation that works for someone else may not be suitable for you. And your needs can change over time, meaning that you may need to make adjustments in the future.

Unfortunately, not every person will get the accommodations they need, either because an employer wrongfully denies them or the individual does not request them. Not only can this make it incredibly difficult to work, but it can also be a violation of a person’s rights.

Thus, if you are preparing to return to work after being on disability leave, assessing your needs and requesting appropriate accommodations should be high on your list of priorities to make the transition easier.

What protections do I have while on maternity leave?

Welcoming a baby into your family through adoption or birth can be an extraordinary and overwhelming experience. Thus, federal and provincial laws entitle new mothers and fathers to take leave from their job.

During this leave, which could last up to 61 or 63 weeks, parents continue to have rights. Parties who violate these rights can face legal and financial consequences. But what, exactly, are the rights that parents have while they are on leave after having a baby?

Protection from retaliation

Retaliation refers to adverse actions someone takes against a new parent because of status or leave-related decisions. Common examples of retaliatory behaviours include:

  • Demoting an employee for taking leave
  • Transferring an employee to a less desirable location, position or schedule because they are pregnant or about to have a child
  • Hiring someone else in the employee’s role while they are on leave
  • Terminating an employee who has plans to take leave
  • Urging a parent not to take leave to which he or she is entitled

These actions violate a person’s rights, and employers would be wise to ensure no such behaviours occur.

Job and benefits protection

When you take leave as a parent, you should expect to have a job to return to. Even if your exact position is no longer available, your employer must offer a similar role with the same or greater pay you earned before taking leave.

Employees also have the right to continue collecting benefits while on leave. Such benefits include pension and life insurance plans, and employers must continue to cover their share of the premiums. Further, time on leave should still count toward a person’s length-of-service.

That said, there are situations in which an employer can lawfully terminate a person on leave, including:

  • Large-scale downsizing and elimination of a person’s role
  • Termination based on legitimate reasons having nothing to do with the person’s decision to take leave

Whether you are an employer or an employee, it is crucial to take seriously any alleged violations under laws, including the Employment Insurance Act and the Employment Standards Act, 2000.

When an employer violates a new parent’s rights, they and their families can face overwhelming complications and challenges. Thus, they should understand that they also have the right to speak with a lawyer to examine the legal and financial remedies that may be available.