Everyone knows that the doctors in Vancouver, especially family doctors, are burnt out, overworked, and underpaid. The problem has gotten so bad the NDP provincial government has put in place new payment schemes to try to keep the family doctors we have in place from leaving their practices altogether, as well as attracting new young doctors to start their practices in British Columbia. 

More and more people find themselves without a family doctor to provide them with care and those people who are lucky enough to have a family doctor sometimes need to wait months to get an appointment.

The shortage and burnout of family doctors have affected everyone in British Columbia, but one class of people it affects the most is people applying for long-term disability.

Doctors are Gatekeepers for Long-Term Disability Benefits

All long-term disability policies require a report from a doctor in order to have your benefits approved.  So in order to access benefits from a long-term disability insurance policy you’ll need your doctor’s help.  Other than times when a disability arises from an external cause like a car accident or slip and fall, it can be very difficult to prove your disability without your doctor’s support and clinical records. 

The medical opinion of a family doctor who has overseen your care for years and knows not only your health history, but you personally, will carry far more weight than that of a doctor who has only seen you once. 

More importantly, however, if your long-time family doctor is helping you apply for long-term disability, chances are they will be passionate about advocating for you, and likely support you on appeal if your initial application is denied.

Doctors play an important part in securing benefits for patients.

Understanding long-term disability insurance

But what if you don’t have a family doctor? The reality is most people don’t have a family doctor who has been caring for them over the years and knows their medical history and that of their immediate family.  For most people when they’re sick or need a prescription they simply look for the nearest walk-in clinic and hope they can be seen. 

This ends up with people not only not having a family doctor who is following their treatment, but having medical records scattered all over at different clinics. Most people won’t even remember which walk-in clinics they went to which leads to the question, how will you prove your medical history to your long-term disability insurance provider when you can’t even tell them where to look for your clinical records?

Securing Benefits for Patients

Not only are you not getting continuity of care at walk-in clinics, but Vancouver and the surrounding areas have some of the longest wait times in the country, with an average wait time to be seen by a walk-in clinic doctor of 79 minutes.

Once you have a doctor who will support your long-term disability application, it’s important for you to understand what you have to prove to your insurance company in order to get approved for long-term disability benefits. Most doctors are not concerned with what words they use to describe your disability in your long-term disability application. 

Documenting medical evidence thoroughly

In the medical world, doctors are focused on your diagnosis, treatment, and outcomes. Unfortunately for those seeking long-term disability benefits, insurance contracts live in the legal world and the legal world is all about specificity and the fine print.

David Goldberg, a disability lawyer at Taylor & Blair LLP in Vancouver says, “A long-term disability policy is a contract for insurance and the insurance companies will make sure that any applicant meets the contractual terms of proving their disability and in how they apply for disability. 

Most doctors feel that their opinion alone is all that is needed to prove a disability but that’s not how the system works. Often that leads to many long-term disability applicants being denied benefits and coming to me for help, usually with their doctors fully supporting their disability and eager to assist in fighting for their patients’ disability benefits. 

Collaborating with insurance providers

However, many of these applicants would have been approved if they and their doctor better understood what they needed to provide the insurance company in the first place.”

In order to ensure your doctor can best help support your application for long-term disability, the best thing you can do is read your insurance policy in detail. Find out exactly what the definition of disability under your contract of insurance is. 

Not every insurance contract is the same and you need to show you meet the specific definition under your policy terms if you want to be approved. 

Securing Benefits for Patients

Most doctors don’t know that if they include specific wording, perhaps something as innocuous as “for the foreseeable future”, their opinion on your disability can carry much more weight as it specifically references the definition of disability as found in your insurance policy. 

The best thing you can do is print out the definition of disability for your doctor to review before they provide the insurance company so they know how to word their report properly.

Even with the support of your doctor, your long-term disability claim is denied in Vancouver, contact an insurance denial lawyer right away as there are time frames in which you need to act.