My name is Brian Goldfinger. I’m a personal injury lawyer. My law firm Goldfinger Injury Lawyers helps accident victims, disability claimants, and their loved ones fight insurance companies to get the benefits and compensation which they deserve after a serious accident, illness or injury.
My law firm only acts on behalf of injured and disabled people. We do NOT act on behalf of insurance companies. The only area of law which we practice is Plaintiff side personal injury law. We do not practice in any other areas. Goldfinger Injury Lawyers serves the province of Ontario with meeting offices in Toronto, London, Peterborough and Kitchener. If you can’t make it to us, we would be happy to visit with you for a free initial consultation.
If you are reading this latest installment of the Toronto Injury Lawyer Blog Post, you likely have some questions about long term disability claims and how they work.
Don’t be ashamed if you have questions about your Long Term Disability claim. Most people have lots of questions because they’ve never needed to make a claim before!
Unlike a car accident where one party is clearly in the wrong and committed a tort (negligence); long term disability cases are different. They are based on contracts of insurance (your policy).
To give you an example, nobody from your Long Term Disability Insurer (Great West Life, Manulife, Sun Life, Industrial Alliance, Desjardins, SSQ etc.) hit you with a baseball bat or ran you over with a car causing you to make a long term disability claim. If they did, you can sue that person in tort for pain and suffering.
For a long term disability case, your compensation (LTD benefits) are based on what the policy says (the contract). Damages for pain and suffering don’t exist. In rare cases, do punitive damages, aggravated damages, or damages for mental anguish/distress apply.
If your policy states that you are entitled to a monthly LTD benefit at a rate of 70% of your gross pre-disability income, to a limit of $4,000/month, then that’s what your award will be based upon.
If your policy states that the maximum term for which LTD benefits will be paid is 7 years, then you’re only entitled to 7 years worth of LTD benefits; no greater even though you may be totally disabled.
If your policy states that your LTD benefits are taxable, then you have to pay tax on your LTD benefits (arrears, not futures).
Personal injury lawyers understand why people have so many questions about long term disability claims. It’s because they are confusion because they’re based on a policy of insurance written in legalese. If you aren’t familiar with insurance policies and legal type wording, then reading one of these LTD policies is like reading a foreign language which you’ve never been trained in. If you’re new to the English language, then forget about trying to understand these policies and the terminology contained therein. Get a lawyer to help you out.
Making a claim isn’t a simple process (although it ought to be!).
Step 1: Get the right LTD claim forms. This sounds easy, but sometimes it can be difficult. I’ve heard horror stories of HR Departments refusing to give out the requisite LTD claim forms, or giving out the wrong ones; or the forms had changed. Sometimes these forms are available online, sometimes they aren’t. Sometimes these forms are available directly from your employer, sometimes you have to go through your union. It all depends on how your employer and LTD insurer work. In any event, getting the right forms quickly is important. Waiting on it will hurt your LTD claim down the line
Step 2: Fill you the right LTD claim forms. Again, this sounds simple and should be straight forward; but it’s often not. There will be a statement which the injured claimant needs to fill out, along with statements which the employer and doctor need to fill out as well. The turnaround time for your doctor or employer to complete these forms can often be long, so make sure you stay on top of it so that too much time doesn’t pass.
Step 3: Submit the forms to the right place. Sounds simple but can be deceiving if you aren’t paying proper attention. There should be instructions on where the LTD package is submitted on the forms. Dropping the forms off with HR or your Union is NOT the same as submitting them directly to your LTD insurer. If you are sending the forms in the mail, send by registered mail. That way you have a tracking number to verify that the forms were received at their destination. You wouldn’t want your LTD claim to fail on account of the Canada Post Monster eating your application and it never arriving to your destination.
Step 4: Go dark on Social Media (Facebook, Instagram, Twitter, etc.). Once an insurer gets your LTD claim, they immediately want to know EVERYTHING about you! That means scouring the internet on any dirt they can find, hoping that it will assist them in denying your claim. If the images portrayed of you on your publicly accessed social media accounts contradict what your medical records/reports say; then an insurer will have a hard time accepting that you are as disabled as you say you are. Social media accounts can be killers to LTD claims. Don’t let the same happen to you.
Step 5: If the insurer needs additional medical records, then get them. Don’t let your LTD claim fail because you have not put your best foot forward in terms of presenting compelling medical evidence to the insurer. If you want their benefits, then you have to jump through their hoops. You have have to pay for these records, but if you get approved then it’s all worth it.
Step 6: Be mindful of what you say over the phone to the adjuster. Nearly every phone conversation with your adjuster is recorded or notes are taken on their end. Those conversations and adjuster log notes can, and will be used against you down the line; so be careful of what you say. If you’re not comfortable talking over the phone because you don’t want to be put on the spot, then put things in writing. But be VERY careful of what you put in writing as well because your words can and will be used against you too as your case progresses.
Step 7: Don’t be afraid to lawyer up! Don’t sit on it in the event of denial. You will get nowhere doing nothing and sitting on your denial. If you are planning on appealing your LTD claim, think twice. Our law firm has written extensively on appeal a denied LTD decision here, and here. We would NOT recommend appealing for a variety of reasons which we have written about and would be pleased to discuss with you.