Litigating Long Term Disability Claims (LTD Claims) can be tricky, especially when the injury is an invisible one; such as chronic pain or a psychological injury.
Firstly, it’s important to note that Long Term Disability Claims aren’t your typical tort or pain and suffering claims. These are special sort of cases.
What this personal injury lawyer means by that; is that the insurance company didn’t intentionally hire a hit man to whack you over the head with a sledge hammer to cause your pain and suffering. While it may feel like the insurer is intentionally causing you harm, the reality is, that in a vast majority of cases; they didn’t do anything intentional to cause your disability. We acknowledge that there are small exceptions where the behaviour of insurers is so outrageous and so disrespectful that it adds to the harm ; or causes harm. BUT, the reality is, that in most cases, while the insurer may have contributed to your harm by their denial of your claim, in the vast majority of cases; they likely didn’t cause you to be disabled in the first instance. The classic example of this was as stated: they didn’t hire somebody to hit you with a baseball bat to cause you to go on disability. Your health can deteriorate over time for a wide variety of reasons. Stress and anxiety from a denied LTD claim? Sure. But there are likely a wide variety of factors which have led to you being disabled from working.
What also makes Long Term Disability cases unique, is that they are for the most part limited to the wording of the LTD policy. The very nature of these claims are in essence, contractual claims. They are for the most part, taking away damages for bad faith, aggravated and punitive damages, along with damages for mental distress; the crux of the LTD benefit claim is the policy (or contract itself). N LTD contract = No LTD claim.
Our lawyers tell people that a bad LTD policy is better than no LTD policy at all. If you didn’t have an LTD policy, then you would NOT have access to LTD benefits. You would be left with nobody to sue if there isn’t any tort feasor (or at fault party who is responsible to pay you benefits).
What can make Long Term Disability Claims even trickier is when the claimant is carrying an “invisible injury“. What’s an “invisible injury” you ask? Good question.
An invisible injury is one which doesn’t show up on any x-ray, scan, test or MRI. It’s an injury which can be soft tissue in nature, or psychological. It’s a subjective injury, which only the claimant and his/her doctor can truly understand or appreciate.
Some LTD policies contain EXCLUSIONS for these types of injuries. That means that if you have chronic pain, or a psychological injury which is preventing you from working, certain LTD policies will preclude you from securing LTD benefits on account of such injuries.
Some LTD policies allow for claiming LTD benefits as a result of chronic pain or psychological injury, BUT, the benefits stemming from such injuries are capped for a shorter duration of time. Most LTD policies state that benefits will be paid until the age of 65. Some LTD policies cap benefits for chronic pain or psychological injury at just 5 years, instead of going up all the way until the age of 65. Check your policy to make sure you know to what degree of protection you have. If you have a broker, speak with that person about your LTD protection. You can always purchase additional coverage if this is a viable financial option for you.
The hard part about making a successful claim for LTD benefits when you have chronic pain or a psychological injury is getting the insurance company to believe your disability is preventing you from working at your own regular occupation or at ANY occupation. It’s hard enough to get the insurance company to accept your LTD claim when the injury is objective (like a broken bone or a head injury). It’s doubly hard to get the insurer to accept your LTD claim when that injury is subjective, like chronic pain, depression or anxiety.
It’s important to present to the insurer as much medical information as you can, so that they can properly assess your claim. It’s important to be careful what you send to them in writing. Preparing lengthy notes or letters to the insurance company detailing your position is just digging your grave deeper and deeper. This is never a good idea for a wide variety of reasons. Chances are, in that long detailed letter, you are writing something which will be used against you to deny your claim. While you may have the best intentions in preparing your note or letter, the insurer is picking up on all of the clues contained in that letter and will use those tid bits of information to defeat your claim. Our personal injury lawyers see this time and time again.
And if you’re one of those people who write long letters to the insurance adjuster, chances are you will also be the sort of person to write your own appeal, and run your own appeal without a lawyer. Again, you’re just shooting yourself in the foot by taking this step. While you have the best of intentions, the reality is that you’re simply playing in to the insurance company’s hands. What you’re allowing them to do is add another set of eyes to your file, to create a patter of “unique denials” from different people at different layers of their company. This only goes to legitimize the initial denial by having it corroborated by a more senior person whose marching orders are simply to deny, deny, deny. That way, the hands of the insurer are clean, and your claim continues to get delayed. And every good lawyer knows that time is one of the big killers for LTD cases. There are strict limitation periods which need to be met. The longer the case lags on without the involvement of a skilled personal injury lawyer, the closer that limitation period gets to lapsing. This is exactly what the insurance company wants. Lesson? Call a lawyer and get the right team working on your LTD case right away. Don’t get hurt twice and don’t get taken advantage of by an insurer who knows how to play at these games.