Toronto Injury Lawyer Blog
Part of Brian Goldfinger’s focus in 2019 for his law firm, Goldfinger Injury Lawyers will be helping to educate consumers on Long Term Disability claims and getting the benefits you deserve.
It all starts with knowing your rights and knowing how your policy of insurance works.
Lots of employees know they have benefits. Detailing what those benefits are is the next step. Understanding whether or not you have private long term disability coverage, and if so, how that coverage works is best when putting your mind to long term disability claims in Ontario.
Recently, Brian Goldfinger did an interview for Advocate Daily entitled “Consumers’ Guide to Long Term Disability Insurance“. You can find the article here.
This is the first in a multi part series which Brian Goldfinger is doing with Advocate Daily to raise awareness as it relates to Long Term Disability cases in Ontario. What Brian Goldfinger has found is that many employees/consumers don’t even know that they may have access to long term disability benefits, let alone how those benefits are activated and acquired.
It’s important to note that consumers are not limited to the Long Term Disability Benefits which their own employer provides. You can purchase your own individual policy which will follow you from employer to employer, regardless of your job. Having you own policy will provide you the freedom and flexibility to manage your coverage, premiums, definitions of disability and duration of benefits.
Rule of thumb: the more generous the benefits, the more expensive the long term disability policy premiums will be. Here’s another rule of thumb from personal injury lawyer Brian Goldfinger:
The longer the duration of payment of benefits, the more expensive the policy premiums will be
Most, of not all insurance companies will require the claimant to attend a medical examination or complete a medical questionnaire before the insurer agrees to set the policy in force and grant insurance to the individual.
The more injured, sick, or illness prone the individual, the more expensive the premiums will be (and perhaps the less the insurer will be able to provide a policy which suits the consumer’s needs). This is all done by the insurance company’s underwriting department.
The situation where medical questionnaires need to be completed generally rests entirely where individuals are seeking out their own policies which will follow them around from job to job. It does not apply for employees who get long term disability insurance as a part of a benefit package through work. Employees generally see benefits kick in at work after they’ve been working for an employer beyond a pre-determined period of time (like a 6 month probationary period). It would be unfair to an insurer, and to an employer to have an employee start working and after a day of work, that employee make a claim for long term disability benefits through the company plan; having only work a single day. But, long term disability insurers have even thought of those scenarios. That’s why your will see “Pre-Existing Exclusion” clauses contained on policies. Those “Pre-Existing Exclusions” mean that the the insurer will not insure the claimant for any pre-existing disability, injury or illness which was treated within the first 6 months +/- prior to the disability claim. These Pre-Existing Exclusions often won’t apply if the employee has been working for a period of 12 months or more. Those clauses are contained in Long Term Disability policies to protect the insurer and the employer from situations where the employee was working for a very short period of time, acquires benefits, and then goes on disability shortly after. With so few hours of work banked, the insurer and the employer take big financial hit on these claims if they are required to pay them out. If these clauses were not included, it would also entice more employers to conduct thorough background medical checks of their employees, new hires or prospective employees which doesn’t exactly scream privacy or human rights. This is not the sort of thing we want in our society. We want people to be hired because of merit and because they are the right person for the job, regardless of their pre-existing health issues; should those issues exist. One’s pre-existing health should not be a factor in determining whether or not you get a job or not.
Long Term Disability benefits don’t have to end at the age of 65. They can be shorter or they can be longer. Brian Goldfinger has seen long term disability policies which end at just 5 years. He has also seen policies which go beyond 65 up to the age of 70. Our lawyers have always wondered by polices have not kept up with the times. More and more Canadians are working much longer in life; well beyond the age of 65. But common long term disability polices will only pay benefits up to the age of 65. So if one wanted to retire at the age of 67, or 72+, then what are they to do if they are too disabled to work and can’t secure long term disability coverage beyond the age of 65. It’s not in the insurance company’s best interest to voluntarily extend benefits under all of their policies from the age of 65 up to 67+++. That would cost them a lot of money. But, it may be a bargaining chip for Unions in their negotiations with Employers that benefits don’t cover their members beyond the age of 65; when their members had every intention of working beyond the age of 65. Some concessions ought to be in order for the Unions to compensate their membership for these lost years where their employees don’t have access to any coverage/benefits.
One final note for today’s Toronto Injury Lawyer Blog Post: it’s not enough for you and only you to believe in your disability. The most important people to believe in your disability are your doctors and treating specialists. If those doctors and specialists don’t believe or support your disability; it will come across that way in their clinical notes and records. A supportive doctor is one of the best things to gain approval for a long term disability case.
