Articles Posted in Long Term Disability Claim (LTD)

This might seem like a very niche topic for the Toronto Injury Lawyer Blog as it relates specifically to Ontario teachers seeking to claim, or who have been denied long term disability benefits by The Ontario Teachers Insurance Plan (OTIP)

The reality is that there are a lot of teachers out there. Teachers have access to long term disability benefits and tend to read blog posts like this. Teaching is a difficult profession where bad days get noticed very quickly by the students and aren’t tolerated. Going in to teach a class day in day out in pain when you aren’t there 100% mentally isn’t good for anyone.

OTIP long term disability polices are some of the most complicated long term disability policies out there. It’s not because OTIP is trying to be difficult towards its membership, or has intentionally made the policies complicated to confuse teachers and to trick them out of getting benefits. It’s just that there are a lot of moving parts for teachers, and a lot of money at stake.

For starters, teachers on average earn a very good and stable income. They generally receive regular raises, and they have access to rehabilitation benefits to help them get better. Teachers are unionized employees as well which adds another layer of potential confusion (like why isn’t my union helping me pursue the long term disability claim?).

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The first long term disability case I had experience with came well before I was a personal injury/disability lawyer.

It happened before I was in law school. It happened to my mom.

She had just gone through multiple surgeries and had not recovered properly, or at all from them. She had been approved for Long Term Disability just before the surgeries took place. She was around 62 years old. After the surgeries, she remained on disability benefits. But shortly there after the long term disability insurer asked that she attend a few “independent” medical assessments with the insurance company’s doctors. She obliged.

Following those assessments, my mom was cut off her long term disability benefits. She was 63 years old, and her benefits were set to expire at the age of 65. She remained at home, in significant pain, and unable to manage her day to day activities of daily living, let along return to any form on employment.

We soon found out that these “independent” doctors who she saw were not really independent. These doctors did minimal to no work through the public OHIP system. Instead, most of their work was generated by referrals from auto insurers, long term disability insurers and WSIB. These doctors did not have a roster of patients who they routinely saw to cure their ailments. Instead, they had institutional clients like insurers, or assessment centres, who referred them people to see on a one shot only basis. After the assessment, they had an army of clerks who would generate reports. The person would arrive at the office for their one and only time to see the doctor. The doctor would check them over, and then someone would generate the report. That report, more often than not went in the favour of the insurer who had referred to doctor the patient in the first place. The doctor would not bite the hand that feeds them so to say.

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Sometimes lawyers are upfront and direct.

Other times, they can be sneaky. It’s those sneaky lawyers that you need to watch out for.

In all of my years of practice, I’ve seen some sneaky stuff. Lawyers and insurers trying to add terms to agreements which weren’t previously discussed, or negotiated. Lawyers and insurers seeking to get in through the back door, what they could not otherwise get in through the front door so to say.

Here are a few examples of those sneaky terms which you should watch out for in the context of your personal injury or long term disability case.

Resignation Clause

A Plaintiff is disabled and his/her claim for long term disability benefits gets denied. The Plaintiff then brings a claim for payment of his/her long term disability benefits. The litigation goes by over the years through the pleadings stage, discovery stage, and then to mediation. But over the years, the Plaintiff does not quit his/her job, get fired, or tender a formal resignation. The Plaintiff is still technically an employee of the company; albeit, and employee who is not working. It can certainly be argued that the employment is frustrated, but that’s an argument for the employer to make.

At mediation the insurer, as a term of settlement requires that the Plaintiff sign a formal resignation from his/her employment in order to get the long term disability settlement. The Plaintiff’s employment is not part of the litigation. If the long term disability case went to trial, the Judge would not be able to make any Order with respect to the employee resigning, or remaining an employee. The Plaintiff’s employment status is a completely separate matter.

Yet, the insurance defence lawyer is insisting that the Plaintiff in the long term disability action sign a formal resignation (without any consideration). The Plaintiff would be sacrificing any potential severance pay, access to other collateral benefits (medical, dental, life etc.) without receiving any consideration save for the long term disability benefits owed to him/her.

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