Articles Posted in Long Term Disability Claim (LTD)

Lots of Canadians have been captivated by the Toronto Blue Jays playoff run into the World Series. A ball club which finished last in their division last year has made a historic turnaround which no fans or baseball pundits expected. They are the most mentally tough and resilient professional sports team I can remember.

One of the stories from the Toronto Blue Jays playoff run has been the injuries to the team, and their ability to cope with those injuries in order to compete at the highest level.

This got me thinking as a personal injury lawyer, and drawing comparisons to the injuries in the Toronto Blue Jays lineup and personal injury law. Specifically, dealing with long term disability cases.

When you think of long term disability, you have to think of it in binary or black and white terms. Either you are disabled, or you are not disabled. There is no middle ground or half way. For many people, this can present a major dilemma. The idea of going off work full time is daunting and scary. There is also no guarantee that the long term disability insurer will accept your claim. And if they do, there is no guarantee that your long term disability benefits won’t get cut off for one reason or another. It’s very scary to have to rely on your insurance company to make ends meet as unlike working, the payment of benefits is entirely outside of your control. You don’t know what the long term disability insurer is thinking; nor can y0u predict what they will do. What I recommend people do is expect the worst, but pray for the best.

The Toronto Blue Jays faced this predicament with a few of their players. You see, before a playoff series begins they have to announce their roster. There are limits on the number of players you can have on your roster. You want to have the right balance of starting pitchers, relievers, infielders, outfielders. Once the roster is set, you can’t go back and reset it, so that roster announcement is a very big strategic decision.

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You know when you’ve been approved for Long Term Disability Benefits. That approval will usually come first verbally, and then be formalized in writing.

While, getting something in writing from the long term disability insurer might feel good, it doesn’t mean anything until the payments start coming in.

That rings true in real world examples:

Let’s say you hear from your adjuster that benefits have been approved. Great!

Then, you receive a letter from the insurance company which formalizes the approval in writing. Great again!

But, as Jerry McGuire would say “Show me the Money“.

When the insurer does examines your file, looks at how much money you made, and how much money you’ve received from other collateral sources, it turns out that the benefit owing to you amounts to ZERO! That means that the long term disability insurer’s approval amounts to no tangible benefits for you; even though you’ve been approved. The reality is that you’ve been approved for nothing!

In that same example, it might be that the insurer had been paying you long term disability benefits. Then, they stopped because you received collateral benefits (like CPP Disability Benefits). Then, having reviewed your file, along with the amounts paid to you in long term disability benefits vs. the amounts paid to you in CPP Disability benefits; it turns out that the long term disability insurer over paid you. Now, they are seeking a repayment of benefits due to the over payment. This means that you owe the long term disability insurer money. Imagine that: a person owing an insurance company money for a over payment (completely unrelated to payments of insurance premiums).

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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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