Long Term Disability Claim (LTD)

Published on: January 22, 2020

One sided pro-insurance company forms in Long Term Disability Cases

We must admit, long term disability cases can be very strange. Liability and calculating damages is not straight forward like in a dog bite or car accident case. The reason for that is long term disability cases are contractual in nature. That means that they are based upon, and defined by your long term disability contract.

This long term disability contract can be under a group benefits plan, or an individual policy of insurance.

Either way, chances are you haven’t taken the time to read the entirely of your long term disability contract because the majority of people (who aren’t lawyers or insurance professionals) simply don’t. Why curl up with a good book when you can read over your long term disability contract right?

Determining liability in a dog bite case is easy. Bad dog bites innocent passerby and causes damages. Liability has been established and now we can move along to damages.

Calculating damages in a dog bite case is easy as well. What are the injuries; look up similar fact case law and damage awards and then process those figures. Factor in the person’s age, education, employment, and how the injuries impact their daily lives along with any past/future care needs.

It’s not so easy when it comes to long term disability claims. Every contract is different, every disability is different as well. There are lots of terms and conditions contained in the long term disability policies our lawyers have seen which are real head scratchers for our clients.

Here are a few of those clauses which tend to confuse long term disability claimants.

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Published on: November 28, 2019

Insurance Brokers Negligence Cases in Ontario

By Goldfinger Injury Lawyers

Buying insurance is more complicated than buying a loaf of bread or a new pair of shoes. For starters, neither bread nor shoes are meant to last a lifetime, nor do they come with a fine print policy or instruction manual explaining what they’re all about. There’s no fine print when it comes to bread or shoes (other than perhaps the list of ingredients contained in the bread).

What you see with bread or shoes, is what you get.

The same can’t be said for purchasing insurance. There are thousands of twists, turns, bobs and weaves contained in each different policy of insurance; regardless of what the insurance is being purchased for. Often what you think you’re purchasing isn’t exactly so; or the insurance product doesn’t work the way you expect it to to work.

Case in point, let’s take the example of long term disability insurance. Here are some common misconceptions:

My long term disability benefits will cover 100% of my income: WRONG! Most policies only cover around 60-80%. Some lesser policies only cover 50% of your pre-disability income.
My long term disability benefits will last for the rest of my life: WRONG! Most policies terminate benefits at the age of 65, despite the fact you may have intended to work until the age of 70. Other less policies only cover benefits for a maximum duration of 5 years, or up to the age of 65; whichever period comes first.
I don’t have to pay any tax on my long term disability benefits. WRONG! Whether or not you pay income tax on your long term disability benefits depends on the wording contained in your policy. Rule of thumb: If your employer pays your premiums, then your long term disability benefits are taxable. Rule of thumb #2: If you lump out your long term disability claim with your insurer; only past benefits are taxable. Future benefits are not.
My long term disability benefits are paid in addition to my CPP Disability benefits and other collateral disability benefits so that I can double dip and make just as much money disabled (or more) than I made while I worked. WRONG! Nearly every Long Term Disability policy our lawyer have seen contains a set of provision whereby to long term disability insurer is entitled to a dollar for dollar set off for any disability income you are receiving; thereby reducing the amount of long term disability benefits owing to you.

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Published on: October 16, 2019

Fibromyalgia Claims

By Goldfinger Injury Lawyers

Fibromyalgia is a serious disorder characterized by widespread pain, fatigue, depression, memory loss and other symptoms which vary from person to person.

Some doctors believe in fibromyalgia.

Some doctors don’t.

The same way that some doctors believe that fibromyalgia exists and is a very real and debilitating condition; and other doctors don’t; some insurance companies accept that fibromyalgia is very real and can have a significant impact on a person’s livelihood and ability to engage in day to day activities.

Some insurance companies don’t accept that fibromyalgia is real. They will want to create a narrative that fibromyalgia is a figment of your imagination. They will hope to establish that because you cannot see fibromyalgia on any sort of objective test like an x-ray, CT Scan or MRI Report that it’s simply not there. They will also try to create the narrative that you can fight through or work through whatever pain or ailment it is that you’re experiencing.

This is a false narrative. There are hundreds of thousands of people across Canada who suffer from fibromylagia, and there are countless doctors across the country who treat people for fibromyalgia. Don’t let your insurance company beat you down and crush your hope; because this is exactly what they’re trying to accomplish.

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Published on: September 25, 2019

Long Term Disability Insurance: When your employer under reports your income

By Goldfinger Injury Lawyers

Long Term Disability insurance is based on the basic premise that you are too disabled to work, and that you are insured for a percentage of your pre-disability income. This percentage can vary anywhere from as low as 50% to as high as 80%, depending on the wording of the policy along with the riders contained in the policy.

You know what your pre-disability income was. But your long term disability insurer does not.

Chances are, your long term disability insurer has never heard of you, met you, or hasn’t the faintest idea what you do for a living until you’ve applied for long term disability insurance.

Once you’ve applied, the only way the insurance company has a chance to get to know you is on paper; based on the forms you’ve submitted to them in support of your application for long term disability insurance.

A very important form is the Employer’s Statement, or Employer’s Declaration.

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Published on: August 15, 2019

Brian Goldfinger on getting “mathed out” of a Long Term Disability Claim

By Goldfinger Injury Lawyers

The personal injury lawyers here at my law firm, Goldfinger Injury Lawyers have developed a unique term for certain long term disability cases.

We call it getting “mathed out“.

What does it mean to get “mathed out“? It means that the math is working against you to defeat your claim, regardless of the merits of your disability.

Let’s explore how long term disability cases work.

These are cases which are based in contract. That contract takes the form of an insurance policy. Often we see our claimants with group policies, which contain sections for health, dental, life, and long term disability insurance. These group policies are a perk of employment (a benefit). Had the person not been gainfully employed, they would not have been covered under the policy; hence they would have no cause of action.

Some employees don’t have any benefits whatsoever, so if they don’t have their own personal long term disability insurance, they won’t have a cause of action.

On one hand the claimant needs to be thankful that they have a policy or long term disability coverage to lean on. But on the other hand, many claimants get upset that the policy seems to work in favour of the insurer and not the other way around.

The wording contained in these policies is written by large insurers. Because large insurers write the policies, you can expect that they contain a lot of favourable clauses protect their own interests and not yours. Why would you expect an insurer to draft a policy that doesn’t work in their favour? We just don’t see this sort of thing.

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Published on: July 17, 2019

How Long should my Long Term Disability Benefits Last?

By Goldfinger Injury Lawyers

The term “long term disability benefits” would lead one to believe that those benefits should last for a long time.

But the term “long” can be misleading and subject to interpretation. Like many things in the practice of the law, the devil’s in the details and you gotta read the fine print.

So while your friends and family may tell you that your “long” term disability benefits will last for a “long” period of time (like your entire life); don’t be mislead.

Different policies of insurance carry different definitions for the duration of those long term disability benefits.

Here are a few examples:

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Published on: May 22, 2019

More Long Term Disability Claim Tips & Tricks (Ontario)

By Goldfinger Injury Lawyers

The last installment of the Toronto Injury Lawyer Blog dealt specifically with tips and tricks for long term disability claims in Ontario.

That Blog entry was a resounding success. We received considerable positive feedback and inquiries that we thought we would keep the ball rolling with a second installment of tips and tricks for long term disability claims in Ontario.

These tips and tricks are based on what our long term disability lawyers see in our every day practice. We see a variety of pitfalls which trip up our clients which we would like you to avoid. Knowing how to deal with a long term disability insurer and making the right moves at the outset of your long term disability claim will help get your claim started on the right foot so hopefully, you don’t get denied.

But if your long term disability claim does in fact get denied, feel free to contact Goldfinger Injury Lawyers in confidence for your free no hassle, confidential consultation. All of our cases are taken on a contingency fee basis meaning you don’t pay any upfront legal fees, unless we win the case for you. This gives you the client access to our Court system which is very expensive and acts as a barrier for most people to bring claims against large deep pocketed insurance companies.

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Published on: May 15, 2019

Long Term Disability Claim Tricks and Tactics for Claimants (Ontario)

By Goldfinger Injury Lawyers

Lots of people call my law firm for legal advice for their long term disability claims. Often for these people, it’s their first time dealing with a large insurance company over a claim of significant value which can impact the course of their financial security for the rest of their lives.

Questions like:

What should I (or shouldn’t) say to the adjuster over the phone?

How do I complete all of these forms?

Who should complete these forms?

When should I apply for long term disability benefits?

How can I apply for long term disability benefits?

What must I do once my long term disability claim gets denied?

Should I appeal the long term disability insurer’s decision; and if so; how do I go about that?

When should I retain a long term disability lawyer?

How much will retaining a long term disability lawyer cost?

How long will my case take to get settled or go to trial?

As you can see, people have a lot of questions regarding their long term disability claims. This is completely understandable. Long Term Disability claims are hard to understand right off the bat! They are contractual disputes. The terms of each contract are different. They all depend on the wording of the policy and each policy of insurance is similar; but it’s NOT the same. This is what makes things a bit confusing.

A car accident is easy to understand. In a car accident case, an at fault driver causes a car accident and is held accountable for the pain, suffering and ensuing economic losses they have created through their own negligence.

A long term disability case is based on the wording contained in the policy of long term disability insurance. These policies are long, verbose and hard to understand. There are multiple clauses, exceptions, time periods etc which makes hard even for an experienced long term disability lawyer to understand.

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Published on: April 10, 2019

Long Term Disability Claims: Because getting cut off is hard to do (Ontario)

By Goldfinger Injury Lawyers

My law firm handles a lot of long term disability claims.

These are cases whereby large insurance companies like Great West Life, Sun Life, Manulife, Canada Life, Industrial Alliance, Desjardins Insurance, La Capitale Insurance, RBC Insurance, Co-Operators Insurance etc. cut off, cease to pay or terminate one’s long term disability benefits.

We have represented people of all ages, from all different walks of life, with different occupations. People like doctors, lawyers, nurses, teachers, postal workers, university employees, municipal/government employees, civil servants, mechanics, general labourers, janitors, casino employees, factory workers, automotive sector employees, machinists, plumbers, tradesmen, bus drivers, truckers, brick layers, retail employees, clerical/secretarial staff, bankers, and even people with cushy desk jobs who work in giant towers in downtown Toronto. The list goes on.

Some people don’t lawyer up. They try to appeal these denials or terminations of benefits on their own. Our long term disability lawyers rarely see these appeals go anywhere. It’s like going to a gun fight with a rubber knife. All the appeal does is to serve the insurance company in establishing a patter of denials and kicking the can down the road for a few months in the hopes that a limitation period lapses to prevent a Plaintiff from bringing their claim in the requisite period of time. It’s an exercise by the insurance company to give the illusion that they are treating your claim with the upmost best intentions. But the reality is that your claim was doomed to succeed in the first place. Once the insurer looks at it in a negative light, it’s very difficult to sway the insurer in the other direction to have the claim approved without the assistance of a personal injury lawyer with experience handing long term disability claims.

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Published on: April 4, 2019

Long Term Disability Tips from Brian Goldfinger for Teachers & Postal Workers (Ontario)

By Goldfinger Injury Lawyers

In the final instalment of a four-part series on long-term disability insurance, Toronto personal injury lawyer Brian Goldfinger discusses some of the unique issues that surface in LTD claims filed by educators and postal workers.

Toronto personal injury lawyer Brian Goldfinger refutes any perception that teachers and postal workers have cushy jobs as they are among the top clients he helps fight for in long-term disability (LTD) claims.

“Both jobs have generous vacations, but that’s a trade-off,” says Goldfinger, founder of Goldfinger Injury Lawyers. “When you sign up for it, there are significant amounts of stress and pressure, and nobody gives these workers their due respect.”

Teachers and postal workers share a number of commonalities, he tells AdvocateDaily.com. “Both are unionized and have access to a variety of benefits, but they’re in very high-stress, difficult jobs and they don’t get proper credit.

“They take some time off for stress, but it gets extended because their doctors or therapists believe their work environment is unhealthy for them,” Goldfinger says.

“It sounds strange because people often assume teachers are in a class of smiling, happy children, or that a postal worker has a dream job,” he says.

Goldfinger says that while many of these cases involve stress leave, physical issues are also common.

He points to a 2017 survey that found almost nine in 10 teachers have experienced or witnessed violence or harassment in the workplace.

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