Articles Posted in Long Term Disability Claim (LTD)

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If you read the last instalment of the Toronto Injury Lawyer Blog, you would have read all about the confusing world of Long Term Disability policies, how they work; how they don’t work; and how ordinary people find them confusing. If you didn’t catch the last instalment of the Toronto Injury Lawyer Blog; don’t fret! You can read up on it here. Brian Goldfinger thinks that you will find it interesting and informative.

What makes our long term disability lawyers mad or frustrated, is when we see what appear to be otherwise meritorious cases, fail on account of a technicality not caught by the innocent disability claimant who doesn’t know any better.Goldfinger-logo-icon-300x300

Enter the recent decision out of Kitchener of Wiles v. Sun Life Assurance Company; released February 15, 2018 by the Honourable Justice G. E. Taylor.

In this case, the Plaintiff commenced an action against Sun Life Insurance for Long Term Disability Benefits. Prior to her disability, she worked at a company called Spaenaur.

The plaintiff states that she became fully disabled as of October 15, 2015, she continued to work full time and perform her employment duties until the date of termination of her employment at the beginning of November 2015. Prior to the termination of her employment, the plaintiff did not request of anyone at Spaenaur to be placed on disability.

In the Attending Physician’s Statement Salary Continuance Services, the plaintiff’s primary diagnosis was stated as “major anxiety disorder”. In the Attending Physician’s Statement Claim for Long-Term Disability benefits, the plaintiff’s symptoms were described as severe anxiety and depression which first appeared on November 3, 2015. The form also described the plaintiff’s symptoms as the result of being dismissed from her employment.

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Our law firm handles many short term disability, and long term disability cases against large insurance companies. These insurers include but aren’t limited to: Manulife, Sun Life, Great West Life, Industrial Alliance, SSQ, Desjardins, Co-Operators, RBC Insurance, La Capitale, and BMO Insurance just to name a few.

It should be noted that not every insurer sells/provides Long Term Disability insurance. Some do, and some don’t.  And not every insurance company handles claims in the same way. Insurers may appear similar, and certainly do similar things; but that doesn’t mean that they are the same.

If you’re reading this instalment of the Toronto Injury Lawyer Blog, you may be contemplating making a claim for Long Term Disability Benefits, and don’t know where to start, what to do, what questions to ask, what to say (or not say) so that you don’t mess up your Long Term Disability Claim.

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The unfortunate realities of Long Term Disability Claims is that in order to be on claim, you can’t be working. If you’re not working, that means that you’re not earning an income.

Whether you live in a big city like Toronto, a medium city like London, or on the outskirts of Peterborough, love alone won’t pay your rent, mortgage, pay for the food for your family, or pay the heating or hydro bills.

People need money to survive, and money doesn’t grow on trees. People need to go out and earn money by working.

But what if their doctors told them that they cannot work?

What if living on a pension, on OW, ODSP, or CPP Disability isn’t enough?

At Goldfinger Injury Lawyers, we understand that making ends meet, even for able bodied people is hard enough. Multiply that degree of difficulty times 5 if you’re disabled. Increase that degree of difficulty if an insurer like Manulife, Great West Life, Sun Life, SSQ, RBC, Industrial Alliance or Co-Operators has denied your Long Term Disability Claim.

The stress of having a Long Term Disability Claim denied in the first place is hard enough. Let alone the devastation of the denial itself. Compound to that the financial hardship that disabled claimant are under; it’s unconscionable.

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One of the most common questions which personal injury lawyers must answers is “how much is my case really worth“?

This question is never easy to answer. These questions are largely fact specific. Even the most serious analysis of the facts and evidence cannot predict the answer with pin point accuracy. The reason for this is that the majority of personal injury cases are heard by juries. Juries by their very nature are unpredictable. Judges can be unpredictable as well. If the Judge and Jury like the Plaintiff, then the award will likely be larger. If the Judge and Jury don’t like the Plaintiff, then the award will likely be smaller. In any event, predicting the outcome of a personal injury case, along with predicting the value is not an exact science.

There are certainly guidelines and parameters which personal injury lawyers use to predict the range of damages for a case. Precedent case law is certainly the most accurate tool for that. The general public can look up old cases FOR FREE on a great website called Canlii.

Free to use. Easy to navigate. With relatively good case updates, although not a comprehensive list of cases; Canlii is certainly an excellent resource even for the non-lawyer.

Some easier predictors for case valuation are long term disability cases. The reason being is that we are fighting over benefits which can mathematically be quantified and are payable over a fixed period of time pursuant to the Long Term Disability policy in place.

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What does it take to be found disabled under your Long Term Disability Policy? A kind adjuster? A lenient policy? Good handwriting on the LTD application? A good LTD lawyer? Or is it just dumb luck?

Our lawyers wish we had the answer to get you approved right away. A good lawyer will certainly help, but a good lawyer can only play the hand that s/he has been dealt.

Even winning claims can take time to win as the insurer has to be satisfied that the applicant’s disability is not only legitimate, but also meets the definition of “disability” contained in the policy of insurance.

The tricky thing for adjusters is that every LTD policy is different. They all contain different definitions of disability, different time lines to consider, along with different benefit amounts.

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Our law firm often gets calls from soon to be Long Term Disability claimants asking our lawyers to fill out their forms. We realize that the LTD application forms can be overwhelming, complex, with some hard to answer questions. Not all questions can be answered in a “yes/no” fashion.

Filling out LTD application forms is not something which our lawyers do. But, we can help give you a few tips on how to get your Long Term Disability claim a fighting chance of getting approved. Without further ado, here are Goldfinger Injury Lawyers’s tips on how to get your LTD claim approved at first instance:

1. If you want a benefit, you first need to apply for it! This seems like such a simple premise, but you would be amazed at how many people don’t understand it. Your Long Terms Disability benefits won’t just land magically in your lap without you first applying! Do you really think that an LTD insurer wants to pay you money without you not even yet applying for said benefit? LTD insurers don’t exist to give away money for nothing… There are mounds and mounds of forms which need to be submitted. And just because those forms have been submitted, doesn’t mean they will be looked at in a timely manner. Get those application forms submitted, and don’t sit around on it. There are  provisions in every LTD policy our lawyers have seen with respect to the timing of the application in relation to the last day you may have worked. Waiting around on getting that application in will jeopardize that timing and may give the insurer a reason to deny your LTD claim for failure to abide by the limitation periods as set for in the LTD policy.

2.  Make sure that your family doctor or specialist is on board with the LTD application. You will need a doctor or specialist to complete a medical certificate in support of your LTD application. If your family doctor or specialist doesn’t believe that your disabled, chances are the medical certificate which s/he completes will also NOT support your LTD application. That unfavourable medical certificate will give the LTD insurer a reason to deny your claim. If you have a more supportive doctor of your disability, consult that doctor for his/her assistance in completing the medical certificate.

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In Canada, we live in a free and democratic society. We are supposed to have access to the Courts when things go wrong in order to pursue justice and protect our rights and freedoms. When you’ve been wronged, and all else fails, you ought to be able to pursue your remedies before a Judge, in a Court of law.

This concept sounds great. But, the reality is, the idea of access to the Courts to protect our rights and freedoms simply does not exist (notwithstanding any delay in having your case heard, or lack of judicial resources; which is a topic for another day).

Want a few examples? Sure….

Innocent injured worker hurt badly on the job on account of the blatant negligence of their employer. Think you can sue? WRONG! Schedule 1 Employee vs. Schedule 1 employer can’t sue. That claim will likely be statute barred, and the injured worker will need to pursue matters through the WSIB. There are no large awards for pain and suffering (or large awards for that matter) at the WSIB. If you don’t like the result at the WSIB, you may apply for leave to appeal the result to the Court, but your case will NOT be heard by a jury of your peers, if it’s even heard at all.

Involved in a single car motor vehicle accident and your own car insurer is denying your accident benefit claims every step of the way? It would seem reasonable and only logical that the injured motorist can sue their own insurer for benefits denied. WRONG! Those sort of claims are now statute barred under the SABS and the Insurance Act. All disputes must go before the License Appeals Tribunal or LAT. The majority of those proceedings occur in writing, so the injured motorist doesn’t even get their “day in Court” so to say. If the injured motorist isn’t satisfied with the LAT’s decision, they can appeal to the Court, but again, their case won’t be heard by a jury of their peers.

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When it comes to litigating Long Term Disability Claims, many disabled claimants don’t know where to start.

How do I sue?

Who do I sue?

Can I sue my own insurer?

If I sue, will I get fired?

How much can I sue for?

Will my case go to trial?

If my case settles, how does the settlement work?

How much do I have to pay a lawyer?

All of these are valid questions. The reality about our law firm is that around half of our clients have NEVER consulted with a lawyer, prior to meeting with one of our personal injury lawyers.

To take that statistic to the next level, did you know that over 95% of our clients have have NEVER consulted with a civil litigation lawyer before (a civil litigation lawyer is a lawyer who sues in Court; personal injury law falls under the realm of civil litigation).

The reality is that a great majority of people are not only new to the legal system, they are also new to the concept of having to sue for denied benefits. It’s understanding this reality which makes us perform betters as lawyers and advocates on behalf of our clients.

With that heartfelt preamble, we prepare the latest installment of the Toronto Injury Lawyer Blog in an effort to help others not so familiar with the law, better understand how the legal system works (when it comes to long term disability matters)

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My law firm gets calls from people all across Ontario with respect to Long Term Disability claims. The questions cover a wide range of topics from:

  • Am I entitled to LTD benefits?
  • What can I do if the LTD insurer denies my claim?
  • How can I apply for LTD benefits?
  • Is it too late to sue?
  • Should I appeal the LTD insurer’s decision not to pay LTD benefits?
  • How many times should I appeal the insurer’s LTD denial?
  • How much is my LTD case worth?
  • How do LTD benefits work?
  • Where can I get my LTD application paper work and how do I fill it in?

One of the reasons people have so many questions when it comes to their LTD claim, is because few people have ever read their LTD policies; LTD claims are the exception for employees; not the norm; and people simply don’t understand how these benefits work.

In fact, we even have people calling our office for completely different reasons (car accident, slip and fall, motorcycle accident), only to find out months, or sometimes years later that they have long term disability coverage through their employer! Some people don’t even know they’re covered!!!

As an aside, this awareness of your rights dovetails in to personal injury lawyer advertising. Insurers don’t want to see lawyers advertise. To be fair, some well connected personal injury law firms don’t want to see other personal injury law firms advertise either (but that’s a different topic).One of the reasons which insurers don’t want to see personal injury lawyers advertise, is so that the general public is kept in the dark when it comes to understanding their rights. The later an injured accident victim, or LTD claimant understands their rights, the better for an insurer.

Case in point: The recent Ontario Court of Appeal decision in Usanovic v. Penncorp Life Assurance Company also known as La Capitale Financial Security Insurance Company 2017 ON CA 395 (CanLII). This Ontario Court of Appeal decision was released on May 18, 2017.

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One of your benefits through work may be a form of Long Term Disability Insurance. LTD Insurance can also be purchased outside of work privately, through a policy which follows you from job to job. Having an LTD policy is always a good thing. You can also have more than one.

Long Term Disability insurance is provided by a large insurance company or bank like Manulife, Great West Life, Sun Life, Industrial Alliance, SSQ, Desjardins, Standard Life, RBC, Co-Operators etc. These are some of the most common insurance companies we see which provide LTD insurance across Ontario. If you’re reading this installment of the Toronto Injury Lawyer Blog, chances are that you may have LTD coverage with one of these companies.

The purpose of this coverage is to ensure that you get paid in the event of serious illness, or disability which prevents you from working for an extended period of time.

An insurer will pay an monthly LTD benefit. The quantum of that LTD benefit depends on the wording of your policy along with your pre-disability income. We commonly see LTD polices which will pay out a range of between 60-80% of the claimant’s monthly pre-disability income. Continue reading →

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