Articles Posted in Long Term Disability Claim (LTD)

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If you have applied for Long Term Disability Benefits with a private LTD insurer such as SunLife, Manulife, Great West Life, Industrial Alliance, SSQ, Co-Operators, Empire Life, RBC Insurance, La Capitale Insurance, BMO Insurance; and had your claim denied, then this is the article you need to read.

It’s important to know that in order to recover a Long Term Disability Benefit from one of these insurers, you first need to APPLY for it. Just sitting around and waiting for a cheque to roll in is a pipe dream. Insurers won’t pay a benefit, unless you’ve taken the time to complete the paper work (properly), and then submit it.

If don’t apply for the LTD benefit, I can assure you that you won’t get approved.

If you wait too long to apply for the LTD benefit, I can assure you that your claim will get denied for delay. Many LTD policies contain clauses that the LTD benefit must be applied for within a certain  period of time. Failure to make a timely application is grounds for an LTD insurer to deny your claim. If you take the time to read the fine print of your Long Term Disability Policy, you will see plenty of clauses which are drafted in favour of the large, deep pocketed insurer, instead of in the favour of the individual policy holder (a person like you and me).

None of this seems fair; but it isn’t intended to be fair. Keep in mind; an insurance policy is a product designed by an insurer to make money. If these policies weren’t profitable, I can assure you that insurers would not put them out there for the public to buy. Continue reading →

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Last week’s Toronto Injury Lawyer Blog Post was entitled “Long Term Disability Claim Delay = No Pay (Ontario). If you didn’t check out that blog entry, you can do so here.

We got a lot of positive feedback from our readership which we have been permitted to share with you! We think these comments will provide some helpful insight in to the challenges which people face when making a claim for Long Term Disability Benefits. There is assurance knowing that “you’re not alone” when it comes to understanding how LTD claims work, how LTD policies work, how/why you’re getting denied; and how insurance works in general.

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Bills stack up. Particularly around the Holiday season. Unless you’re independently wealthy or have amassed considerable savings, you’re ability to pay off these bills comes through income generated from working (or very generous monetary gifts!). What could be worse than being unable to return to work on account of a disability; or losing your job because you can’t work.

Most LTD Policies pay a monthly benefit at rates of 80%, 70%, or 66% or your net pre-disability income. This leaves a significant shortfall; even if your LTD claim has been approved by the LTD insurer. If you’re lucky, you may have one of those few policies which pay out LTD benefits at a higher percentage. But, those policies are expensive and few and far between.

Many clients want to know how they can speed up the processing and response time of their LTD claim. How can they get approved faster; so that their debt burden is more manageable?

If our LTD lawyers knew the answer to these questions, we would share it with the world. Unfortunately, there is no science behind the speed at which your LTD claim will get approved or denied. A lot of it depends on the insurance adjuster on the other end; the nature of your disability; the culture of the insurance company you happen to be dealing with; along with the amount of medical records involved in your LTD claim. The fewer records which an insurer has to review, the less time it ought to take to deliver a decision on your claim.

But, we see a number of instances where the LTD insurer requests more and more records. One set is just never enough for them to make a decision; one way or another. Some see this approach as thorough; and the LTD insurer is just doing their job. Others see it as frustrating; and an effort by the insurer to latch on to a document to deny a meritorious claim.

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Long Term Disability Plans are what they call in the insurance industry “living policies” or “living benefits“. You need to be alive in order to recover on going LTD Benefits.

In their most basic form, these LTD policies are there to protect an insured person in the event of serious disability which prevents that person from working at their own occupation, or at any gainful occupation.

If an insured person meets the test for disability, and they have filed all of the proper paper work, then in a perfect world; that person will receive long term disability benefits for the period for which they are disabled.

The amount of the monthly LTD benefit depends on your policy along with your pre-disability income. Some polices have a set monthly benefit amount like $1,000/month; regardless of income. Other policies base the monthly benefit amount on a percentage of your monthly pre-disability gross or net income, depending on the wording of your policy (ie 66.67% of your gross income averaged in the year before your disability).

All of these calculations sound simple enough. But have you ever read the fine print of these policies? Have you ever paid attention to how long some LTD policies can be?

The devil’s in the details, and the wording of these LTD policies can rise up and have a negative impact on your long term disability case.

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I would like to begin this Toronto Injury Lawyer Blog Post by discussing our law firm’s experience reporting a case of auto fraud to the Financial Services Commission of Ontario (FSCO). I will get in to what exactly the auto fraud was in a later post, as I simply don’t have the space this week to get in to the story.

FSCO is the government body which takes care of car accident and accident benefit fraud in Ontario. This was our first time reporting an incident.

When you wish to report a fraud, there is a Fraud Hotline, 1-855-5TIP-NOW or 1-855-584-7669. There is also an online form you can complete on the FSCO website. Accident Benefit and Car Accident Fraud has been made to be a big deal with all of the huffing and puffing which insurers do about this “epidemic“. You would think that reporting a fraud would be simple, and that the fraud team at FSCO would know what they’re dealing with, and get right on it seeing as it’s such a big deal.

I was passed on to four separate people at the FSCO Fraud Hotline (plus a hang up altogether)  before they even took down any of the fraud victim’s information to investigate the matter. It seemed like nobody knew what to do, nobody knew what to look for, and nobody wanted to deal with our report. I was being passed, from person to person without getting any answers. I had to advance a theory of the fraud which made them say “AH-HA! That’s it!” before they even understood the cause/root of the alleged fraud. It was like they hadn’t even dealt with car accidents or accident benefit cases before.

After much pressing and energy, the fraud has now been reported. What happens now is beyond our law firm’s control. Whether or not we get a progress report from FSCO regarding their investigation is uncertain. I’m doubtful they’ll get back to our office or to the fraud victims. Reporting car accident and accident benefit fraud should NOT be an exercise of jumping through hoops. It should be a clear and easy process with responsive, knowledgeable and accountable staff who get results. Results matter and I got the feeling in dealing with the FSCO fraud team that didn’t know what they were doing. Just our opinion based on our experience.

Now, on to the remainder of the Toronto Injury Lawyer Blog which focuses on Long Term Disability Claims and their tricky limitation periods…..

If there’s one thing which causes Plaintiff side injury lawyers to panic or lose sleep, it’s the fear of missing a limitation period. Conversely for defence counsel and their insurer clients, the prospect of getting a clear cut win on summary judgment motion because a Plaintiff missed their limitation period is exciting; along with a fast and cost effective way to close a file.

Determining when a limitation period begins to run has always been a challenge in certain types of cases. For motor vehicle accident claims, establishing the date of loss is rather simple. Most of the time, with certain exceptions, all the Court needs to do is look at the date of loss. But the same approach does not apply in the context of long term disability claims where there can be multiple denials, multiple levels of appeal, or the denial is not clear and unequivocal. There can be heated debate between Plaintiff and Defence Counsel as to when a limitation period should begin to run. Continue reading →

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Our law firm gets a ton of calls from people who have been denied Long Term Disability (LTD) benefits from their insurers (Great West Life, Manulife, Sun Life, Industrial Alliance, SSQ, Co-Operators, RBC Insurance, Desjardins, Equitable Life, La Captiale Insurance, Canada Life, and the list goes on…).

Although none of the people who contact our law firm have met, there are many common threads in the phone calls. A serious injury, illness or disability denied, or not properly communicated to the insurance company. Feelings of loss, anger, hopelessness, worry and despair on account of the denial. A sense of loss and simply now knowing what to do, or what to expect for their case or future.

These are all common and perfectly normal feelings. After all, you’re not a lawyer and this is probably the first time your applying for Long Term Disability benefits; let along your first time seeing how an insurer is reacting to your claim. It may be your first time calling a lawyer as well!

The experience of calling a lawyer should NOT be scary and NOT be intimidated. At our law firm, we do our very best to make the experience as comfortable and easy to understand as possible. There is no reason why excellent customer service should not extend to personal injury lawyers.

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Long Term Disability Insurance, and Critical Illness insurance are both “living policies“. They differ from a death benefit or life insurance policy in that the insured is still alive and the beneficiary; while alive; is able to recover the benefits.

In a “death policy” or “non living policy” only the designated living beneficiary, trust or corporation can recover the benefit. Somebody will need to have died in order to make a claim or recover benefits.

When making a claim for long term disability or critical illness benefits, it’s important to know what you’re getting in for.

Those application forms and questionnaires are very important. They are source documents for your case. They will go on to provide evidence upon which an insurer will use to potentially defeat your claim. These forms will also be scrutinized by a Judge or Jury with respect to how they were completed, what they say, and even when they where filled out.

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A number of our clients ask our lawyers whether or not they should try returning to work after they’ve been denied Long Term Disability Benefits, denied Income Replacement Benefits, denied CPP Disability Benefits, or are simply recovering from a serious injury caused by an accident; car, motorcycle, fall, or otherwise.

Let’s first paint a clear picture.

You’ve been hurt or injured in a serious car accident. Or, you have a medical condition (psychological, physical or otherwise) which is preventing you from returning to work.

Your doctors tell you that it’s not safe for you to work, and that you should take time off.

Your application for Long Term Disability Benefits, Income Replacement Benefits, or CPP Disability Benefits has been denied.

Your savings have been run dry. You’re borrowing money from friends and family members. You’re cashing out on your RRSP’s and other retirement savings in order to make ends meet. Your visa and credit are maxed out to the limit and those interest payments are accumulating. To say that you’re having financial difficulty is an understatement.

What do you do in this situation?

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A lot of our practice is focused on litigating short term, and long term disability claims against large insurance companies such as Manulife, Great West Life, Sun Life, Industrial Alliance, RBC Insurance, La Capitale Insurance, Co-Operators Insurance, Equitable Life, Canada Life etc.

These claims arise when a policy holder, of disability claimant; makes a claim on their Long Term Disability Policy (LTD), but their claim gets denied by the insurer. When that happens, people call our law firm and we’re able to help them get the benefits and justice which they deserve.

The area of Long Term Disability Law can be very confusing. Unlike a car accident, slip and fall or dog bite claim where we are able to clearly identify the wrong doing or negligence, a Long Term Disability Claim is purely contractual. That means if you don’t have an LTD policy, then you can’t have an LTD claim. It’s that simple.

The parameters of the claim are set up by the wording of the policy. Because every LTD policy is unique, every claim is very different.

Here’s a quick example. Some LTD Policies provide for benefits at 65% of your gross monthly earnings. Other policies provide for benefits at 75% of your net monthly earnings. Some policies provide for LTD benefits up to the age of 65 years old. Other policies provide for LTD benefits for just 5 years. The definitions of disability in each policy is also different and can vary dramatically from policy to policy. Some policies contain onerous exclusions for disability if based on a soft tissue injury or psychological illness. Other policies don’t contain those sort of exclusions.

The level and amount of coverage all depends on the policy, and how good (or bad) it is for the claimant. The claimant didn’t draft the policy. They were drafted by insurers, for the benefit of insurers to limit their potential exposure.

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Our law firm handles a wide array of personal injury and disability claims. Many of our cases are against large, multi-national insurance companies who provide all types of insurance coverage. One of the most common sort of claims we see are Short Term, and Long Term Disability claims against such companies as SunLife, Manulife, Great West Life, Industrial Alliance, Canada Life, Co-Operators, RBC Insurance, Desjardins, SSQ etc.

One of the biggest eye openers for our clients is what happens when they take a look at the fine print contained in their respective long term disability policies. After all nobody other than a personal injury lawyer uses an LTD Policy as their night time reading material.

These LTD policies are written by insurers, to minimize the potential exposure of an insurer; while giving the appearance that you’re getting amazing coverage. For most group and individual policies, you get what you pay for. The cheaper the policy, the cheaper the coverage. But even the best, and most iron clad policies are riddled with loop holes which may minimize your potential claim.

The purpose of this week’s edition of the Toronto Injury Lawyer Blog Post is to examine your run of the mill LTD Policy, and examine those provisions therein designed to limit your claim.

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