Articles Posted in Long Term Disability Claim (LTD)

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 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 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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