TORONTO INJURY LAWYER BLOG

It’s an unscientific fact that insurance companies don’t like fibromyalgia claimants. It makes no difference of the context of that fibromyalgia claim. It could be for your short term disability claim, long term disability claim, slip and fall or car accident.

Don’t take it personally. It’s not YOU they don’t like. It’s your symptoms, injuries, and what they stand for.

Here’s the harsh reality about fibromyalgia. It won’t show up on an x-ray, CT scan, MRI or any other fancy objective scan. There are trigger points but those don’t show up on computer tests. Insurance companies LIKE those sort of tests. It puts your injuries in to a black and white context. If it’s there on the scan and visible to the naked eye on a computer screen, then you have it and you’re likely suffering from it. If your injury doesn’t show up on the scan, then it doesn’t exist. It’s probably a figment of your imagination, or a way for you to lie in your attempt to deceive the insurance company.

It makes it much easier for an insurance company to lump your claim in to a simple formula that an unskilled, and untrained adjuster can follow. If the claimant has an ankle fracture, then he/she is entitled to “X” amount of dollars. If the claimant has a broken femur then he/she is entitled to “Y” amount of dollars…And so forth. I hope you get the picture.

The moment that your injuries cannot be put in to a simple mathematical and easy to understand equation is the moment that the insurance company needs to think and take a better look at your claim. When the insurance company has to slow down its operations for your claim, it hampers their productivity and profits. This is NOT good for their business.

The problem is that fibromyagia cannot be put into a simple mathematical equation and cannot be looked at from a “black and white” perspective. There’s a lot of grey area when dealing with these types of claims.
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We receive many calls every week from people who have been denied their Long Term Disability Benefits, by private disability insurers such as Great West Life, SunLife, Manulife, Standard Life, Industrial Alliance, SSQ, Co-Operators, Empire Life, RBC Insurance and others.

People want to know what to do after they’ve been denied.

Denial, or termination letters are often lengthy detailed letters which include the provisions of your LTD policy, the definition of the term “disability” based on the policy, excepts from medical records or medical reports, along with the insurer’s reasoning to deny or terminate benefits.

After these long winded reasons are provided, the insurer will also then include ways that you can appeal their decision. Statements like you have 90 days from the date of this letter to appeal this decision through our Appeals/Investigation Committee are common. People call our law firm in an absolute PANIC stating that they’re under the gun and that their opportunity to appeal the claim is fast approaching.

What I tell these people is NOT TO WORRY, and NOT TO PANIC. These internal reviews or internal appeals are often a waste of time and energy. Here’s why Continue reading →

We received quite the response from a recent Toronto Injury Lawyer Blog post dealing with trends in long term disability claims. The response was so overwhelming, we thought that we would futher explore those new trends in long term disability law and policies, along with other things which you ought to know when advancing your claim.

The first thing which you should know about making a long term disability claim is that with the exception of a bad faith claim, a claim for mental distress, along with a punitive/aggravated damages; these claims are essentially claims for your BENEFITS. The amount of what those benefits are is defined by your policy of insurance. This means that if your policy sets out that your monthly disability benefit amount of 66.67% of your pre-disability net income (which amounts to lets say $2,100/month), then your monthly disability benefit is $2,100/month.
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