Welcome

The secrets to winning a Long Term Disability Case against the insurance company(Ontario)


April 25, 2013

Our law firm handles a wide variety of short term, and long term disabilty claims. The insurance companies we go up against in these cases are well known to our lawyers as we have dealt with them on countless occassions. Large, deep pocketed insurance companies such as Great West Life, Manulife, SunLife, Desjardins, SSQ, Standard Life, Industrial Alliance, Canada Life, RBC Insurance and BMO Insurance are some of the most common LTD and STD carriers we see.

Time and time again, we also observe people being taken advantage of by their insurance company. We want this to stop, and we want you to better understand what it takes to win a difficult LTD or STD action. That's why this Toronto Injury Lawyer Blog Post will be devoted exclusively to Long Term and Short Term Disabilty Claims. If after reading this blog post, you still have questions about these sort of claims, don't hesitate to contact the offices of Goldfinger Personal Injury Law for your free consultation with one of our attorneys. Our offices are located in Toronto, London and Peterborough. If you can't make it to one of our three offices, then we would be happy to meet with you at a place more convenient to you.

One of the most common misconceptions about disability claims, is that they are for pain and suffering. Your lawyer can make a claim against the insurer for bad faith in the handling/adjudication of your file; for mental anguish and distress based on the denial or their poor treatment of you; or for aggravated damages. BUT, your lawyer will need to establish these factors which is never easy to do. It will take a psychological or psychiatric expert to establish a claim for mental anguish or distress. Bad faith claims will require the lawyer to establish some completely erroneous claims handling procedures and treatment of you which was not in the utmost good faith.

In any event, it's very important for the client to understand the difference between the monthly benefit amount, and general damages.

If you were working for 10 years as a mail clerk Level 3 for Canada Post, earning $42,000/year, your LTD policy (likely with SunLife) will cover 66% of your pre-disability earninst. This equates to $27,720 annually, which equates to a monthly LTD benefit of $2,310 per month.

The policy might stipulate that the monthly LTD amount cannot exceed $3,500. So, $3,500 is the MAXIMUM amount which you would be entitled to under the policy.

Having this information, your lawyer cannot recover greater than the amount stipulated under the policy. Your lawyer has to work within the framework of the policy in order to recover the benefits which are owing.

Keep in mind that your lawyer can still claim that interest is owing on the overdue amounts, and that you`re entitled to damages for mental anguish, bad faith, distress or aggravated damages. BUT, these claims are separate and apart from the monthly disability amount.200px-Bostonmarathonlogo.jpg

Not all LTD policies are equal. In the above noted example with the Canada Post Worker insured by SunLife, benefits are paid at a rate of 66% of income up top the age of 65, with a max monthly benefit of $3,500 per month.

Let`s take the example of a lesser policy with a company like Industrial Alliance. In this example, they are insuring a brick layer. Benefits cover 50% of the brick layer`s pre-accident income, and only last for a maximum of 5 years following the date of disability, or up to the age of 65, (whichever period comes first). If the bricklayer is 40 years old, he would earn benefits for just 5 years as there is a cap on the duration at which LTD benefits are paid. If the bricklayer was earning $30,000 per year, annual LTD benefits would be calculated at 50% ($15,000) which equates to a monthly LTD benefit of just $1,250 per month.

Even more upsettlng for disability claimants is that under most, if not all policies, there are set offs for any other income which the claimant recovers. So, if the claimant is also recovering CPP Disability Benefits at a rate of $500 per month, and the monthly LTD benefit is calculated at $1,500 from an insurer like Great West Life; then Great West Life is entitlted to deduct the CPP benefit from the LTD benefit. This means that you subtract $500 in CPP benefits from the $1,500 LTD benefit, leaving the claimant with $1,000 from Great West Life, and $500 from CPP, for a grand total of $1,500 (not $2,000 as the claimant is NOT allowed to double dip).

Even more hurtful is when the CPP disability benefits comes in after LTD benefits have been paid. That puts the claimant into a repayment position whereby they might actually owe money back to the LTD insurer on account of the set off provisions contained in the policy.

Every LTD policy is different. Every claimant and injury is different as well. That`s what makes these sort of cases so unique and so challenging. All of the parties have to work within the framework of rthe policy which presents its own set of tricks and turns. I`ve seen a terrible policy which prohibiited any disability claims based on soft tissue injury, brian injury or psychological injury. This basically only leaves open a claim for loss of limb or broken bones, which made it extremely difficult for the client, or for anyone for that matter to bring a successful claim. In that case, our law firm had to sue the broker who sold our client that terrible policy. We alleged that the broker failed to explain to the client how the policy worked, and what the exclusions were. Our client also could not read, write or speak English. The broker could not communicate with him in his native tongue, so how the policy even got signed, or approved remains a mystery (although a favourable settlement for our client soon followed).

In other news, it`s April and it`s still snowing in London, and it`s flooding in Peterborough and the Kawarthas. I was just at the Peterborough office last week, and people round town were telling me about the horrific flood levels in their communities and in their own backyards. We wish everyone the best of health, and hope that the damages are minimal. BUT: I have a prediction for all of Ontario`s homeowners. Mark my words: your home owner`s insurance will INCREASE significantly next year and insurance companies will justify that increase on account of the flooding and property damage done in North Eastern Ontario. Any excuse to raise premiums.