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Top questions for Long Term Disability Claims in Ontario

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.

Because LTD law can be complicated, the purpose of this Toronto Injury Lawyer Blog Post is to identify some of the most common questions our lawyers get for Long Term Disability claims.

+ Do I need a lawyer to complete my initial LTD paper work?

The quick and short answer to this question is “No”. Be honest and truthful in the paperwork you’re asked to complete. If you truly are disabled, this should jump out off the page for the insurer and an approval ought to be relatively fast. You will however need a supportive family doctor who believes in your disability. If your family doctor or treating physician does not support your disability, this too will jump out at the insurer and give them good reason to deny your LTD claim.

+ Why is the insurance adjuster asking me so many questions? Do I have to answer them?

By asking all of their questions, and requesting mountains of health records, the insurance adjuster is just doing their job. If they approved every claim without asking these questions and requesting records, they wouldn’t be doing their due diligence. At the end of the day, they’re just doing their job. Some adjusters are kinder and less vindictive in going about their job than others. When it comes to answering questions from the insurance adjuster, unfortunately, if you want the insurance company’s benefits, then you have to jump through their hoops. I don’t make up the rules. That’s just the way these things work. The last thing you want is for your claim to get denied for non-compliance. The same applies when it comes to certain insurance examinations. Talk to a lawyer about this one…London Head Shot Brian Goldfinger

+ If my LTD claim is denied, should I appeal that decision?

Our lawyers have never seen a claim which has been denied at first instance, later get approved on appeal, unless there has been a substantial change in the claimant’s health, or there is new and overwhelming medical evidence which is proving the disability. Only in VERY RARE cases are denied LTD claims overturned on appeal. By appealing, you’re just letting the insurer pad their file, and create a chain of denials to corroborate and legitimize the denial at first instance. If your LTD claim has been denied at first instance, stop messing around. Contact a personal injury lawyer right away. Your future benefits and financial stability are too important to jeopardize.

+ Do I have to apply to CPP Disability after applying for LTD Benefits?

Most LTD policies that our lawyers have seen either have a requirement that you apply for CPP Disability or a provision for a set off for CPP Disability. Either way, why wouldn’t you apply for CPP Disability? CPP doesn’t send you out for insurance medical examinations? They don’t conduct surveillance on you. They won’t cut you off at the drop of the hat? Benefits will go up to the age of 65 with minimum questions asked, and then CPP Old Age benefits kick in. When it comes to disability insurance, CPP Disability is pretty hard to beat.

+ How much is my LTD Case worth?

LTD cases are based on a number of factors. Our lawyers can quantify your case with a degree of mathematical accuracy. We quantify your case by taking in to consideration your age, earnings, monthly LTD amount, date of denial, duration of LTD benefits, along with a present value calculation for future benefits. Based on our mathematical calculations, we can tell you the total value of your LTD claim if all arrears are paid, and benefits are paid for the lifetime of the policy.

+ What can a Judge do if my case goes to Court?

Notwithstanding any claims for bad faith, mental distress, aggravated damages, punitive damages etc.; the only thing a Judge can do for you at trial is order that the insurance company pay the arrears, with interest, plus costs, and order that the insurer put you back on claim. That means that the insurer will pay your LTD benefits month to month on a go forward basis pursuant to the policy. But, pursuant to the policy, the insurer can conduct surveillance on you, can send you to a medical examination, and can require periodic updates about your health. Many claimants want a clean break/clean divorce from their LTD insurer. The LTD insurer wants the same thing. This is why a vast majority of LTD claims settle for a lump sum which factor in the value of arrears, interest on those arrears, payment for future benefits, plus a contribution towards legal fees. A good settlement is one whereby both parties are pleasantly unhappy such that the Plaintiff feels like they’ve accepted too little; and the insurer feels like they paid too much.

Got more questions about LTD Claims? Give Brian Goldfinger and his team at Goldfinger Personal Injury Law a call at 1-877-730-1777 or email us at brian@goldfingerlaw.com With offices in Toronto, London, Peterborough and Kitchener-Waterloo, we serve claimants all over Ontario.

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