Published on:

Long Term Disability Claim Delay = No Pay (Ontario)

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.

The practical realities of LTD insurers also needs to be taken in to consideration. Is the adjuster handling your claim on vacation? Is that LTD adjuster over worked because somebody else left the company? Are the faxes and emails you’re sending to the LTD insurer going to the right office? Many of these LTD insurers have multiple offices and multiple departments. You may be sending things to the office in Toronto, when your LTD claim is ┬ábeing handled in say London or Kitchener-Waterloo. That’s not to say that the LTD insurer isn’t getting your mail. But, it’s taking an extra few days for that mail to be transferred from one office to the other.

Are any of these considerations an excuse for an LTD insurer not to be dealing with your claim in a prompt and professional manner? Of course not. But the reality of litigation is that the wheels of justice turn slowly. The way Ontario’s legal system is set up, lawyers cannot magically get you a trial date tomorrow, next week, or even next year. In fact, if you were to magically commence a civil action today, have the Statement of Defence file today, have discoveries, undertakings and exchange medical and expert reports today, and then magically file your trial record TODAY; your case won’t see the inside of a Courtroom for Pre-Trial of at least a year or a year and half. Having your trial heard can take even longer.

Unfortunately for the LTD claimant, they have to wait to have their day in Court, all the while their LTD claim has not been approved and they are losing money every day. The insurance company has time on their side. They are more than happy to wait you out because they don’t have the same financial pressures as a person does.

An insurer would rather hold on to your money and collect interest on their own corporate investments, rather than pay out an LTD claimant in benefits.

Most, if not all LTD insurers in Canada are publicly traded companies. The trade on the Toronto Stock Exchange. Companies like Manulife, Sun Life, Great West Life, Industrial Alliance, Desjardins and Co-Operators are all large multi national insurers who the general public can invest in.

The more money these companies retain in profit, the higher their stocks rise. The more money they have to pay out in benefits, the less money they can report in profits which cuts in to their bottom line.image1-2-300x225

It’s in an insurer’s best interest to delay and drag out your case longer. Long Term Disability claims are “living policies“. You have to be alive in order to recover benefits. If you die, so does your LTD claim for future benefits as well! If you magically recovery from your disability, your LTD claim for future benefits goes away too!

While it’s true, for an insurer that a closed file is a good file, dragging their feet all the way to the Courtroom in the hope that a claimant settles because they are so worn down and strapped for cash is also an effective strategy.

In situations where there is significant delay in bringing the LTD insurer to the bargaining table, it’s important for the claimant to apply for CPP Disability, Ontario Works, or Ontario Disability Support (ODSP) as soon as possible. These government resources are great ways of getting some monthly income while waiting for your LTD case to have resolved. Just because you apply for these benefits, doesn’t mean that you’ll get approved, or that you’ll get an answer in a prompt manner. The government can be slow and hard to deal with. There are a lot of complicated forms which need to be submitted by you and your family doctor in support of your disability and assistance. Our advice is to get cracking on these application sooner, rather than later, so that you have some benefits while you are waiting for your civil claim against the LTD insurer to settle or find its way to the trial list.

That concludes this installment of the Toronto Injury Lawyer Blog. From everyone here at Goldfinger Injury Lawyers, we wish you and your families a Happy and Safe Holiday Season.

Contact Information