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Basic steps for initiating a Long Term Disability Claim in Ontario

When it comes to litigating Long Term Disability Claims, many disabled claimants don’t know where to start.

How do I sue?

Who do I sue?

Can I sue my own insurer?

If I sue, will I get fired?

How much can I sue for?

Will my case go to trial?

If my case settles, how does the settlement work?

How much do I have to pay a lawyer?

All of these are valid questions. The reality about our law firm is that around half of our clients have NEVER consulted with a lawyer, prior to meeting with one of our personal injury lawyers.

To take that statistic to the next level, did you know that over 95% of our clients have have NEVER consulted with a civil litigation lawyer before (a civil litigation lawyer is a lawyer who sues in Court; personal injury law falls under the realm of civil litigation).

The reality is that a great majority of people are not only new to the legal system, they are also new to the concept of having to sue for denied benefits. It’s understanding this reality which makes us perform betters as lawyers and advocates on behalf of our clients.

With that heartfelt preamble, we prepare the latest installment of the Toronto Injury Lawyer Blog in an effort to help others not so familiar with the law, better understand how the legal system works (when it comes to long term disability matters)

  1. Where do I begin my LTD claim?

In life, if you want something, you need to ask for it. In very rare circumstances do things of value (or benefits) magically fall from the sky and land on your lap.

The same notion rings true when it comes to long term disability claims. In order to recover LTD benefits, you must first follow the proper channels and apply for these benefits through your insurer. It seems so simple, but this concept of applying and filling out LTD forms is so foreign to so many people.

The good news is that the forms to apply for LTD benefits ought to be readily available from your LTD insurer, your Union Rep, or from your employer (talk to your manager or HR rep). Some insurers even have the forms online in a e-portal system which you can log in to with the number on your benefits card and a password. It all depends on your insurer. Other insurers will email you, or mail you the forms.

Fill out those forms in a timely manner. Sitting on the forms won’t do you any good. Most, if not all policies our lawyers see come with a clause stating that the application for LTD benefits must be made within a certain amount of days. Again, this depends on the policy of insurance and wording therein.London-Head-Shot-Brian-Goldfinger-201x300

Just because you have the forms in hand, doesn’t mean that you have all you need to complete the LTD Application Package. Most LTD insurers want medical records. They will also request some form of medical certificate from your treating doctor or specialist. They will also request a form to be completed by your employer setting out such information as your first day or work, last day of work, salary/hourly wage, job description, job demands, and regular work hours.

You filling out your own forms is one thing. But having your employer or doctor complete the LTD forms is an entirely different challenge in and of itself. The forms may take a long time to get completed. The forms may get lost. The forms may not have been completed correctly. Your doctor may have checked a box which they didn’t intend to check off. All of these factors will have an impact on how your Long Term Disability Claim is assessed by the insurer.

2. After I submit the forms, what do I need to do?

At Goldfinger Personal Injury Law, we are cautiously optimistic that after your claim has been submitted, that your LTD benefits will get approved. Imagine that!

Unfortunately, this is not the case for many people. There’s certainly more work which needs to be done on both ends before any decision is made.

The LTD insurer will often ask for more paperwork, medical records, reports, or forms etc. The LTD insurer may ask for a brief phone interview, or may even send you for a medical assessment, or vocational evaluation with an assessor of their choosing.

3. Do I have to jump through all of these hoops in the early stages to get benefits?

The sad reality is that in a majority of Long Term Disability Cases, the answer is “yes“. If you want the insurer’s benefits, most of the time, you have to jump through their hoops (within reason).

The worst way to get denied LTD benefits can be on account on of non-compliance. Most LTD policies have provisions contained therein which state that the insurer is not only allowed to ask for further medical documentation, but also allowed to send you to a medical assessor of their choosing for testing. Failure to co-operate or participate can be deemed as non-compliance with the LTD policy, and seen as a justifiable reason to deny Long Term Disability benefits.

So if that LTD insurer has requested that you attend testing with their “quack” doctor, you may likely have to attend at such an examination. There are circumstances when your failure to participate in such an examination or assessment may be reasonable. You should consult with a personal injury lawyer to find out when those circumstances exist, and if they apply to your particular case.

Can I sue my own Longer Term Disability Insurer for denied benefits?

Sometimes YES, sometimes NO. Let’s start out with the sometimes “No” part:

If you are a Unionized Employee, and the terms of your collective bargaining agreement specifically state that all Long Term Disability disputes must be dealt with by way of the Grievance/Collective Bargaining; then you’re out of luck. You will need to let your Union handle the LTD matter and you won’t be able to advance your case in the Courts with a personal injury lawyer. We have seen a number of LTD cases which have been commenced by unionized employees against their LTD insurer kicked out of Court because it had to be dealt with through the Union given then terms of the collected bargaining agreement.

BUT NOT ALL UNIONIZED EMPLOYEES ARE BARRED FROM SUING their LTD insurer.  It all depends on the wording of the collective bargaining agreement. Ask a lawyer or your union rep if you can sue.

In all other cases, you can sue your long term disability insurer for benefits wrongly denied. Your claim must be commenced within 2 years from the date of the denial. Determining the precise denial date can get tricky at times given the appeal process for LTD claims, but this is something which your lawyer can assist you with.

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