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Brian Goldfinger and the Case of the Long Term Disability Insurance Denial

Throwing my name “Brian Goldfinger” into the title of the Toronto Injury Lawyer Blog posts makes the post sound like a Young Adult mystery novel. My daughter has found the titles to the Toronto Injury Lawyer Blog posts with my name in them quite interesting. But she has told me that the content of the posts doesn’t quite live up to the hype of the title. Let’s see if we can change that with this instalment.

There are a lot of Long Term Disability Insurance companies out there. Sometimes you get the chose which company you can go through by purchasing individual benefits outside of work directly from an insurer or an insurance broker. Other times, the individual has no choice and goes through their company benefit plan which was negotiated by the company or through the Union. Sometimes a company will switch benefit providers; so you may have stared with one private insurer; and then the entire company switches over to another long term disability insurer.

Sometimes there is choice. Other times, there isn’t choice.

It all depends on the individual facts and circumstances of employment.

Some examples of insurance companies which provide long term disability benefits in Ontario or Canada for that matter include, but aren’t limited to:

  • SunLife
  • Manulife
  • Canada Life
  • Great West Life
  • SSQ
  • La Capitale
  • Blue Cross
  • Industrial Alliance
  • RBC Insurance
  • Co-Operators Insurance
  • Desjardins Insurance
  • Equitable Life

Most auto insurers don’t offer long term disability insurance; the same way that most long term disability insurers don’t offer auto insurance. Although, there are a few companies which offer both. But this is not ordinary in the world of long term disability insurance.

There are a few things you need to keep in mind when seeking out a long term disability lawyer.

For starters: have you made your long term disability claim and has that claim been denied?

You would be amazed by the amount of people who want to sue their long term disability insurer for benefits denied; when in fact they haven’t yet been denied benefits because they have not even made their claim.

How can a long term disability insurer deny you benefits, if you have yet to properly make your claim?

Take it one step further; what happens if after you properly make your long term disability claim that your benefits get approved? Why will you now need a long term disability lawyer in your life? There’s nothing to fight for because you are getting paid benefits; which is a good thing!

Are you a Unionized, or non-Unionized employee?

This is very important. For many (but not all) Unionized employees; any disagreement (such as a denied long term disability claim), must go through the Collective Bargaining process through the Union. That means that no outside lawyer can get involved and that your Union must handle the long term disability dispute. No lawsuit. You can only proceed by way of grievance pursuant to the terms of the Collective Bargaining agreement.linkedin-2-300x300

Other times, Unionized employees are allowed to bring a formal lawsuit against the long term disability insurer for benefits denied because long term disability dispute are NOT governed by the Collective Bargaining agreement.

The route you must proceed with all depends on the wording contained in the Collective Bargaining agreement.

This is why it’s best for Unionized employees to ask their Union Rep on whether or not they can proceed with a civil lawsuit for denied long term disability benefits; or if they have to go down the grievance route through their Union. You cannot do both.

Are you disabled, or are you still working?

This is important. After all, it is a claim for Long Term Disability Benefits. If you are still working, then it’s very hard to make a case that you are in fact disabled.

Some policies offer a definition of “partially disabled” to support workers who can only work modified hours. This is different than “totally disabled” which supports disability benefits for totally disabled workers.

Find out if your policy contains a provision for benefits for “partially disabled” workers. If not, then it begs the question as to what the definition of disability is under the policy. For the majority of policies, this means that the worker cannot perform his/her job at all. After the two year mark, the definition of disability generally changes from working at your own job; to ANY JOB for which the candidate is reasonably suited by virtue of education, training and experience. This is a very broad definition making it very difficult for many claimants to qualify for long term disability benefits beyond the two year mark.

Most of the denials which our law firm sees take place after the two year mark, when the definition of disability changes from “own occupation” to “any occupation“.

Have you applied for CPP Disability Benefits? 

If you are disabled and unable to work, you should apply for CPP Disability Benefits. It makes no sense waiting on uncertain result of a lengthy lawsuit; when in the meantime, you can make a separate application for disability benefits from the Government of Canada. While there is no guarantee that you will get approved, it doesn’t hurt to apply (it costs nothing). In the event that you get approved, it makes it really hard for a private insurer to turn around and maintain the LTD denial when the Government of Canada has accepted that you meet their definition of disability. The definitions for disability under Long Term Disability policies, and for CPP Disability are similar, but not the same. For CPP Disability, the claimant needs to have made sufficient CPP contributions; and his/her injuries need to be deemed both “severe and prolonged“. Under LTD policies, the definition of disability varies, but generally can be summed up and simplified to mean the inability to work at your “own occupation” over the first 2 years from the date of disability; and thereafter; the inability to work at “any occupation” given the claimant’s education, training and experience.

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