Articles Posted in Fibromyalgia

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Our law firm often gets calls from soon to be Long Term Disability claimants asking our lawyers to fill out their forms. We realize that the LTD application forms can be overwhelming, complex, with some hard to answer questions. Not all questions can be answered in a “yes/no” fashion.

Filling out LTD application forms is not something which our lawyers do. But, we can help give you a few tips on how to get your Long Term Disability claim a fighting chance of getting approved. Without further ado, here are Goldfinger Injury Lawyers’s tips on how to get your LTD claim approved at first instance:

1. If you want a benefit, you first need to apply for it! This seems like such a simple premise, but you would be amazed at how many people don’t understand it. Your Long Terms Disability benefits won’t just land magically in your lap without you first applying! Do you really think that an LTD insurer wants to pay you money without you not even yet applying for said benefit? LTD insurers don’t exist to give away money for nothing… There are mounds and mounds of forms which need to be submitted. And just because those forms have been submitted, doesn’t mean they will be looked at in a timely manner. Get those application forms submitted, and don’t sit around on it. There are  provisions in every LTD policy our lawyers have seen with respect to the timing of the application in relation to the last day you may have worked. Waiting around on getting that application in will jeopardize that timing and may give the insurer a reason to deny your LTD claim for failure to abide by the limitation periods as set for in the LTD policy.

2.  Make sure that your family doctor or specialist is on board with the LTD application. You will need a doctor or specialist to complete a medical certificate in support of your LTD application. If your family doctor or specialist doesn’t believe that your disabled, chances are the medical certificate which s/he completes will also NOT support your LTD application. That unfavourable medical certificate will give the LTD insurer a reason to deny your claim. If you have a more supportive doctor of your disability, consult that doctor for his/her assistance in completing the medical certificate.

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One of your benefits through work may be a form of Long Term Disability Insurance. LTD Insurance can also be purchased outside of work privately, through a policy which follows you from job to job. Having an LTD policy is always a good thing. You can also have more than one.

Long Term Disability insurance is provided by a large insurance company or bank like Manulife, Great West Life, Sun Life, Industrial Alliance, SSQ, Desjardins, Standard Life, RBC, Co-Operators etc. These are some of the most common insurance companies we see which provide LTD insurance across Ontario. If you’re reading this installment of the Toronto Injury Lawyer Blog, chances are that you may have LTD coverage with one of these companies.

The purpose of this coverage is to ensure that you get paid in the event of serious illness, or disability which prevents you from working for an extended period of time.

An insurer will pay an monthly LTD benefit. The quantum of that LTD benefit depends on the wording of your policy along with your pre-disability income. We commonly see LTD polices which will pay out a range of between 60-80% of the claimant’s monthly pre-disability income. Continue reading →

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If you have applied for Long Term Disability Benefits with a private LTD insurer such as SunLife, Manulife, Great West Life, Industrial Alliance, SSQ, Co-Operators, Empire Life, RBC Insurance, La Capitale Insurance, BMO Insurance; and had your claim denied, then this is the article you need to read.

It’s important to know that in order to recover a Long Term Disability Benefit from one of these insurers, you first need to APPLY for it. Just sitting around and waiting for a cheque to roll in is a pipe dream. Insurers won’t pay a benefit, unless you’ve taken the time to complete the paper work (properly), and then submit it.

If don’t apply for the LTD benefit, I can assure you that you won’t get approved.

If you wait too long to apply for the LTD benefit, I can assure you that your claim will get denied for delay. Many LTD policies contain clauses that the LTD benefit must be applied for within a certain  period of time. Failure to make a timely application is grounds for an LTD insurer to deny your claim. If you take the time to read the fine print of your Long Term Disability Policy, you will see plenty of clauses which are drafted in favour of the large, deep pocketed insurer, instead of in the favour of the individual policy holder (a person like you and me).

None of this seems fair; but it isn’t intended to be fair. Keep in mind; an insurance policy is a product designed by an insurer to make money. If these policies weren’t profitable, I can assure you that insurers would not put them out there for the public to buy. Continue reading →

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Many of our clients suffer from fibromyalgia, depression and chronic pain. These injuries arise and present themselves in a wide variety of ways. Each case is fact specific. We never know how these injuries will present themselves or manifest.

Our lawyers see fibromyaligia, depression and chronic pain in the context of car accidents, long term disability (LTD) claims, motorcycle accidents, slip and fall cases and assault claims.

Even though the starting of these points of these claims may be different, the end result is similar. An inability to work, function, or engage in your normal routine of daily living.

The struggle of having to explain to family, friends and loved ones the nature of your injury and how it impacts you life, when the injury is invisible is taxing. It would almost be easier if you had a broken leg. That way, everyone would see what’s wrong with you. Having to describe the pain and depression is difficult and hard for others to understand or sympathize with.

Insurers know this. That’s why in chronic pain, depression and fibromyalgia cases we see lawyers for insurance companies file Jury Notices right away. They know that they can play upon the subjective nature of chronic pain, fibromyalgia and depression in order to defeat your claim. Their goal is to have the jury disbelieve your version of the events along with your pain, such that your case will get dismissed.

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Our law firm gets a ton of calls from people who have been denied Long Term Disability (LTD) benefits from their insurers (Great West Life, Manulife, Sun Life, Industrial Alliance, SSQ, Co-Operators, RBC Insurance, Desjardins, Equitable Life, La Captiale Insurance, Canada Life, and the list goes on…).

Although none of the people who contact our law firm have met, there are many common threads in the phone calls. A serious injury, illness or disability denied, or not properly communicated to the insurance company. Feelings of loss, anger, hopelessness, worry and despair on account of the denial. A sense of loss and simply now knowing what to do, or what to expect for their case or future.

These are all common and perfectly normal feelings. After all, you’re not a lawyer and this is probably the first time your applying for Long Term Disability benefits; let along your first time seeing how an insurer is reacting to your claim. It may be your first time calling a lawyer as well!

The experience of calling a lawyer should NOT be scary and NOT be intimidated. At our law firm, we do our very best to make the experience as comfortable and easy to understand as possible. There is no reason why excellent customer service should not extend to personal injury lawyers.

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Here’s the scenario:

You’ve been working diligently for the same employer, at the same job for years. You’ve given it your all. Countless hours of pain staking work. The job pays well. You have some great colleagues at work. And you have a benefits plan that you believe is fantastic. Part of that so called benefits package is disability insurance; which; in theory; you’ve been told will cover your wages if for whatever reason you can’t return to work on account of injury, illness or disability. You know little about the disability plan because you’ve never had to use it before and you’ve never missed out on work for a prolonged period of time. Your past work attendance has been excellent. Your performance reviews are always top notch.

And then; things happen to change. Some really bad luck. A fall here that never quite heals. You throw out your back on account of a minor slip and fall. Or perhaps chronic pain starts to take over your body such that you can no longer focus, get out of bed or function like you used to. Or maybe you just aren’t the same person any more on account of psychological illness like anxiety, depression, sadness or a combination thereof. Perhaps you’ve been diagnosed with chronic pain or fibromyalgia. Whatever the reason, disability happens. Unfortunately, it’s a part of life for many. And when disability happens, you would hope that your long term disability insurer and employer are both there to support you when you need the help the most. After all, you’re the all star employee who has given it his/her all over the past 10+ years at work.

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Our law firm handles a wide variety of Long Term Disability (LTD) Claims against pretty much every deep pocketed insurer you can think of: Manulife, SunLife, Great West Life, Desjardins, SSQ, RBC Insurance, Empire Life, Canada Life, Industrial Alliance, Equitable Life, Co-Operators, Standard Life (Now Manulife). If you can name them, we have probably sued them.

Although every LTD claim is different, and every insurer handles claims in their own way, our lawyers see many similarities for these denied claims. Because we have years of experience helping people get the benefits they deserve, we are able to share some of our wisdom with you, our readers of the Toronto Injury Lawyer Blog.

For today’s instalment, we would like you share with some of the top reasons why Long Term Disability Insurers deny claims.

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Many people have benefits through work. Most understand those benefits to cover medical expenses such as massage, physiotherapy, medication, and dental expenses. Few think of those benefits as covering a portion of your income while you’re disabled and unable to work. This concept is called “disability benefits” or “disability insurance“.

These disability benefits are VERY important. Having them is excellent and great idea. Even if they aren’t offered through your employer’s benefit program; you can still purchase such benefits on your own from an insurer, or from an insurance company. These benefits are commonly referred to as Short Term Disability Benefits, and Long Term Disability Benefits. They typically run up until the age of 65 in the event of disability. Large insurers which offer LTD insurance are such companies as Manulife, Great West Life, Canada Life, Sun Life, Industrial Alliance, SSQ, Desjardins, RBC Insurance, Co-Operators, Equitable Life amongst others.

But it’s not enough to have access to this insurance. It’s important to understand HOW IT WORKS, and how to apply for it in the event of disability. Every policy is unique. Every policy will contain it’s own definitions of disability, their own exclusions, along with their own benefit amounts. Some policies are better than others. A BAD LTD policy is ALWAYS better than NO POLICY whatsoever. Usually, you get what you pay for. And, just because your employer offers LTD insurance through work, doesn’t mean that it’s a good LTD policy. Check it out for yourself how it works or talk you a broker or a lawyer about it.

As with any insurance, just because you’re hurt, doesn’t mean that benefits will automatically begin to flow. You have to jump through some hoops in order to get those benefits to begin. At the end of the day, you have something the insurance company has; and which the insurance company does NOT want to give up; it’s their money!

The first rule of insurance is that if you don’t claim for it; you won’t get it. The same applies to your LTD policy. If you don’t make a claim on it, then you won’t be able to collect benefits on the policy. But claiming these benefits isn’t as simple as putting in a phone call, or filling out a form online. There are a few forms which you, and your doctor  and employer will need to complete. The whole process can take some time.

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There are two schools of thought when it comes to fibromyalgia.

Some doctors believe it exists, and it’s a very real illness/disabling condition.

Other doctors don’t believe it exists, and that it’s all in your head.

Insurance companies and their lawyers, tend to side with the latter. Personal injury lawyers and their clients tend to side with the former.

In any event, fibromyalgia is one of the most difficult disabling conditions for a lawyer to prove. Next to a minor brain injury which doesn’t show up on any type of x-ray, scan or MRI, it’s right up there.  It’s also one of the most difficult disabilities for somebody to explain to another person. You look fine. You don’t have any visible breaks, abrasions or wounds. So, what could possibly be wrong?

Some of the most common things our lawyers hear things from clients are complaints such as:

  • It’s hurts all over
  • I have really bad headaches
  • I’m tired all the time
  • I can’t think properly, I can’t concentrate, I can’t read, I can’t remember things, My mind is like mush
  • I’m sad
  • I cry for no reason or really easily
  • I have problems sleeping at night
  • I have little motivation to do things
  • The pills I take don’t work and make me drowsy
  • I keep to myself and don’t socialize as much anymore
  • Nobody understands what I’m going through

YOU’RE NOT ALONE!!!!  These complaints are very common.

Our law firm has helped countless fibromyalgia sufferers over the years get the compensation and medical support they deserve. We understand that communicating things which can’t be seen on any x-ray scan or MRI are difficult to explain to a lay person, friends or a family member. What’s most important is having the right legal team set up your claim properly from day #1 so that your case is set up to win.

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Sometimes, the Toronto Injury Lawyer Blog examines recent cases that we think our readership will enjoy. We do our best not to make the legal analysis too technical, because that just turns in to a snooze fest. We want to keep things light, upbeat and easy/enjoyable to read. The law can be very dry and we don’t want our blog to become a bore.

Reading the Ontario Reports this week, we came across an interesting Long Term Disability Benefits decision involving a disability claimant, Ms. Garneau; and her LTD insurer, Industrial Alliance.

The decision was taken to Ontario’s Highest Court, (just shy of the Supreme Court of Canada); to the Ontario Court of Appeal on Queen St. in Toronto.

The decision appeal decision of Garneau v. Industrial Alliance Insurance and Financial Servics Inc. 2015, ONCA 234 can be read here. The motion for a reduction in set offs at the Superior Court level can be read here. The initial decision which was being appealed can be read here.

What makes this case so interesting for our law firm? Read on and we will share with you.

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