Articles Posted in Insurance

Long Term Disability insurance is based on the basic premise that you are too disabled to work, and that you are insured for a percentage of your pre-disability income. This percentage can vary anywhere from as low as 50% to as high as 80%, depending on the wording of the policy along with the riders contained in the policy.

You know what your pre-disability income was. But your long term disability insurer does not.

Chances are, your long term disability insurer has never heard of you, met you, or hasn’t the faintest idea what you do for a living until you’ve applied for long term disability insurance.

Once you’ve applied, the only way the insurance company has a chance to get to know you is on paper; based on the forms you’ve submitted to them in support of your application for long term disability insurance.

A very important form is the Employer’s Statement, or Employer’s Declaration.

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The term “long term disability benefits” would lead one to believe that those benefits should last for a long time.

But the term “long” can be misleading and subject to interpretation. Like many things in the practice of the law, the devil’s in the details and you gotta read the fine print.

So while your friends and family may tell you that your “long” term disability benefits will last for a “long” period of time (like your entire life); don’t be mislead.

Different policies of insurance carry different definitions for the duration of those long term disability benefits.

Here are a few examples:

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Lots of people call my law firm for legal advice for their long term disability claims. Often for these people, it’s their first time dealing with a large insurance company over a claim of significant value which can impact the course of their financial security for the rest of their lives.

Questions like:

What should I (or shouldn’t) say to the adjuster over the phone?

How do I complete all of these forms?

Who should complete these forms?

When should I apply for long term disability benefits?

How can I apply for long term disability benefits?

What must I do once my long term disability claim gets denied?

Should I appeal the long term disability insurer’s decision; and if so; how do I go about that?

When should I retain a long term disability lawyer?

How much will retaining a long term disability lawyer cost?

How long will my case take to get settled or go to trial?

As you can see, people have a lot of questions regarding their long term disability claims. This is completely understandable. Long Term Disability claims are hard to understand right off the bat! They are contractual disputes. The terms of each contract are different. They all depend on the wording of the policy and each policy of insurance is similar; but it’s NOT the same. This is what makes things a bit confusing.

A car accident is easy to understand. In a car accident case, an at fault driver causes a car accident and is held accountable for the pain, suffering and ensuing economic losses they have created through their own negligence.

A long term disability case is based on the wording contained in the policy of long term disability insurance. These policies are long, verbose and hard to understand. There are multiple clauses, exceptions, time periods etc which makes hard even for an experienced long term disability lawyer to understand.

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Long Term Disability insurance isn’t easy to understand. It’s not a common tort or a common cause of action.

It’s not an intentional act which causes harm, or a negligent act by an individual defendant which causes harm. That means it’s not easy for many people to understand.

Here’s a concept that’s easy for people to understand:

A Red Honda Civic runs a red light and t-bones a Blue Cadillac. The driver of the Red Honda Civic which ran the red light is charged and convicted for his bad driving. The passengers in the Blue Cadillac are all seriously injured in the car accident. The innocent accident victims in the Blue Cadillac sue the at fault driver of the Red Honda Civic.

In this very brief fact pattern, we have liability (the driver of the Red Honda Civic is at fault), and we also have damages and causation (the passengers of the Blue Cadillac got injured; and those injuries were a direct result of the negligence of the Red Honda Civic driver). The personal injury case against the at fault driver of the Red Honda Civic is clear and easy to understand.  This case is built in tort and based on negligence.

These concepts are relatively easy (in comparison to other causes of action) to understand.

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It’s not often that the Toronto Injury Lawyer Blog comments on cases decided at the Human Rights Tribunal of Ontario.

The reason being is that car accident cases, slip and falls, long term disability cases, motorcycle accidents etc. are all dealt with before the Ontario Superior Court; not the Human Rights Tribunal.

But ever so often, cases heard at the Human Rights Tribunal of Ontario intercede with cases relevant to the field of personal injury law in Ontario.

Talos v. Grand Erie District School Board is one of those cases.We here at Goldfinger Injury Lawyers believe this to be a very important decision for employees, employers, insurance companies and lawyers alike.

In 2006, the Province of Ontario passed a law that ENDED an employer’s right to terminate an employee at the age of 65. This allowed people to work much longer, and ended discriminatory practices based on age to people over 65.

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One of the most common questions which personal injury lawyers must answers is “how much is my case really worth“?

This question is never easy to answer. These questions are largely fact specific. Even the most serious analysis of the facts and evidence cannot predict the answer with pin point accuracy. The reason for this is that the majority of personal injury cases are heard by juries. Juries by their very nature are unpredictable. Judges can be unpredictable as well. If the Judge and Jury like the Plaintiff, then the award will likely be larger. If the Judge and Jury don’t like the Plaintiff, then the award will likely be smaller. In any event, predicting the outcome of a personal injury case, along with predicting the value is not an exact science.

There are certainly guidelines and parameters which personal injury lawyers use to predict the range of damages for a case. Precedent case law is certainly the most accurate tool for that. The general public can look up old cases FOR FREE on a great website called Canlii.

Free to use. Easy to navigate. With relatively good case updates, although not a comprehensive list of cases; Canlii is certainly an excellent resource even for the non-lawyer.

Some easier predictors for case valuation are long term disability cases. The reason being is that we are fighting over benefits which can mathematically be quantified and are payable over a fixed period of time pursuant to the Long Term Disability policy in place.

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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)

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