Articles Posted in Long Term Disability Claim (LTD)

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Fibromyalgia is a serious disorder characterized by widespread pain, fatigue, depression, memory loss and other symptoms which vary from person to person.

Some doctors believe in fibromyalgia.

Some doctors don’t.

The same way that some doctors believe that fibromyalgia exists and is a very real and debilitating condition; and other doctors don’t; some insurance companies accept that fibromyalgia is very real and can have a significant impact on a person’s livelihood and ability to engage in day to day activities.

Some insurance companies don’t accept that fibromyalgia is real. They will want to create a narrative that fibromyalgia is a figment of your imagination. They will hope to establish that because you cannot see fibromyalgia on any sort of objective test like an x-ray, CT Scan or MRI Report that it’s simply not there. They will also try to create the narrative that you can fight through or work through whatever pain or ailment it is that you’re experiencing.

This is a false narrative. There are hundreds of thousands of people across Canada who suffer from fibromylagia, and there are countless doctors across the country who treat people for fibromyalgia. Don’t let your insurance company beat you down and crush your hope; because this is exactly what they’re trying to accomplish.

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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 personal injury lawyers here at my law firm, Goldfinger Injury Lawyers have developed a unique term for certain long term disability cases.

We call it getting “mathed out“.

What does it mean to get “mathed out“? It means that the math is working against you to defeat your claim, regardless of the merits of your disability.

Let’s explore how long term disability cases work.

These are cases which are based in contract. That contract takes the form of an insurance policy. Often we see our claimants with group policies, which contain sections for health, dental, life, and long term disability insurance. These group policies are a perk of employment (a benefit). Had the person not been gainfully employed, they would not have been covered under the policy; hence they would have no cause of action.

Some employees don’t have any benefits whatsoever, so if they don’t have their own personal long term disability insurance, they won’t have a cause of action.

On one hand the claimant needs to be thankful that they have a policy or long term disability coverage to lean on. But on the other hand, many claimants get upset that the policy seems to work in favour of the insurer and not the other way around.

The wording contained in these policies is written by large insurers. Because large insurers write the policies, you can expect that they contain a lot of favourable clauses protect their own interests and not yours. Why would you expect an insurer to draft a policy that doesn’t work in their favour? We just don’t see this sort of thing.

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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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The last installment of the Toronto Injury Lawyer Blog dealt specifically with tips and tricks for long term disability claims in Ontario.

That Blog entry was a resounding success. We received considerable positive feedback and inquiries that we thought we would keep the ball rolling with a second installment of tips and tricks for long term disability claims in Ontario.

These tips and tricks are based on what our long term disability lawyers see in our every day practice. We see a variety of pitfalls which trip up our clients which we would like you to avoid. Knowing how to deal with a long term disability insurer and making the right moves at the outset of your long term disability claim will help get your claim started on the right foot so hopefully, you don’t get denied.

But if your long term disability claim does in fact get denied, feel free to contact Goldfinger Injury Lawyers in confidence for your free no hassle, confidential consultation. All of our cases are taken on a contingency fee basis meaning you don’t pay any upfront legal fees, unless we win the case for you. This gives you the client access to our Court system which is very expensive and acts as a barrier for most people to bring claims against large deep pocketed insurance companies.

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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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My law firm handles a lot of long term disability claims.

These are cases whereby large insurance companies like Great West Life, Sun Life, Manulife, Canada Life, Industrial Alliance, Desjardins Insurance, La Capitale Insurance, RBC Insurance, Co-Operators Insurance etc. cut off, cease to pay or terminate one’s long term disability benefits.

We have represented people of all ages, from all different walks of life, with different occupations. People like doctors, lawyers, nurses, teachers, postal workers, university employees, municipal/government employees, civil servants, mechanics, general labourers, janitors, casino employees, factory workers, automotive sector employees, machinists, plumbers, tradesmen, bus drivers, truckers, brick layers, retail employees, clerical/secretarial staff, bankers, and even people with cushy desk jobs who work in giant towers in downtown Toronto. The list goes on.

Some people don’t lawyer up. They try to appeal these denials or terminations of benefits on their own. Our long term disability lawyers rarely see these appeals go anywhere. It’s like going to a gun fight with a rubber knife. All the appeal does is to serve the insurance company in establishing a patter of denials and kicking the can down the road for a few months in the hopes that a limitation period lapses to prevent a Plaintiff from bringing their claim in the requisite period of time. It’s an exercise by the insurance company to give the illusion that they are treating your claim with the upmost best intentions. But the reality is that your claim was doomed to succeed in the first place. Once the insurer looks at it in a negative light, it’s very difficult to sway the insurer in the other direction to have the claim approved without the assistance of a personal injury lawyer with experience handing long term disability claims.

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In the final instalment of a four-part series on long-term disability insurance, Toronto personal injury lawyer Brian Goldfinger discusses some of the unique issues that surface in LTD claims filed by educators and postal workers.

Toronto personal injury lawyer Brian Goldfinger refutes any perception that teachers and postal workers have cushy jobs as they are among the top clients he helps fight for in long-term disability (LTD) claims.

“Both jobs have generous vacations, but that’s a trade-off,” says Goldfinger, founder of Goldfinger Injury Lawyers. “When you sign up for it, there are significant amounts of stress and pressure, and nobody gives these workers their due respect.”

Teachers and postal workers share a number of commonalities, he tells AdvocateDaily.com. “Both are unionized and have access to a variety of benefits, but they’re in very high-stress, difficult jobs and they don’t get proper credit.

“They take some time off for stress, but it gets extended because their doctors or therapists believe their work environment is unhealthy for them,” Goldfinger says.

“It sounds strange because people often assume teachers are in a class of smiling, happy children, or that a postal worker has a dream job,” he says.

Goldfinger says that while many of these cases involve stress leave, physical issues are also common.

He points to a 2017 survey that found almost nine in 10 teachers have experienced or witnessed violence or harassment in the workplace.

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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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Part of Brian Goldfinger’s focus in 2019 for his law firm, Goldfinger Injury Lawyers will be helping to educate consumers on Long Term Disability claims and getting the benefits you deserve.

It all starts with knowing your rights and knowing how your policy of insurance works.

Lots of employees know they have benefits. Detailing what those benefits are is the next step. Understanding whether or not you have private long term disability coverage, and if so, how that coverage works is best when putting your mind to long term disability claims in Ontario.

Recently, Brian Goldfinger did an interview for Advocate Daily entitled “Consumers’ Guide to Long Term Disability Insurance“. You can find the article here.

This is the first in a multi part series which Brian Goldfinger is doing with Advocate Daily to raise awareness as it relates to Long Term Disability cases in Ontario. What Brian Goldfinger has found is that many employees/consumers don’t even know that they may have access to long term disability benefits, let alone how those benefits are activated and acquired.

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