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Articles Posted in Long Term Disability Claim (LTD)

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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.

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Not every case is perfect. That’s the reality of the law. Each case has its strengths, and weaknesses. Each case has its own unique set of warts so to say.

Some of these weaknesses can be avoided. Some of these warts can be treated.

As personal injury lawyers, we see clients make mistakes all the time; and that’s ok. Nobody is perfect. But the reality is that many mistakes can be avoided if people understand how the law works; and has a grasp of the consequences of their own actions; or lack thereof.

So without further a due, we will examine the top mistakes which personal injury clients conduct in the course of their accident and long term disability cases. It’s our hope that by understanding some of these mistakes, that personal injury claimants will prevent them from happening to strengthen their claims so they can get the compensation which they deserve.

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Cases are built upon evidence.

Lawyers will try to highlight certain pieces of evidence in order to better suit, or to create a narrative which suits their client’s best interests.

It’s up to a Judge or a Jury to sift through the evidence in order to determine where the truth.

While lawyers can spin evidence any way they want, there are sometimes objective facts which simply cannot be spun.

With today’s instalment of the Toronto Injury Lawyer Blog, we will try to highlight hurdles which our personal injury lawyers have seen in long term disability cases. Sometimes these hurdles can be cleared. Other times, these hurdles cannot be overcome and really hurt a long term disability case.

Long Term Disability Hurdle #1: The Plaintiff as returned to work. There is nothing wrong with returning to work, so long as you tell your lawyer and don’t hide it. In fact, the Plaintiff has a legal obligation to mitigate his/her damages, which means trying to return to work. We tell our clients that there’s nothing better for a case than a failed return to work attempt. It shows that the Plaintiff tried to mitigate his/her damages by attempting to return to work and that the return to work failed because their injury/disability is bonafide and very serious. If a Plaintiff does not attempt to return to work, the insurer will certainly question why not. If there are notes in the doctor’s records which suggest that a return to work is possible yet was not attempted; the insurer will insist that the Plaintiff has not even attempted to mitigate despite a doctor suggesting that a return to work is possible. Not trying to return to work can delegitimize a Plaintiff’s injury or disability (if a return to work is on the table). If a Plaintiff returns to work without telling their lawyer, or is working under the table for cash it looks like the Plaintiff is trying to pull a fast one on the insurer. This will be frowned upon. This is why it’s so important to have good communication with your personal injury lawyer and fill him/her in on the significant changes in your lifestyle or health. You both want to be on the same page. If your lawyer is advocating for your disability into the future, yet you returned to work months ago; it’s not a good look for your long term disability case.

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On August 10, 2021 the Honourable Justice Grace ordered that “all civil jury trials scheduled to commence in London, Ontario during September, October, November and December 2021 and all civil jury trials scheduled to commence in London, Ontario during September and October 2021” are adjourned. There will be a special civil assignment court to be conducted by teleconference on September 16, 2021 at which time new trial and potentially new pre-trial dates will be set.

The reason for the blanket adjournment of all of these civil trials? COVID-19.

His Honour cited “the impact of COVID-19 on the operations of the Superior Court of Justice and the significant backlog of criminal and family cases”.

Omnibus_Endorsement_of_Justice_Grace_re_civil_trials_for_Fall_of_2021_London (1)

So where does that leave your personal injury or long term disability case?

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Most unionized employees have benefits through their employer. Those benefits have been negotiated by their unions as a perk of employment. They help make life inside and outside of the workplace that much better and add a layer of security and value to one’s employment.

But if you asked a unionized employee what benefits they are covered for, and for what amounts: most will tell you that they aren’t really sure; but they are sure that they are covered for some things (dental, physio, life, disability or something else).

Not every employee memorizes their benefits booklet and that’s ok. Those benefits booklets can also get confusing given that employees are assigned into different categories where insurance benefits and amounts vary depending on the level of seniority or position of the employee.

You union can play a big role, or a small role in your long term disability claim.

Understanding the interaction between the employee and his/her union in the context of a long term disability claim is important. Failure to understand the union’s role can defeat a long term disability claim before it even has the chance of getting off the ground.

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Our law firm receives a lot of calls from people who have been denied Life Insurance, Long Term Disability Insurance, Mortgage Insurance and Critical Illness claims.

Some of these policies are group policies which are offered through an employer.

Sometimes these are private policies which are purchased from an insurance broker or from a bank.

This Toronto Injury Lawyer Blog post will focus more on those private policies which individuals purchase on their own. The thing with private policies is that you need to apply, and qualify for coverage. Monthly premiums vary depending on age, health, disability history, lifestyle choices and other risk criteria.

These risk criteria are examined in detail by an underwriting department at the insurance company.

These underwriters have very important jobs. They have to assess the risk of insuring individuals and put a dollar figure on that risk. Premiums are largely determined based on the risk of insuring the individual and the level or amount of insurance which the individual is seeking.

A life insurance policy which pays out a $50,000 benefit will be less expensive than a life insurance policy which pays out a $5,000,000 benefit.

The same way that a life insurance policy for a 9 year old person will be less expensive than a life insurance policy for a 99 year old.

There are so many factors which go into underwriting that it’s hard to understand. This is why insurance companies narrow down these underwriting criteria based on a set of questions when applying for insurance.

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Lots on people who are applying for Long Term Disability insurance benefits; or who are receiving Long Term Disability benefits want to know why their insurance company is asking (or demanding) that you apply for Canada Pension Plan Disability Benefits (CPP-D).

What does one set of benefits have to do with the other? Why is my long term disability insurer so adamant that I apply?

All of these are great question and as personal injury lawyers who handle a lot of long term disability claims; we see them all of the time.

For starters, contained in the very very fine print of each and every single long term disability insurance policy that we have seen is a provision which states something to the effect that:

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One of the most commonly asked questions of me, Brian Goldfinger, is:

Do I have a good case?

It’s generally hard to say whether or not a person has a strong case or not. But there are a few indicators as to the strengths, or weaknesses or one’s case.

This edition of the Toronto Injury Lawyer Blog will focus on case strengths, and case weaknesses as they relate to Long Term Disability cases. In some respects, the same reasoning can be applied to car accident cases, slip and fall cases, dog bite cases etc. But there will be some specifics dealing with Long Term Disability cases which are unique to those sort of claims.

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Twitter has it that close to 4,000+/- Ontario lawyers tuned in to an on line professional development program called the Mental Health for Legal Professionals Summit 

That’s a lot of lawyers for one on-line conference; and there’s nothing wrong with that.

In fact, there are a lot of positives to so many attending. It helps shine a light on mental health; it shows that lawyers aren’t invincible and will give those participating some coping strategies. It’s encouraging that during these difficult Pandemic and Lock Down days which have grinded on all of us, that lawyers are open to and receiving help. This is very reassuring and comforting. We all need support systems around us; particularly when isolated away from the workplace; so that we can feel connected and fulfilled.

While we are seeing this with lawyers; we don’t see this in every workplace. This has resulted in what we believe to be a spike in depression and mental health disability related claims.

Unlike a physical injury where an insurer, judge or jury case see the injury; we cannot see mental health injuries.

There are no band-aids, crutches, wheelchairs or canes for depression and anxiety. The co-worker who you see on Zoom may be suffering a lot on the inside; but you can’t tell over your weekly video meeting. They are likely struggling a lot on the inside. Reaching out to them to make sure they’re ok is great; but it doesn’t amount to professional help like counselling, CBT or medication.

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Long Term Disability claims are not claims for pain and suffering or general damage claims.

They are claims for a defined monthly disability amount based on percentage of your pre-disability earnings and last  for a pre determined period of time. Under most policies, that period of time is the age of 65; although some policies have provisions whereby benefits last shorter, or longer. It all depends on what it says in the policy.

When you are receiving long term disability benefits, chances are you won’t be made entirely whole. That means that you won’t be earning as much on long term disability; as you would if you were working and earning an income.

Some policies provide that long term disability benefits are taxable. Some policies state that long term disability benefits are not taxable. Again, it all depends on what the long term disability policy states.

Many people want to know what is the best possible outcome in a long term disability case. This can be a difficult question to answer; given that everyone has different ideas on what the “best” outcome for their case is.

For starters, nobody from the insurance company will be going to jail for having not approved your long term disability benefits; or for cutting you off your claim. In addition, a personal injury lawyer cannot seize the home, car or bank accounts of the person(s) responsible at the insurance company for not approving your claim. These forms of relief simply don’t exist. Although I do suspect if these forms of relief did exist that insurance adjusters would be extra cautious and careful when handling your claim. Not all insurance adjusters are bad people. They do make mistakes from time to time. But that’s no excuse. They aren’t the ones who have to live day to day without being able to work and try to make ends meet.

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