Articles Posted in Long Term Disability Claim (LTD)

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A lot of our practice is focused on litigating short term, and long term disability claims against large insurance companies such as Manulife, Great West Life, Sun Life, Industrial Alliance, RBC Insurance, La Capitale Insurance, Co-Operators Insurance, Equitable Life, Canada Life etc.

These claims arise when a policy holder, of disability claimant; makes a claim on their Long Term Disability Policy (LTD), but their claim gets denied by the insurer. When that happens, people call our law firm and we’re able to help them get the benefits and justice which they deserve.

The area of Long Term Disability Law can be very confusing. Unlike a car accident, slip and fall or dog bite claim where we are able to clearly identify the wrong doing or negligence, a Long Term Disability Claim is purely contractual. That means if you don’t have an LTD policy, then you can’t have an LTD claim. It’s that simple.

The parameters of the claim are set up by the wording of the policy. Because every LTD policy is unique, every claim is very different.

Here’s a quick example. Some LTD Policies provide for benefits at 65% of your gross monthly earnings. Other policies provide for benefits at 75% of your net monthly earnings. Some policies provide for LTD benefits up to the age of 65 years old. Other policies provide for LTD benefits for just 5 years. The definitions of disability in each policy is also different and can vary dramatically from policy to policy. Some policies contain onerous exclusions for disability if based on a soft tissue injury or psychological illness. Other policies don’t contain those sort of exclusions.

The level and amount of coverage all depends on the policy, and how good (or bad) it is for the claimant. The claimant didn’t draft the policy. They were drafted by insurers, for the benefit of insurers to limit their potential exposure.

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Our law firm handles a wide array of personal injury and disability claims. Many of our cases are against large, multi-national insurance companies who provide all types of insurance coverage. One of the most common sort of claims we see are Short Term, and Long Term Disability claims against such companies as SunLife, Manulife, Great West Life, Industrial Alliance, Canada Life, Co-Operators, RBC Insurance, Desjardins, SSQ etc.

One of the biggest eye openers for our clients is what happens when they take a look at the fine print contained in their respective long term disability policies. After all nobody other than a personal injury lawyer uses an LTD Policy as their night time reading material.

These LTD policies are written by insurers, to minimize the potential exposure of an insurer; while giving the appearance that you’re getting amazing coverage. For most group and individual policies, you get what you pay for. The cheaper the policy, the cheaper the coverage. But even the best, and most iron clad policies are riddled with loop holes which may minimize your potential claim.

The purpose of this week’s edition of the Toronto Injury Lawyer Blog Post is to examine your run of the mill LTD Policy, and examine those provisions therein designed to limit your claim.

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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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Litigating Long Term Disability Claims (LTD Claims) can be tricky, especially when the injury is an invisible one; such as chronic pain or a psychological injury.

Firstly, it’s important to note that Long Term Disability Claims aren’t your typical tort or pain and suffering claims. These are special sort of cases.

What this personal injury lawyer means by that; is that the insurance company didn’t intentionally hire a hit man to whack you over the head with a sledge hammer to cause your pain and suffering. While it may feel like the insurer is intentionally causing you harm, the reality is, that in a vast majority of cases; they didn’t do anything intentional to cause your disability. We acknowledge that there are small exceptions where the behaviour of insurers is so outrageous and so disrespectful that it adds to the harm ; or causes harm. BUT, the reality is, that in most cases, while the insurer may have contributed to your harm by their denial of your claim, in the vast majority of cases; they likely didn’t cause you to be disabled in the first instance. The classic example of this was as stated: they didn’t hire somebody to hit you with a baseball bat to cause you to go on disability. Your health can deteriorate over time for a wide variety of reasons. Stress and anxiety from a denied LTD claim? Sure. But there are likely a wide variety of factors which have led to you being disabled from working.

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Not too long ago, the Toronto Injury Lawyer Blog focused on limitation periods in the context of Long Term Disability Claims, and how insurers will delay, delay, delay such that enough time has passed that they could ask the Court to dismiss your claim. Delay is the enemy of a Plaintiff and the friend of an insurer.

The longer a denied claim goes without litigation, the greater the chance that the delay argument will swing in the favour of the LTD insurer. It’s clear that time is NOT on the claimant’s side when it comes to filing an LTD claim, and then litigating it at Court.

One of the larger LTD Insurers, RBC Life Insurance Company recently brought their delay argument to the Ontario Court of Appeal in the hopes of having a claimant’s case dismissed completely.

The case is Dube v. RBC Life Insurance Company and the initial decision at the Superior Court level can be found in the above noted link.

In this case Mr. Dube was a full time employee of the Windsor Essex Housing Corporation. He began working there in around November 2008. He was entitled to benefits under a group disability policy with RBC. One of those benefits was Long Term Disability Benefits. These benefits were supposed to pay for a percentage of Mr. Dube’s salary, in the event of serious injury, illness and/or disability. Basically, if you’re too hurt to work, RBC will pay you a portion of your salary to help make ends meet. In theory, this sounds like a great thing. Almost too good to be true…

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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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Generally speaking, adults have 2 years from the date of a car accident, or slip and fall to sue. If you wait until after two years from the date of the accident, you’re likely out of time to sue. This is called a “limitation period“. These limitations, are set out by statue. The best place to look when it comes to limitation periods is Ontario’s Limitations Act, 2002, SO 2002, c. 24. or the applicable act for the subject matter you’re dealing with. You’ll likely need a lawyer to help sort these things out, so have a good one to call if you have any questions about this sort of thing. But this isn’t the purpose to today’s instalment of the Toronto Injury Lawyer Blog.

Sometimes, large insurers try to contacts OUT of the limitation periods which are set for in the Limitations Act,  2002, or other statues. Personal injury lawyers often see this in the context of long term disability litigation.

Long Term Disability claims are unique, because unlike a car accident or slip and fall case where the applicable law is generally tort law from our common law system along with other statutes such as the Negligence Act, Occupier’s Liability Act, or Insurance Act; Long Term Disability Claims (LTD) are entirely contractual claims. The insurer and their underwriters draft the contract. The claimant is suing for benefits which are supposed to be provided for under that contract. If the contract doesn’t exist, then there’s no LTD claim. If the benefits don’t exist under the contract, then they won’t exist in your claim.

A trend which Plaintiff side lawyers have been seeing more and more in the context of LTD litigation are instance whereby large LTD insurers, such as Manulife, Great West Life, Sun Life, SSQ, Desjardins, RBC, Equitable Life, Industrial Alliance and others are trying to contract OUT of statutory limitation periods to reduce them. They do this by virtue of tucking in clauses to those lengthy and complicated LTD insurance contracts.

An LTD claimant, or lawyer may assume that they have two years from the date of denial to sue. This would seem entirely reasonable. BUT, the insurer is relying on one of these limitation clauses to have the claim dismissed from Court, so that they don’t have to pay out any benefits on the claim.

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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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