Our law firm handles many short term disability, and long term disability cases against large insurance companies. These insurers include but aren’t limited to: Manulife, Sun Life, Great West Life, Industrial Alliance, SSQ, Desjardins, Co-Operators, RBC Insurance, La Capitale, and BMO Insurance just to name a few.
It should be noted that not every insurer sells/provides Long Term Disability insurance. Some do, and some don’t. And not every insurance company handles claims in the same way. Insurers may appear similar, and certainly do similar things; but that doesn’t mean that they are the same.
If you’re reading this instalment of the Toronto Injury Lawyer Blog, you may be contemplating making a claim for Long Term Disability Benefits, and don’t know where to start, what to do, what questions to ask, what to say (or not say) so that you don’t mess up your Long Term Disability Claim.
These questions and uncertainties are a good thing. If you didn’t have these fears or questions, you are either too familiar in the process; in which case you’re frequently disabled having made these LTD applications all the time, or you work in the LTD field as an adjuster, insurance company employee, or personal injury lawyer.
Insurers feast on your lack on knowledge and lack of confidence at the outset of a claim. They can have your claim grounded before it even has a chance of getting up off the ground.
The golden rule for Long Term Disability Claims is that you NEED TO APPLY for the benefit, in order to receive it. LTD benefits will not just land gratuitously on your lap. This is NOT the way which insurance companies like Manulife, Great West Life, Sun Life, Industrial Alliance, SSQ or Desjardins operate. In life if you want anything as an adult, you almost always need to ask for it. Think of completing the application for LTD benefits as “asking” for the benefit to be paid.
There is a benefits package with a bunch of forms which will need to be completed by you, the applicant, your doctor, and your employer. Get these forms completed! If you don’t get your LTD application completed, I can guarantee that you won’t be entitled to Long Term Disability Benefits. You can get the LTD Application in a lot of different ways:
- Your employer
- Your Union
- Sometimes online
- Sometimes directly from the LTD insurer
- Sometimes the application is attached to a benefits booklet/benefits package
If all else fails in terms of getting the LTD application package, put it in writing to your employer/union/insurer documenting the efforts you have made without success to get your hands on the application forms, and that you intend on applying for Long Term Disability Benefits immediately.
Applying for, or giving notice of your intention to apply for LTD benefits in a timely manner is IMPORTANT. Don’t believe me? Check the wording of your policy. It likely has provisions therein requiring you to give notice or apply for LTD benefits within a certain time period from the date of the onset of your disability.
Here is what the Court had to say about timely notice of Long Term Disability Claims from Ortiz v Great-West Life Insurance, 2016 ONSC 1078 (CanLII):
The evidence before the court indicates that, unlike accident benefit claims, LTD carriers must assess if an insured is totally disabled from their own occupation within the first 24 months and, after a further 24 months, if they are totally disabled from engaging in any occupation for which they are reasonably qualified. Both periods had already elapsed by May 2014, so even before suit was commenced against Great West Life.
To further complicate the matter, though there is no evidence on the record before the court, plaintiff’s counsel advised that his client had been involved in a motor vehicle accident in 2011. I am unclear as to why he added this to the mix. In fact, it illustrates why it is critical for LTD carriers to assess a claim early. It allows them to establish an insured’s status soon after the event that led to the LTD claim, so that any changes caused by intervening incidents that could impact on his ability to work can be taken into account. Plaintiffs cannot double-dip and make the same claim against an auto and an LTD carrier. In view of the lack of evidence on this point, I will not include it in my deliberations. I refer to it only to emphasize the importance of an LTD insurer being able to make an early assessment.
As benefits are only available for up to five years (or age 65, whichever is less), the lack of notice to either insurer for more than 3 years post disability date is a significant gap. Here, the 5-year time frame had already elapsed before Manulife got notice of this claim. As a result, even if the claim had been approved, payment of benefits would have already ceased. That means that the only benefits the plaintiff could seek would be for an earlier period, during which time no assessments were performed. That time frame cannot be physically recreated at this time.
This is not simply a case where Manulife can step into GWL’s shoes and pick up where they left off in terms of assessment, as the plaintiff suggests. It is clear that, throughout the 11 months that the plaintiff /his representative exchanged only a few letters with GWL, the latter was never in receipt of all of the documents they sought in order to make even an initial assessment. It is as a result of these gaps that the claim was not approved.
In the Ortiz case, the Court refused the Plaintiff to add Great West Life to the Claim, for a variety of reasons, but one of which was the late notice provided by the Plaintiff to Great West Life of the claim itself. That late notice caused significant prejudice to Great West Life in terms of how it handled and adjudicated its claim. The argument was that if Great West Life had better notice, they would have been able to:
- Offer services to the Plaintiff to help them get better so that they could return to work
- Determine if modified duties or workplace accommodations were available to the plaintiff
- Send the plaintiff to experts of their choosing to better handle the matter
- Set a proper reserve for the value of the claim
Unfortunately for Mr. Ortiz, his claim against Great West Life was dismissed, and he was ordered to pay Great West Life’s legal costs for the motion in the amount of $7,500. His Long Term Disability case never had a chance of succeeding, because of the lack of proper notice to the insurer of the claim.