Toronto Injury Lawyer Blog
It’s not mistake that Long term disability claims use the word “long“. Long is used for good reason.
Long is meant to define the duration of the period from the claimant’s first day off work, to the time period they are eligible to receive long term disability benefits. It’s a “long” period in contrast to a “short” period as found in short term disability claims.
Long also defines the duration for which the claimant is eligible to receive long term disability benefits. That period is longer than you would find in short term disability cases. In most long term disability cases, the eligibility period, or payment period, generally goes up to the age of 65. But, this is fact dependent upon the wording contained in the long term disability policy. In contrast, the duration of short term disability benefits is generally a few months (90 days, 120 days). This too is fact dependent and is specific to the wording of the policy. In any event, the use of the word “long” is meant to distinguish from the use of the word “short” in the case of disability policies.
For personal injury lawyers, and for many disability claimants, the use of the word “long” can also mean something completely different. It can be seen as a reminder to the claimant that it may take a long time to get an answer from the insurance company on whether or not the claim for benefits has been approved or denied.
In other circumstances, it can take a long time for the claimant to get paid their benefits, even after they’ve been approved.
For lawyers, the use of the word “long” is a gentle reminder that long term disability cases take time get through the Courts, or to ultimately resolve by way of Judgment or out of Court Settlement. Make no mistake, there is nothing “short” about a long term disability case once it’s been litigated.
Part of that feeling that the case moves slowly is no fault of your own. Part of the blame lies mainly in our civil litigation system. Cases move slowly through the Courts. That’s the way it’s been for decades.
It can take months, or years, to have a case ready with hospital records, employment records, tax returns, union files, doctor records, therapist records, and expert reports. Even if the case is ready for trial, there are a lot of steps in between in order to get to the mark. And even once those pre-trial benchmarks have been hit, getting a trial date in any Courthouse in Ontario is slow, tedious and difficult. The cold, hard, truth is that the civil justice system is over burdened with cases, and does not have the resources to hear as many cases as you would think. There is a shortage of Judges, clerks, court staff, even physical space in some instances to hear cases. You would think that the civil justice system would be perfect, or close, but it’s nowhere near that.
There are sometimes more self centered motives at play.
Do you really think that an insurance company profits on paying out quickly on cases? If you were the president or CEO of a large disability insurer, would you direct all of your adjusters and lawyers to pay out on every claim which came across their desk? Or, would you look to the best way to profit on these cases?
A great way to profit is to hold off on payment. A lot of things can happen in the interim.
The claimant can die. Once the claimant dies, so does their case. There will be exposure to future benefits which the insurer would be exposed to.
The claimant can get involved in a secondary accident, or have a secondary and non-related accident/injury. This would help mitigate the risk for exposure, liability and damages.
The claimant can return to work. If the insurer drags the case out long enough, what will the claimant be doing for money? They have to eat, pay the rent/mortgage and pay for their costs of daily living. If they aren’t working, where is this money going to come from. It has to come from some place. If the insurer finds out that the claimant is working, when they are claiming a total disability, then it completely changes the nature and value of the case. The Plaintiff’s credibility will be shattered, which bodes well for an insurer in holding down their hard line position.
The claimant may get frustrated with the lengthy litigation process, and give up altogether; or perhaps they will do something which they should not be doing according to their doctors or medical experts. This is where surveillance comes in. Insurance companies will play the ground game and pay private investigators to follow around claimants to see what they are up to on a day to day basis. Those videos and pictures tell a thousand words. And if that surveillance catches a claimant doing something which they swore they couldn’t do, then there goes the Plaintiff’s credibility and there goes their case.
When an insurer holds off on paying, they get to earn interest on the money which you expected to receive in the form of long term disability benefits. That interest earned helps them profit, or offset some of their losses. Holding off on settling, or delaying the case can also influence the plaintiff to settle for less than what they could otherwise receive. The Plaintiff is so frustrated with the process and has been grinded down so much that they may settle for cents on the dollar.
There is no hiding that long term disability cases are difficult, frustrating and can take a long time. The key is to expect the worst going in, and hope for the best. The more you know, and the more realistic which your expectations are for the case; then the better outcome you can expect to achieve. Don’t loose faith and don’t give up hope. It’s a long journey full or ups and downs, but there is light at the end of the tunnel.
