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.
Here are some scenarios which our long term disability lawyers see far too often which make us really upset.
Scenario #1 Getting cut off or denied at an old age when the finish line is so close you can taste it.
In this scenario, the Plaintiff has been working at one job for a very long time (or perhaps not so long). Either way, they are an employee in good standing, earning a decent salary/wage, and really enjoyed their job. The Plaintiff may be in their late 50’s or early 60’s. The Plaintiff cannot return to work on account of a disability (depression, anxiety, PTSD, chronic pain, fibromyalgia, carpel tunnel, MS, MD, cancer, kidney disease, IBS, etc.) The insurance company has either paid them long term disability benefits, or has never paid them benefits to begin with. Long Term Disability Benefits run up to the age of 65. In the case of a claimant who is in their 60’s, we’re talking at 5 years of long term disability benefits (or less) that we are fighting over. You would think that with benefits expiring in 5 years or less that the insurance company would accept that the Plaintiff is not capable or doing their own occupation, any occupation and given their age and medical restrictions that they are not a candidate for re-training. What employer do you know will want to take their chances on a new hire in their 60’s with medical problems who left their previous job because they couldn’t get on disability?
When this happens it makes a lawyers’ blood boil. Why would the insurance company force someone heading in to their golden years the satisfaction of riding peacefully in to the sunset. Doesn’t the insurance company know that employees earn more money while working than they do receiving some form of long term disability benefit.
What’s even more upsetting is that the insurance company is forcing the hand of the elderly employee to retain a lawyer to fight for their long term disability benefits. Should the employee to nothing, not lawyer up and not fight for their rights, they will get shut out and won’t get the compensation which they deserve.
Scenario # 2 Getting denied or cut off when your career has barely started (the young plaintiff)
In the award winning medical fiction book House of G-d, there was a theory by the general internist residents at Beth Israel Hospital. The old people who the doctors saw didn’t die (Rule #1 GOMERS DON’T DIE). But when the doctors saw young people in their ward, they knew something was really wrong. And those young patients died; and they died fast once admitted to hospital.
This rings true for long term disability cases. Young people are supposed to be healthy, energetic and have strong working careers. They aren’t supposed to go on long term disability (because they ought to be young and healthy). So when a young person say in their 30s or 40s has to apply for long term disability benefits, something is really wrong. Their health must be very bad. These young Plaintiffs have their entire lives, careers and earning potential in front of them. An LTD claim at should not be in the cards for a young person. Unfortunately, insurance companies don’t see it that way (perhaps more long term disability adjusters should read House of G-d).
In their eyes, a young person should be healthy; so the disability which the doctor has described on the medical questionnaire/disability certificate can’t be real. It must be a figment of someone’s imagination or not as serious as it’s made out to be. The answer for the insurance company is to send the claimant’s file for a “medical review/paper review” or conduct an “independent” medical examination by one of the long term disability insurer’s hired gun doctors. These are doctors who are paid directly by the insurance company to see patients, review files and give their medical opinions on whether or not the claimant meets the test for long term disability benefits. Many of these doctors bill the majority of their work through insurance of some form and not through OHIP. Here are links to two articles from the Globe and Mail which should tell you all you need to know about the medical assessment industry.