Toronto Injury Lawyer Blog
You know when you’ve been approved for Long Term Disability Benefits. That approval will usually come first verbally, and then be formalized in writing.
While, getting something in writing from the long term disability insurer might feel good, it doesn’t mean anything until the payments start coming in.
That rings true in real world examples:
Let’s say you hear from your adjuster that benefits have been approved. Great!
Then, you receive a letter from the insurance company which formalizes the approval in writing. Great again!
But, as Jerry McGuire would say “Show me the Money“.
When the insurer does examines your file, looks at how much money you made, and how much money you’ve received from other collateral sources, it turns out that the benefit owing to you amounts to ZERO! That means that the long term disability insurer’s approval amounts to no tangible benefits for you; even though you’ve been approved. The reality is that you’ve been approved for nothing!
In that same example, it might be that the insurer had been paying you long term disability benefits. Then, they stopped because you received collateral benefits (like CPP Disability Benefits). Then, having reviewed your file, along with the amounts paid to you in long term disability benefits vs. the amounts paid to you in CPP Disability benefits; it turns out that the long term disability insurer over paid you. Now, they are seeking a repayment of benefits due to the over payment. This means that you owe the long term disability insurer money. Imagine that: a person owing an insurance company money for a over payment (completely unrelated to payments of insurance premiums).
In the next example, you’ve been approved again. Both over the phone and in writing. The insurer examines their file and indicates in writing that you’re entitled to a monthly long term disability benefit of $3,000/per month tax free. Amazing! But, don’t go spending all that money until you get it. You wait, and wait and wait for the cheque to arrive, but it never does. You call the adjuster; and their manager; but they don’t respond. What’s happening here? You’ve been approved, in writing, with a determined monetary benefit. What’s the holdup? Well, turns out that the insurer had conducted some surveillance of you and now they are reversing their decision to approve your benefits. Your approval has turned into a denial in the blink of an eye.
Or, perhaps some additional medical records which the insurer had requested (with your consent), arrived post approval and have since been reviewed. The medical records show a discrepancy; or show a pre-existing injury which would exclude you from coverage; or simply don’t show a disability. Either way, in the blink of an eye, that approval has been revoked! This is why we tell people not to count their chickens before they hatch, especially in all areas of personal injury law (such as long term disability). An insurer will take any reason not to pay out on a claim; even the most trivial of reasons.
Your approval only really matters when the cheques come in. Show Me The Money. When the cheques roll in, that’s when you know that you’ve been approved because you have something tangible to show for the approval. Otherwise, the insurer’s approval are just cheap words with no real benefit to you.
This is not to suggest that you can’t retain a personal injury lawyer to fight the denial, or the reversal of the insurer’s position. This happens frequently. But, this means that you will have to wait for your benefits to flow again. Insurers know that bills start to mount up and time is your enemy. Those collection agents are quick to act while bills start to go unpaid and tend to mount up very quickly. Conversely, time is the ally of long term disability insurers. They are designed to play the long game and wait you out. They get to hold on to the benefits and earn interest on that money. They can report these as retained earnings for their quarterly reports to increase their profitability to their shareholders on the open markets. Time is also their friend because these long term disability claims are not open forever. You have 2 years from the date of the clear and unequivocal denial to sue; otherwise the limitation period will expire. That means that your case won’t be heard on its merits. It means that the case will be dismissed on a legal technicality. Namely, you failed to start your claim in time. Even if your case would win, you would lose because you failed to meet the limitation period. This is why insurers love delay. Insurers will point to letters or emails they’ve sent to you addressing the clear and unequivocal denial. It’s up to you to do something about it. Ignoring the letters or emails won’t help your situation, nor will failing to read them hold up as an excuse in Court. Long term disability insurers are NOT required to go out of their way to make sure that you are paying attention. All they need to do is send you a letter detailing the denial, and advising you of the pending limitation period. Chances are, you won’t read the letter thoroughly because nobody every likes to read long legal letters full of bad news. Let’s be honest: you either have to be a lawyer to do that, or a real glutton for punishment. It’s not a good feeling. Never mind if English isn’t your first language!
For you, it’s personal. For them, it’s a cold, hard and calculated business transaction. They’ve done the math in terms of the most profitable way for them to come out on top. The way that happens is if you do nothing about the denial. If you do nothing, then they win every single time. Money won’t just fall from the sky, particularly after you’ve been denied long term disability benefits. Large insurers don’t magically change their minds, particularly when there isn’t a personal injury lawyer fighting for you. Wins happen once a personal injury lawyer has been retained, and a formal legal action has been commenced. By doing nothing, you will get nothing; and the insurer will have achieved what they set out to do.
