It has become quite common for long term disability insurance companies to wrongfully deny long-term disability benefits claims either after paying short-term disability or after paying benefits for a year or two, either by asserting that a claimants’s condition has improved, they are not following a treatment plan or that the definition of disability has changed.
The first thing to remember is that this is not the end. You may have been denied due to insufficient medical evidence, a change in definition, damaging surveillance, not following a proper treatment plan – but instead of guessing – you should seek professional advice by a qualified disability lawyer.
If you have been denied or cut-off your long-term disability benefits, you need to speak to a disability lawyer as soon as possible. You have the right to take legal action against your disability insurance carrier – assuming that you suffer from a total disability as per your policy definition and you are following a proper medical treatment protocol. It is vital that you get legal advice sooner rather than later.
Remember, when you hire a disability lawyer, you are not starting a personal injury case (and suing someone that was negligent) but rather, you are filing suit against your disability insurance company for breach of contract and declaratory relief. You will not be seeking damages or compensation, but rather a Court declare you disabled as per the policy definition. We would assist you, as a disability claimant, to seek an order that you are entitled to recover long-term disability benefits from your insurance carrier because you continue to be totally disabled within the meaning of your long-term disability policy.
As your Ontario disability lawyers, If we are successful with your case and a declaration is so ordered, we would then ask a Court to award you payment of all outstanding disability benefits from the date of denial to the date of trial, which represents the amount of monthly disability benefits that would’ve been paid to you had you been approved for benefits and continued on claim. A Court may then order your disability benefits reinstated and continued to be paid to you, provided that you remain totally disabled as per your policy definition.
It would be tremendously helpful if you could obtain a copy of your actual long-term disability policy. Your long-term disability policy is a contract that will set out the terms and definitions of your benefit coverage, and may also contain many other provisions that could potentially impact both the determination of benefit amount and entitlement.
The policy would also stipulate exclusions, rehabilitation provisions and collateral benefit setoffs (i.e. CPP Disability). If you are a long-term disability policy holder through a group contract (which is the most common type of disability policy) you would’ve likely been provided by your employer (or insurer) a benefits brochure or booklet which is not the actual long-term disability contractor policy and unfortunately may not include precise language used in the actual policy. It’s better to try your best to obtain a copy of the original policy for review by your disability lawyer. Your benefits administrator would be able to get a copy of this for you.
Most, if not all long-term disability policies in Canada fall into two broad categories or two separate stages – that of “own occupation” and “any occupation.”
The first stage is usually for the first two years of disability. During this time, in order for you, as the claimant to qualify for long-term disability benefits, you must be totally disabled from your own occupation – meaning that you must be unable to complete the substantial duties of your own job that you were doing when you first became disabled.
In most policies, at the two-year mark from disability, the definition of total disability changes. The definition normally changes from a claimant being disabled from performing the duties of his or her own occupation to being unable to perform the duties of any occupation for which he is reasonably suited by reason of education training or experience. Therefore, after two years of disability, you would have to meet a very different (stricter) test before you will remain entitled to continued long-term disability benefit payments.
Typically factors such as the claimant’s age, degree of specialization of his or her occupation, level of specialized training or education and level of income the client is accustomed to earning in his own occupation are all involved in the determination of total disability.
It is therefore important that you obtain a copy of, or as much information as possible about your long-term disability policy before meeting a disability lawyer. Also, it’s important to bring any CPP or WSIB documentation to discuss – if in fact you have made that application. Many policies require that LTD benefit claimants apply for benefits from other sources such as CPP or WSIB, since these additional benefits would be deducted from LTD benefit payments they receive. If the claimant chooses not to apply for these benefits, your LTD care can still in fact deduct the amount you would have been entitled to receive, from your monthly LTD benefit.
If you have been denied or cut off your long-term disability benefits fill in a contact form or call our office today at 905-333-8888. Remember it takes one phone call to begin your case. You have the full right to commence an action against your disability insurance company for wrongfully denied benefits. Protect your future and call our Hamilton Disability lawyers today.
You will never have travel to our office. We can work remotely to make the process as effortless as possible. Although we enjoyed meeting all of our clients in person, we can accommodate your case no matter where you live. Also remember we will never ask you for money upfront. We understand that pursuing long-term disability benefits that have been denied is an expensive and complex process which typically involves many costs such as court filing fees, medical records, as well as medical and vocational expert fees. We make sure that you stay informed throughout your case and we are available to discuss your particular situation at any point during the process.