HAMILTON LONG TERM DISABILITY LAWYERS

Disability Lawyers Serving ALL of Ontario since 2003. Call us Today.

Have you been Wrongfully Denied your Long-Term Disability Benefits? You have Rights.

You DO NOT have to accept being Denied your Long-term Disability! You have the right to fight for your monthly benefits.  Call or Send our Hamilton Long-Term Disability Lawyers an Email through our website today to get your Long-Term Disability Benefits back on track.

We’ve seen it over and over again. You’ve paid premiums to your insurance company for years – yet you feel like your adjuster has ignored or mistreated you for months, then your claim is suddenly denied. when your insurance carrier refuses to believe you suffer form a disability that prevents you from working. We see it time and time again – but don’t give up, no matter what your disability adjudicator tells you – you have rights. 

If you need to stop working because of an injury or illness, you may be entitled to continued disability claims benefits. If you file for disability insurance benefits and your insurance company unreasonably denied your long-term disability payments, you have the right to hire a disability lawyer to file a claim for payment.

Our disability lawyers have recovered millions of dollars in disability benefits for claimants in Hamilton and throughout Ontario. We represent claimants at various stages of denied disability benefits, which includes denied short term disability benefits, denied disability benefits and disability benefits that are cut-off at the two-year mark or at the “change of definition”.

We understand the stress and financial disaster that individuals and families are often forced into when their insurance companies decide to cut them off their disability benefits without good reason. The process of appealing your long-term disability denial could be complex and confusing –  our Hamilton disability lawyers have recovered millions in wrongfully denied insurance benefits, and we can help you.

If you have been denied or cut-off your long term disability benefits don’t give up the fight.  We are long-term disability lawyers in Hamilton, serving claimants all over Ontario.  Since 2003, Matt Lalande has represented many disabled claimants who have been unreasonably denied or cut-off their long term disability benefits. We have litigated against every major disability insurance company in Canada.  If your claim has been denied we can assist you through all stages of your claim for denied benefits and we will never ask you for upfront fees.

Common Disability Questions

  1. I've been cut-off or denied long-term disability, what should I do?

    We understand that you may be confused and upset – but if you've been cut off or denied your long-term disability benefits you need to get legal advice from a disability lawyer now. It's important to understand that you may still be entitled to your monthly benefits even thought they have been denied.

  2. Do you offer free long-term disability consultations?

    Talking with our long-term disability lawyers is ALWAYS free. We never ask our clients for money upfront.

  3. Why do most disability claims get cut off after 2 years on disability?

    Normally most disability policies have a change of definition. The first two years of being on disability, a claimant only needs to be substantially disabled from performing the regular duties of his or her own job. After two years, the definition changes. At that point, in order to qualify for disability benefits, a claimant must be totally disabled from any employment for which he or she is suited by education training and experience. In essence, definition changes becomes more difficult for claimants to obtain disability benefits and, it is the time when most disability carriers cut claimants off the plan.

  4. Do I need to come into your office for my free disability consultation?

    You do not! We represent disability claimants all over Ontario! We are more than happy to meet you via Zoom, Google Meet or Facetime. Also, our office technology allows for remote file and digital signature access – so we are fully operational remotely.

  5. Do your disability lawyers represent disability claimants outside of Hamilton?

    We do! Our Hamilton disability lawyers represent denied disability claimants throughout Ontario. We have represented hundreds of disability insurance claimants outside Hamilton and throughout the Golden Horseshoe area—from Niagara Falls to Ottawa to Sudbury. We are happy to discuss your situation at any time. We will never ask you for money up front, and your consultation is without obligation

  6. Can I lump or settle out my LTD benefits?

    It depends. When a disability lawsuit if filed, you are requesting that a Judge declare you are totally disabled in accordance with the definition of your disability policy.  However like other lawsuits, disability claims do sometimes settle for lump sum payments.

  7. Why does long-term disability deduct CPP Disability benefits?

    Most, if not all LTD disability policies mandate that a claimant is to apply for CPP disability. Most LTD carriers will request that a claimant apply for CPP disabilty after two years of disability payments. Your LTD insurance company then gets to “set-off” or deduct your CPP monthly payment from the amount of long-term disability payable to you.

  8. What does a long-term disability insurance company get to deduct from my monthly payment?

    It all depends on what your disability policy says – however most policies state that the following may be deductible from your long-term disability benefits IF you are receiving the benefit:

    1. Severance packages
    2. Ontario Works benefits
    3. Ontario Disability Support Plan (ODSP)
    4. Workplace Safety Insurance Board (WSIB) benefits
    5. Employment Insurance (EI)
    6. Financial Gifts

  9. What is the “change of definition” that my adjuster keeps talking about?

    Typically, LTD policies contain a provision that considers a person eligible to receive benefits if he is disabled from working at his own occupation for the first two years. This is known as the “own occupation” (own occ) period. Thereafter, the test changes to a more difficult definition which requires the individual to be disabled from performing any occupation for which he is reasonably suited (language like “qualified, or could become qualified for, by reason of education, training or experience”). This is known the “any occupation” (any occ) period.

    Because the test for the “own occ” period is less onerous, and the insurance company's potential exposure is lower, insurers will often pay benefits during the “own occ” period, but resist paying benefits into the “any occ” period. During the latter period the potential payout, especially for a young person, could be significant.  Before the “own occ” period expires, the insurance company may send the insured to one or more independent medical examinations (IMEs) with a view to obtaining medical evidence to use to support terminating the claim at the end of the “own occ” period or conduct surveillance.

  10. Why were my disability benefits cut-off?

    There are a variety of reasons why an LTD claim may be denied or terminated:

    1. Lack of forms and necessary documentation.
    2. Employer did not provide the proper documentation.
    3. Misrepresentations on claims forms or other supporting documentation, such as a pre-existing condition that was not mentioned or not fully disclosed.
    4. Missed time limit for submitting claim.
    5. Failure to have the injury or condition properly documented by the client’s doctors.
    6. Failure to participate in treatment regiment.
    7. Surveillance evidence contradicting the client’s claimed level of disability.
    8. The change of definition.
    9. Adjuster inattention.
    10. The insurance company not having understood your disorder or disease.
    11. A biased insurance company medical expert.

  11. What happens if I’m denied disability?

    If you been denied long-term disability the best thing you can do is contact our Hamilton disability lawyers to discuss your situation, no matter where you are in Ontario. We can help guide you through the process and offer you options with respect to your denied claim and how to appeal it through the court system.

  12. What does Total Disability Mean?

    Total disability in the context of disability insurance typically has two meanings. The vast majority of disability policies provide that total disability within the first two years of benefit payments is established where the insured is unable to perform the important duties of his or her regular job, even though the insured may be capable of performing another occupation. This is otherwise known as the “own occupation” disability provision. After 24 months of disability, most policies provide that payments of benefits will be made to an insured who is unable to perform the activities of any occupation for which he or she is suited by reason of education training and experience.

  13. What does “own occ” or “own occupation” mean?

    A person is totally disabled and unable to carry on his or her own occupation if the disability prevents him or her from performing the substantial duties of that occupation and from carrying out its major functions

  14. How long to Long-Term Disability benefits Last?

    An Long-Term Disability policy generally pays a portion of the policyholder’s usual salary or income as a monthly benefit until the person (in most cases) is:
    1) Able to return to work.
    2) No longer meets the definition of being disabled.
    3) Reaches retirement age (age 65), so long as the person continues to meet the policy requirements.
    Some policies only pay for a defined period (such as 5, 10 or 15 years). Other policies cover the person for life.

  15. My LTD Carrier is telling me to apply for CPP – do I need to do this>

    Yes, most policies have a requirement that the insured apply for CPP disability benefits and, in some cases, also require the insured to appeal a denied claim. In addition, there may be a provision for an offset for CPP disability benefits received by the insured.

Types of Disability Claims & Conditions

When it comes to long-term disability insurance benefits, the definition of disability varies according to the terms and limitations of your policy – but generally most policy definitions are the same. Typically, a total disability is defined in that you are unable to complete the substantial duties of your own occupation for the first 24 months after the onset of your disability.

After 24 months, a claimant will be deemed totally disabled if he or she is unable to complete the substantial duties of any occupation for which he or she is reasonably suited by way of education, training and experience. 

Since 2003, disability lawyer Matt Lalande has represented disabled claimants all over Ontario at all stages of disability benefits against every major Canadian insurance company – with disabilities such as:

You Paid your Premiums for years. Now your Insurance Company refuses to pay you in a time of need.

If you have become sick or disabled and are suddenly unable to work, you have the right to Hamilton disability lawyer and file a benefits claim through your private insurance company or through your work (group policy) for payment of benefits to replace your income. 

Unfortunately many claims are initially denied. Disability application can can be denied at the application stage for a variety of different reasons and if this occurs, it’s important that you retain experienced disability lawyer to ensure that your case is handled efficiently so that you can receive the disability benefits you deserve. Most disability claimants obtain disability insurance through their work group disability policies. Disability insurance in Ontario covers all types of medical conditions, such as severe bi-polar diorder, anxiety, depressionschizophrenia, severe chronic pain, MS and other related health conditions. In order to qualify for long-term disability benefits in Ontario, you must suffer a total disability, meaning you are deemed by medical professionals to be unable to perform the substantial duties of your own occupation.   Individuals that suffer severe injury or illness often rely on monthly income benefits to pay their bills and contribute to family finances – however some insurance companies unreasonably deny disability benefits to properly qualified claimants. The system is complicated – it’s important that you talk to a Hamilton disability lawyer today to learn your rights.

Have your long-term disability benefits been wrongfully cut-off?

If your insurance company has wrongly cut-off your disability benefits, it’s important that you speak to an experienced Hamilton long-term disability lawyer. Disability polices in Canada provide that claimants are entitled to payment of benefits if they satisfy their policy definition of total disability. The definition “total disability” within the first two years, is established when you are unable to perform the important duties of your “own occupation”,  even though you may be capable of performing another job.  After two years, most disability policies change their definition to “any occupation”, meaning that you must be unable to perform the activities of any occupation for which you are reasonable suited by your education, training and experience.

It’s normally at the two-year mark that disability companies cut-off disability benefits.  Insurance companies will often use the argument that you are able to work at “some type of job” – when this may not entirely legally proper. While it’s true that insurance companies can terminate your benefits at any time if they find that you are no longer meet the definition of “total disability, it’s equally true that rogue insurance adjusters will cut-off benefits unreasonably and unfairly.  If this happens, you have the right to contact a disability lawyer to make a claim for benefit reinstatement.

Why do I need a Hamilton Disability Lawyer?

Disability claims are extremely complex to litigate and not something for the faint of heart. An experienced Hamilton disability lawyer knows the disability process can assist you in having your disability income benefits reinstated. Typically our disability lawyers will review your case with you – at no cost.  We can help evaluate your insurance claim and advise you on disability laws in Ontario and your options with your appeals. 

If we decide to work together we will then take a detailed inventory of your clinical history, request that your medical providers send us your a synopsis of your medical history and clinical records, rehabilitation records and medication records. A claim would be started against your disability carrier, asking a Judge for  for a “declaration” that your disability insurance carrier pay you all of the past benefits owned to you (which they denied) and order that you are reinstated on claim – meaning that your benefits will be re-started and continue.  Our Hamilton disability lawyers work with the best experts from all over Ontario and will ensure that the best specialist is hired to provide an opinion on your case. Remember – you have the burden of proving your disability, and to do this, you need to work with experienced Hamilton disability lawyers.

Our Disability Consultations are Always Free.

We understand that the last thing you need after being cut-off or denied the monthly income you need is a legal bill. When you contact our Hamilton Disability Lawyers, your disability consultation is always free and we will never ask you for money upfront. In addition, you are under NO obligation to retain our firm. We are more than happy to discuss your case with you and advise you of your legal rights.

Remember, the disability claims process is often discouraging and time-consuming. The complex language of the insurance contract adds to the frustration. If you’ve been denied disability benefits, you need an experienced disability lawyer to help protect your rights and get you the benefits your deserve. We welcome your live chat, email or telephone call in order to set up a phone or in-person consultation to answer any questions you may have about your case without charge, no matter how long it takes.

Want to learn more? Read all about How Much it Costs to Hire a Disability Lawyer here.

Do you Serve Disability Clients all over Ontario?

Yes, our disability lawyers are locally based in Hamilton, but we serve claimants all over the province! We are more than happy to travel to your location to meet you, no matter where you reside. Or, in the alternative, we are more than happy to review your disability policy or other pertinent documents and discuss your case via Zoom, Facetime, Google Meet or telephone. Our technology allows us to represent clients all over Ontario.  It is our job as Hamilton Disability Lawyers to try to get our clients paid their disability benefits as fast as possible; therefore it is actually preferred that we have our initial consultation via telephone or Zoom.

LTD benefit denials can be discouraging and time-consuming – so get the help you need. If you’ve been denied disability benefits it’s important to understand that it’s not the end of the road. You have the full right to challenge your disability benefit denial and let a Judge decide whether or not you are disabled as per policy definition. Don’t give up without talking to an experience disability lawyer. 

Getting your Disability Benefits back on Track  – We will Fight for You

If you suffer from a disability that renders you unable to perform the substantial and material duties of any occupation for which you have education, training, and experience, then it is vital that you contact a disability lawyer and inform yourself of your legal rights.

Taking on a disability insurer in Ontario is not for the faint of heart—don’t try to do it alone. We see claimants come to us after being bombarded with an endless barrage of anti-coverage grenades that share a single target: preventing them from collecting disability benefits.

How do disability insurers do this? They will often hire their own doctors to conduct medical examinations that will inevitably find you in “perfect” health. Alternatively, the doctors might not be qualified to render an opinion regarding your condition but may do so anyway. In real life, they would surely send their own patients to specialists.

If you happen to be wealthy, insurance companies may suggest that you stopped working out of choice or because you are burned out—not because you are truly and genuinely disabled. If that fails, insurance companies will often have their own paparazzi survive you to catch you, for a minute, exhibiting behavior that allegedly contradicts your medical records.

At times, disability carriers might also attempt to manufacture a “choice” argument by offering to retrain or rehabilitate the insured person. If the insured declines the offer, the insurer will argue that the insured has chosen to remain disabled and is therefore not entitled to disability benefits.

Total disability does not signify an absolute state of helplessness. Rather, you must be unable to work in any position for which you are suited by way of education, training, or experience.

If you have been denied disability benefits in Ontario, speak with a Hamilton disability lawyer who specializes in denied LTD claim litigation. Matt Lalande has represented hundreds of individual claimants at all stages of disability claims, including claim denial, denial at the change of definition, or lawsuits to recover disability benefits.

When you hire our Hamilton long-term disability lawyers, we need to prove to your insurance company—or, ultimately, a judge—that you satisfy the definition of total disability under your policy.

Our Hamilton disability lawyers will fight to see your benefits continue uninterrupted for your maximum period of benefit recovery, which is normally to age sixty-five. In addition to this, our disability lawyers will argue that you should be paid all past disability benefits owed to you up to the date of your settlement or trial.

Lump-sum settlement awards for future benefits are sometimes negotiated during settlement talks but should not be a factor when starting a claim for denied benefits. The insurance company is not obligated to settle with you for a lump sum amount, but it must reinstate you and pay your benefits every month if you’re totally disabled.  Matt Lalande is a disability lawyer in Hamilton that has been fighting disability insurance companies since 2003 – and if we decide to work together – he will fight for every penny, and every step of the way.

Why is it Important to hire a Disability Lawyer?

If your disability claim was wrongfully delayed or denied,  you should consult an experienced Hamilton disability lawyer who focuses  on disability insurance cases.

We understand that being denied or cut-off long-term disability insurance can be financially disastrous to people that rely on their monthly benefits.  Most claimants that we speak to are often surprised and caught off  guard when they’re denied benefits. If you are like most disability insurance policyholders, you too are probably surprised by your claim denial. You paid the premiums, privately or through work, for your policy as agreed. You expected to receive your benefits as agreed – and then your turned away.

It’s important that you do not delay in contacting a disability lawyer that can help you get your disability benefits back on track.  An experienced disability lawyer can provide you with proper guidance and advice on how to advance and appeal your denied disability claim. Our disability lawyers are experienced with marshaling the medical evidence needed to assist you in proving that you satisfy your policy’s definition of today disability – either being your own occupation or any occupation to which you are reasonably trained. Remember – the longer you wait, the longer it will take to get your monthly benefits started again.

Understanding your Disability Claim

Below are some of our disability resource guides to assist you with understanding your disability claim:

Why does my adjuster keep telling me that I do not suffer a “Total Disability?

Your adjuster might tell you that you do not suffer a total disability because that is the language that is used in most disability definitions within disability insurance policies. Generally speaking, total disability in the context of long-term disability insurance means two things.

The vast majority of long term disability policies in Canada provides that – a person is  considered totally disabled within the first 24 months of benefit payments if he or she is unable to perform the substantial duties of his or her “own occupation” and from carrying out its major functions. If the claimant is only able to perform minor functions of the job, then he or she is nonetheless totally disabled. This is typically called total disability of your “own occupation.”

After two years or 24 months, most disability policies disability typically switch to what is called an “any occupation”definition. A policy with the any occupation definition usually requires that the definition of total disability is satisfied when the insured person is prevented from engaging in any occupation or performing any work for compensation – for which he or she is deemed fit by education training and experience.

Normally insurance companies tend to stop disability payments at the two-year mark and make the argument that you can engage in “some type” of work for compensation, when, by law, it’s a bit more complicated than this. If your adjuster says that you are not totally disabled call our Hamilton disability lawyers for more information so we can review your case and advise you of your rights.

Do I need to come to your Office to hire you as my Disability Lawyers?

Luckily, you do not! We’re certainly able to discuss your claim by Zoon or Factime or by telephone. We are usually able to make a determination as to whether or not your long-term disability insurance company unreasonably denied or cutoff your benefits quite quickly. We are happy to schedule a free consultation with you to discuss your situation. If we are of the opinion that you have a case, we are more than happy to meet with you by Zoom, Facetime or Google Meet anytime you need. We also have the technology to serve clients remotely – for example, you can have access to your file digitally, and any and all signatures or other things we need from you can certainly be done remotely – wuite easily!

Talking to our disability lawyers is ALWAYS FREE. If you’ve been Denied your Long-Term Disability Benefits, call us today to get your monthly payments back on track.

Most, if not many people, never need to speak to a lawyer unless they buy a house or make a will. We understand that you may be apprehensive about speaking to a disability trial lawyer about your specific situation – but don’t be. We are approachable, friendly, and will speak to you about your particular disability situation at your convenience – at no cost to you.

Disability appeals are complex. Do not try and make the appeal on your own. Hiring a knowledgeable disability lawyer with experience in litigating against every major Canadian disability insurance company is the best thing you can do. We welcome your telephone call, live chat, email inquiry, form inquiry 24/7 and we would be happy to speak to you about your particular case.

Remember, we work on a contingency fee basis. This means that we do not get paid until we win your case. If we don’t, there are no fees charged to you.

Lalande Personal Injury Lawyers are long-term disability lawyers who have been representing claimants who have been wrongfully denied or cut-off their disability benefits since 2003. to. Please complete the contact form below or give us a call no matter where you are in Ontario at 1-844-LALANDE or local in the Hamilton / GTA at 905-333-8888. Otherwise, you can speak to our like chat operator or fill in a contact form and one of our Hamilton disability lawyers will get back to you within 24 hours.


The essence of a long-term disability policy is for the insurer to pay a monthly benefit to you as the policy holder – provided that you meet the applicable definition of disability and you are not precluded from receiving disability benefits due to any applicable exclusion in your policy.

Unfortunately, many long-term disability insurance policies have exclusions and limitations that may prevent you from collecting long-term disability benefits. If you read the fine print in your long-term disability policy, you will no doubt notice a provision entitled “exclusions”.   Anybody who owns or is considering purchasing it should be aware of its exclusions. What are some of the typical disability insurance exclusions found in long-term disability policies?

  • Alcohol and Substance Abuse – many policies many policies do not have coverage for absenteeism because of substance abuse.
  • Self Inflicted injuries or illness – if you have hurt yourself or caused yourself to be sick you may be declined long-term disability insurance.
  • Medical or surgical care that is not necessary – if you “elect” surgical care that is not vital to receive, you can be denied long-term disability benefits.
  • Committing or attempting to commit an assault – assault will more likely than not void will cause you to be declined benefits.
  • Being involved in or committing a criminal act – will probably void coverage.

There are three types of disability insurance coverage:

Government Plans – which include the Canada Pension Plan (CPP), employment insurance, and Worker’s Compensation (WSIB).

Group Benefit Plans – which are available through an employer or an association. Group plans offer more limited disability protection but at a lower cost to the insured and employer.

Individual Long-Term Disability Policies –  available directly from an insurance company or broker, on a client by client basis. They offer the most extensive protection but at higher cost to the insured.

Short-term disability (STD) are benefits that carry from the date of onset of diability and the application for long-term disability. STD is often offered through group employer plans. Short-term disability is meant to carry you through the elimination period. Common elimination periods are 30, 60, 90 and 120 days. After the elimination period is over, the claimant would then apply for long-term disability. STD policies are usually paid for by the employer and cover income replacement for the first 120 days of injury or illness.

There is usually a qualifying or elimination period, which can range from 90 to 180 days, during which no benefits are paid but during this period the person may cover their lost wages by drawing on a short-term disability (STD) policy, employment insurance or government sickness benefits, which may provide an additional 15 weeks of sick benefits.  STD policies are usually paid for by the employer and cover income replacement for the first 120 days of injury or illness. The longer the elimination period, the lower the disability premium, often dramatically so. The most common elimination that we see is 90 days.

This waiting period is otherwise called your elimination period. Typically most policies have a 120 elimination period. It’s during this period that you would apply for short term disability.

The essence of long-term disability insurance is for disability carrier to pay at the stipulated monthly benefit to the insured, provided the insured meets the applicable policy definition of total disability and is not otherwise precluded from receiving benefits due to the operation of any applicable exclusion to receiving benefits.

No, there are a myriad of policy definitions of disability, making it impossible to cover every possible scenario in any text on the subject.

If you been denied long-term disability the best thing you can do is contact our Hamilton disability lawyers to discuss your situation, no matter where you are in Ontario. We can help guide you through the process and offer you options with respect to your denied claim and how to appeal it through the court system.

Total disability in the context of disability insurance typically has two meanings. The vast majority of disability policies provide that total disability within the first two years of benefit payments is established where the insured is unable to perform the important duties of his or her regular job, even though the insured may be capable of performing another occupation. This is otherwise known as the “own occupation” disability provision. After 24 months of disability, most policies provide that payments of benefits will be made to an insured who is unable to perform the activities of any occupation for which he or she is suited by reason of education training and experience.

A person is totally disabled and unable to carry on his or her own occupation if the disability prevents him or her from performing the substantial duties of that occupation and from carrying out its major functions

In considering own occupation, if the claimant is able to perform only minor functions of his or her job, the claimant is nonetheless totally disabled.

The most cited test to determine whether an individual is totally disabled was stated by Laskin C.J. in Paul Revere at 546:
The test of total disability is satisfied when the circumstances are such that a reasonable man would recognize that he should not engage in certain activity even though he literally is not physically unable to do so. In other words, total disability does not mean absolute physical inability to transact any kind of business pertaining to one’s occupation, but rather that there is a total disability if the insured’s injuries are such that common care and prudence require him to desist from his business or occupation in order to effectuate a cure; hence, if the condition of the insured is such that in order to effect a cure or prolongation of life, common care and prudence will require that he cease all work, he is totally disabled within the meaning of health or accident insurance policies.
This test has been consistently followed in B.C.: Asselstine v. Manufacturers Life Insurance Co., 2005 BCCA 292 (B.C. C.A.); Halbauer v. Insurance Corp. of British Columbia, 2002 BCCA 5 (B.C. C.A.); Eddie v. UNUM Life Insurance Co. of America, 1999 BCCA 507(B.C. C.A.); Mathers v. Sun Life Assurance Co. of Canada, 1999 BCCA 292 (B.C. C.A.), leave to appeal to ref’d (2000), [1999] S.C.C.A. No. 334 (S.C.C.).
228      Being able to perform one or more important aspects of the occupation separately will not necessarily disqualify the insured from coverage; they do not need to be totally helpless. What matters is that the insured is unable to perform substantially all of the duties of that position: Paul Revere, at 545 – 546.
An Long-Term Disability policy generally pays a portion of the policyholder’s usual salary or income as a monthly benefit until the person is:
  • Able to return to work.
  • No longer meets the definition of being disabled.
  • Reaches retirement age (age 65), so long as the person continues to meet the policy requirements.
Some policies only pay for a defined period (such as 5, 10 or 15 years). Other policies cover the person for life.

Policies may provide, for example:

Benefits equal to:

    • 65% of gross monthly earnings;
    • 75% of net monthly earnings;
  • Benefits that last:
    • up to age 65; or
    • for only fix years.
Reductions may apply so that your total income from all sources does not exceed a certain amount. For example, the policy provision may state that the employee’s total income from all sources is not to exceed 85% of your pre-disability earnings if the benefit is taxable or 85% of the pre-disability net earnings if the benefit is non-taxable.
Benefit amounts may also be reduced by other benefits that a person receives or in entitled to receive from sources specified by the policy wording
 You should be aware of deductions that may be made from an LTD benefit amount based on policy wording. Some typical sources that may reduce the LTD benefit amount include benefits the employee/plaintiff receives or in entitled to receive from:
  • Canada pension plan (CPP).
  • Workers’ compensation (WSIB) or similar coverage.
  • Group, association or franchise plan.
  • Retirement or pension plan.
  • Earnings or payments from any employer, including severance payments and vacation pay.
  • Self-employment income.
  • Government plans, except those that are excluded such as EI benefits.

Yes, most policies have a requirement that the insured apply for CPP disability benefits and, in some cases, also require the insured to appeal a denied claim. In addition, there may be a provision for an offset for CPP disability benefits received by the insured.

The deductibility of severance packages depends on the policy wording for the most part. If the wording is clear and unambiguous, you will have to look no further, but that is not always the case. Where the wording is not clear, consideration must be given to the nature of the severance package.

yes, some policies contain offsets for amounts received through WSIB claims.

In Richer v. Manulife Financial, 2007 CarswellOnt 1713 (Ont. C.A.), the insured’s policy provided for an offset for amounts he was entitled to receive through a WSIB claim. The insured plaintiff had made a WSIB claim but it had not yet been resolved. Entitlement to receive payments was not dependent on an application for compensation being approved. Manulife was entitled to reduce the monthly benefit payable to the insured under the policy by the amount of WSIB benefits to which he would have been entitled had he not elected to proceed with an action. See also Robert Wilken v. Sun Life Assurance Company, 2017 CarswellOnt 19517 (Ont. C.A.), where the court noted, at paragraph 3:
“The plaintiff’s voluntary decision to make a retroactive election, foregoing WSIB benefits to pursue a tort action, effectively would deny the insurer its contemplated and permitted offset, thereby elevating the insurer’s relevant coverage obligation to a ‘first payor’ status that obviously was not intended.”

Typically, a lawsuit must be commenced within two years of the date the benefits were denied unless otherwise specified by the contract. Determining when the limitation period begins to run is not always obvious and often the principle of discoverability complicates matters.

Yes. The case law is clear that a person can still be considered totally disabled even if they return to work for a short time during recovery, or after benefits have been terminated by the insurer: Ferguson v. UNUM Life Insurance Co. of America, [1998] B.C.J. No. 531 (B.C. S.C.); Nicholas v. Metropolitan Life Insurance Co. of Canada, 2003 BCSC 506 (B.C. S.C.); Hood v. Metropolitan Life Insurance Co., [1993] S.J. No. 227 (Sask. C.A.). The idea in these cases is that plaintiffs should not be prejudiced or disadvantaged from receiving benefits by attempting to work again. See also Tanious v. Empire Life. Judge Brown notes that the plaintiff’s tasks and abilities cannot be considered sensibly in a piece-meal fashion. As stated earlier, what matters is that the insured is unable to perform substantially all of the duties of that position.  In this case, the plaintiff had been told by her family physician earlier that she should not be working; but in what was an exercise in obvious poor judgment, ignored the advice and continued to work, fearful of losing her position. Just because the plaintiff was able to perform some of her duties, does not mean she was able to perform substantially all her duties on a continued and satisfactory level. In other words, going through the motions of some tasks when the plaintiff clearly should have ceased work on advice of her physician should not be to her prejudice.

Judge Brown reviewed this in Tanious v. Empire Life. A plaintiff’s suitability for any occupation under a Policy was referred to in Plouffe v. Mutual Life Assurance Co. of Canada, 2001 BCSC 900 (B.C. S.C.), Slade J. analyzed what a reasonable occupation would be under the “any occupation” definitions of total disability:
The test for disability has been held to be a subjective one, related to the background and education of the disabled person in question: Labelle v. Great-West Life Assurance Co.[1986] 17 C.C.L.I. 173 (B.C.S.C.).
 In Labelle, Proudfoot J. (now J.A.) construed an “any occupation” definition of total disability with these qualifying words:
Notwithstanding this all-embracing definition, this does not mean that the person is not entitled to the benefit if he is so sick that he can take on only trivial or inconsequential work, or work for which he is over- qualified, or work for which he is completely unsuited by background.
A person is considered not to be totally disabled from engaging in ‘any’ occupation if his condition would enable him to enter into an occupation reasonably comparable to their old occupation in status and reward, and reasonably suitable in work activity in light of their education, training and experience.

No. Being able to perform one or more important aspects of the occupation separately will not necessarily disqualify the insured from coverage; they do not need to be totally helpless. What matters is that the insured is unable to perform substantially all of the duties of that position: Paul Revere, at 545 – 546.

Yes, Legal expenses paid to collect or establish the right to reinstatement of disability insurance benefits or the right to a lump sum disability insurance settlement of past and
future benefits are deductible for tax purposes. Where a claimant incurred legal expenses, those expenses are deductible from the settlement amount as being reasonable necessary expenses incurred to realize the settlement that was achieved. Without the legal expense, the settlement amount would not have been realized by the claimant. Where the lump sum disability insurance settlement between the claimant and the disability insurer does not specify the amount of legal costs, the Tax Court of Canada will consider the evidence of what legal expenses were incurred.

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