HAMILTON LONG TERM DISABILITY LAWYER

THEY PROMISED TO PAY YOUR LONG-TERM DISABILITY. MAKE THEM KEEP IT.

HAVE YOU BEEN DENIED OR CUT-OFF YOUR LONG-TERM DISABILITY BENEFITS? LET US FIGHT FOR YOU.

WE’VE RECOVERED MILLIONS IN WRONGFULLY DENIED DISABILITY BENEFITS SINCE 2003 – AND WE’RE READY TO HELP YOU. CALL OR SEND US AN EMAIL TODAY FOR YOUR FREE CONSULTATION.

You’ve paid premiums to your insurance company for years yet your claim is ignored and discarded 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 disability payments, you have the right to hire a disability lawyer to file a claim for payment.

disability lawyer hamilton 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 disability benefits 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 long-term disability benefits and we will never ask you for upfront fees.

Denied your Long-term Disability Benefits?

If you have become sick or disabled and are suddenly unable to work, you have the right to Hamilton disability lawyer and file a disability 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 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.

Cut-off your Disability Benefits?

If you have been cut-off your disability benefits, it’s important that you speak to an experienced 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.

Types of Disability Cases we Have Litigated

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 durites of yoru 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:

Why do I need a 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 beneifts 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 disbability 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.

Did you know that talking to us about your disability case is absolutely 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 Claimants all over Ontario?

Yes, our disability lawyers are locally based in Hamilton, but we serve claimants all over Ontario. 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 zoon or telephone. Our technology allows for digital signatures and anything else that may be required.  It is our job as Hamilton Disability Lawyers o try to get our clients paid their disability insurance 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 is Not for the Faint of Heart – but 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 long-term 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 long-term 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 Speak to a Disability Lawyer?

If your valid 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 long-term disability 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 marshalling the medical evidence needed to assist you in proving that you satisfy your policy’s definition of today disability – either being yor own occupation or any occupation to whic 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 don’t suffer from 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 performdisability lawyers hamilton 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 physically come to your office to retain your services?

No you do not. We’re certainly able to discuss your claim 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. We are happy to schedule a free telephone conversation with you to discuss your situation. If we are of the opinion that you have a case, we will need to meet you, but if more convenient, we can visit you. Our job as your Hamilton disability lawyers is to try and reinstate our clients long-term disability benefits that have been denied, as soon as possible, so we encourage you to telephone us with any questions you may have concerning your denied disability benefits.

Contact our Hamilton Disability Lawyers today – we Represent Claimans all over Ontario

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.

You will find that a Hamilton car accident lawyer at Lalande Personal Injury Lawyers understands your worries and is easy to talk 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 ours.

No, you do not have to come to our office, we are more than happy to meet you via zoom, and our office’s technology allows for digital retainer signatures. We have many disability claimants as clients that reside all over Ontario.

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.

It depends. When a lawsuit if filed, you are claiming a declaration – or a Judge to delcare you are totally diabled.  However like other lawsuits, disability claims do settle for lump sum payments.

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.

Otherwise calls the waiting period, the elimination period is a time of self-insurance at the beginning of a disability which no long-term disability benefits are payable. Common elimination periods are 30, 60, 90 and 120 days although not all combinations are available from every company. The longer the elimination period, the lower the disability premium, often dramatically so. The most common elimination that we see is 90 days.

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.

Collateral benefits, which may be relevant in terms of interaction with these potential claims and in relation to deductibility include:

  • Severance packages.
  • Ontario Works benefits.
  • Ontario Disability Support Plan (ODSP).
  • Workplace Safety Insurance Board (WSIB) benefits.
  • Employment Insurance (EI).
  • Gifts.
It is important to recognize and understand the interaction amongst these potential sources of monies as, ultimately, they will impact the bottom line of recovery.
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

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.
 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.”
There are a variety of reasons why an LTD claim may be denied or terminated:
  • Lack of forms and necessary documentation.
  • Employer did not provide the proper documentation.
  • Misrepresentations on claims forms or other supporting documentation, such as a pre-existing condition that was not mentioned or not fully disclosed.
  • Missed time limit for submitting claim.
  • Failure to have the injury or condition properly documented by the client’s doctors.
  • Failure to participate in treatment regimen.
  • Surveillance evidence contradicting the client’s claimed level of disability.

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.

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