Long Term Disability Claims

Long Term Disability Claims  

An insurance claim denial requires finding the lawyer best for you.  No one hopes or prays for a long-term illness or debilitating injury. But bad things happen to good and bad people alike. So, when you insure yourself against long-term disability, you’re actually preparing for the worst, as everyone should. However, many insurance companies have made the process of claiming long-term disability benefits arduous. The complicated nature of such claims doesn’t help matters either. Many claimants do not know what constitutes a long-term disability and the coverage they are eligible for. Insurance companies tend to take advantage of this and hold back on honoring their legal obligation to assist you in your time of need. Our experienced insurance lawyers are ready to come to your rescue and help you fight for what’s yours.  

We do not act for insurance companies.  We will help disabled clients obtain the disability benefits they deserve.

What are long-term disability benefits?

Long-term disability benefits insure individuals against an inability to earn an income due to a long-term illness or disability. Though the income may not be as much as what the individual would receive while in the workforce, the benefit can go a long way to ease the suffering of people with sudden disabilities or chronic debilitating conditions.  

Generally, insurance companies will pay a long-term disability benefit to an individual that meets the terms of the insurance policy.  The benefit is usually a monthly amount to offset their losses of income from being unable to work.  Some policies will also provide for some coverage for rehabilitation or retraining in order to return to the work force.  In other cases, there may be coverage for rehabilitation through the extended health portion of a benefits package.

Who pays the benefits?

Various parties may be responsible for paying long-term disability benefits. If you have an private long-term disability coverage with an insurance company at the time you became disabled, the company is obligated to pay you long-term disability benefits. In other cases, many employers may have disability coverage as part of their benefits packages.  In some cases those premiums are paid by the employer and in other cases by the employee.  When a claim is made the specific wording of the policy or contract will determine who pays the benefits.

In some cases where an employee is unionized or under a collective bargaining agreement, the rules for when a benefit is paid can depend on the wording of those agreements.  It is important to speak with a lawyer to understand your rights. 

 

What kind of disability does the policy cover?  

Most long term disability policies cover illnesses and disabilities that prevent you from returning to work.  Every policy will contain different language that can provide insurance coverage or can exclude or limit the coverage.   In a private disability policy, the insurer has usually done an underwriting before issuing the policy to determine if there are pre-existing conditions that it does not want to insure.  In most group insurance policies obtained through employers, there can be specific conditions that are not covered such as psychological or subjective disabilities.

Many policies will set out a definition of disability.  These words are important as the degree of disability can impact on whether you receive benefits.  Many policies will consider whether you can work in your own occupation as the test for disability for the first two-year period.  Thereafter, the test is more strict requiring you to be disabled from any occupation.

It is important to have an experienced insurance lawyer review your insurance policy to determine if you have a case in the event of a denial.

 

How long do I have to wait before I can file my claim?  

It is important to file your claim as soon as your disability or long-term illness sets in. If you take too long, you may become ineligible for the benefits. Also, fighting for your claim becomes harder when there is a long interval between the disability and the filing of the claim as there may be less medical proof of your disability.

In many policies there is a waiting period before you can apply there and receive long term disability benefits.  Often  there may be coverage during this waiting period for short term disability benefits or employer sponsored payments.  

How much am I entitled to?

The amount of a long term disability benefit will depend on the wording in the insurance policy.  Some coverages will set provide a pre-set amount while others will set out a formula which can range from 50-80% of your normal earnings.   The amount of the benefit can be reduced by other sources of income such as CPP Long Term Disability and Workplace Safety and Insurance Benefits.  Any offsets or reductions will be set out in the insurance policy.

 

How long can I receive disability benefits?

Most insurance policies will set a time or age limit on how long the benefits can run.  It is common that most policies will set out that the benefits will terminate at the earliest date where you are no longer disabled, return to work, or quit or are terminated from your job.  Many policies will provide benefits until age 65, while some others may only provide a five year fixed period.

 

What if my claim is denied?

When an insurance company denies a long term disability claim it will have immediate financial consequences.  In some cases, the denial of the claim coupled with their disabilities can create an overwhelming situation.  A call or email to our experienced disability lawyers should be your first step after a claims denial.  Our experienced lawyers will ask to review your case including your insurance policy and medical records.  The consultation with our lawyers is free.

 

What are the steps to getting my benefits paid?

Every case is different and will require our experienced insurance lawyers knowledge and judgment.  Many cases will require expert opinion evidence from your health and medical practitioners to support your claims for disability.  The claim may also require litigation to obtain the results you deserve.  A lawsuit can often resolve through a mediation or negotiated settlement, while other cases may require a trial.  Our experienced insurance lawyers will advocate for you throughout the process and will assist you in getting the results you deserve.