Long Term and Short Term Disability Lawyers

Disability Claims FAQs.

Who Can Apply for the Canada Disability Benefit (CDB)?

To be eligible for the Canada Disability Benefit (CDB), the applicant must be between 18-64 years old, be approved for the Disability Tax Credit, and have filed income tax returns in the previous year.

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Do I need to be under continuous medical care to receive long-term disability benefits in Ontario?

Yes, to qualify for and continue receiving LTD benefits in Ontario, most insurance policies require you to remain under regular, ongoing medical care for your disabling condition. This demonstrates that you are actively seeking treatment and complying with medical advice to improve your health or manage your condition.

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How long does it take to resolve a long-term disability lawsuit in Toronto?

The timeline for resolving an LTD lawsuit in Toronto can vary depending on several factors, including the complexity of the case, the responsiveness of the insurance company, and whether the matter is settled out of court or proceeds to trial. On average, LTD lawsuits typically take 1 to 3 years to resolve.

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How is long-term disability insurance different from WSIB benefits in Toronto?

When it comes to benefits related to disability and workplace injuries, there is often some confusion between Long-Term Disability (LTD) benefits and Workplace Safety and Insurance Board (WSIB) benefits. LTD benefits are insurance payments provided for individuals unable to work due to non-workplace-related illnesses or injuries and are typically included in employee group benefits plans or purchased privately. WSIB benefits are compensation programs administered in Ontario for workers injured or made ill due to workplace-related incidents, offering support without requiring proof of fault.

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Is there a maximum amount of long-term disability benefits I can receive in Toronto?

Yes, there is typically a maximum amount of long-term disability (LTD) benefits you can receive in Toronto, as it depends on the terms of your specific insurance policy.

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Can I apply for long-term disability benefits in Toronto if I’m already receiving short-term disability?

Yes, you can apply for long-term disability (LTD) benefits while you are still receiving short-term disability (STD) benefits. Many disability insurance plans are designed to transition seamlessly from short-term to long-term coverage, ensuring continuous financial support if your condition prevents you from returning to work.

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What happens if I delay disputing an insurance company’s denial of long-term disability benefits?

If you wait too long to challenge an insurance company’s denial of your long-term disability benefits, you could lose your right to sue the insurer. This is one reason, among many, why it is essential to contact a lawyer immediately following a denial or termination of benefits.

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Can a long-term disability insurance company make me see a doctor they choose for a medical assessment?

Before a lawsuit starts, an insurance company is usually entitled, by the terms of the policy, to request reasonable medical examinations in order to substantiate or refute a claim of disability. 

However, this right has limits. You can ask for help in traveling for an assessment. This includes transportation, meal costs, and overnight hotel stays. 

Even after a lawsuit begins, the insurance company can set up medical assessments. The Rules of Civil Procedure, which dictate how lawsuits are to be conducted, allow specifically for this. 

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If I start a long term disability lawsuit, will I have to go to court?

The majority of lawsuits settle without going to court. Settlements, not court trials, are typically the preferred way to resolve LTD claims, wherever possible, because: 

• Settlements allow the parties to control the outcome of the case and therefore achieve certainty as to outcome, rather than leaving an uncertain outcome to the courts. 

• Settlements can be reached at any time, rather than the parties having to await a potentially costly trial that can be many years away. 

• Settlements remove the risk that the losing party will have to pay the winning party a substantial amount of money in legal costs. 

One crucial, but often overlooked, reason for settlements is that they can include money for future LTD benefits. Trial judges cannot force an LTD insurer pay benefits for the future. Rather, judges only have the power to order the payment of past LTD benefits and interest if the insurer is found to have wrongly denied benefits. Judges can also order the reinstatement of LTD benefits based on the contract terms. Those terms typically speak only to current, not future, entitlement for which the claimant must continuously qualify. 

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How long do I have to file a lawsuit if my long-term disability claim is denied in Ontario?

If your insurance company denies your long-term disability benefits claim, you should immediately talk to a lawyer. Most policies require that you bring your objection to the insurer within 30, 60, or 90 days. 

Policies may require that a lawsuit for denial of benefits be commenced within a year of the denial. The provincial limitations statute that applies to long-term disability insurance claims, however, will typically allow you up to two years to sue the insurer from the denial date. To avoid a problem in this regard, it is best to consult with a lawyer as soon as you are notified by your long-term disability insurer that your benefits claim is denied or is being terminated. 

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Can I appeal a long-term disability denial on my own, or do I need a lawyer?

Yes, you can, but doing so may not be a good idea. When an insurance company denies a claim, it will typically inform you of your right to appeal the decision within the insurance organization itself. You will likely be advised to send to the insurer, at your own expense, further information to support your claim, usually medical documentation.  

In most cases, unfortunately, internal appeals do not result in insurance companies reversing their decisions to deny benefits. Moreover, the time required to start a lawsuit may begin to run from the date of the insurer’s initial denial, while you pursue the internal appeal process, which may be prejudicial to your rights in the event that your appeal is unsuccessful. It is for those reasons, and potentially other reasons as well, that we generally will not recommend that you pursue an internal appeal.

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What should I do if the system initially rejects my long-term disability benefits?

LTD insurance companies can immediately reject your long-term disability claim in certain circumstances. The denial may be because of an injury, condition or illness that the insurer does not accept as genuine or as sufficiently supported by medical evidence.  

Our long-term disability lawyers are well-suited to step in at this point. We have represented many people throughout Ontario who have struggled with their LTD insurance companies. 

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Will I lose my entitlement to long-term disability benefits if my employer terminates my employment?

No. Even if your employer ends your job, you may still get long-term disability benefits as long as you continue to meet the eligibility criteria.  

In contrast, your right to participate in group benefit plans may end if your employer terminates your employment. However, this is separate from your right to continue receiving long-term disability benefits.

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What is Surveillance in Long-Term Disability Insurance?

Surveillance in the context of Long-Term Disability (LTD) insurance refers to the practice where insurance companies may conduct covert monitoring and observation of claimants to investigate the validity of their disability claims. This surveillance is typically carried out by professional investigators who gather visual evidence, such as photographs or videos, to assess the claimant's activities and functional limitations. Here are key points to understand about surveillance in LTD insurance:

• Purpose: The primary purpose of surveillance is to verify the extent of a claimant's disability and ensure that the reported limitations align with their actual activities. Insurance companies use surveillance as a tool to prevent fraud, confirm the accuracy of claims, and protect the integrity of the LTD system.
  
• Activities Monitored: Surveillance may involve monitoring various aspects of a claimant's daily life, including physical movements, interactions with others, engagement in recreational activities, and participation in events that could indicate the level of disability.
  
• Covert Nature: Surveillance is typically conducted covertly, meaning that the claimant is not aware that they are being monitored. This approach aims to capture the claimant's behavior and activities in their natural state without influencing their actions.
  
• Legal Compliance: Surveillance activities must comply with legal regulations and privacy laws to ensure that the rights of the claimant are respected. Investigators must adhere to ethical standards and obtain evidence lawfully.
  
• Impact on Claims: The results of surveillance can influence the outcome of an LTD claim. If the surveillance footage contradicts the claimant's reported limitations or suggests misrepresentation of disability, the insurance company may use this information to deny or terminate benefits.
  
• Frequency: Surveillance is not conducted continuously for all claimants but is often employed selectively based on specific factors, red flags, or suspicions raised during the claims process.
  
• Balancing Privacy and Investigation: While surveillance is a legitimate tool for insurance companies to verify claims, it raises concerns about privacy invasion and the potential misinterpretation of normal activities as evidence of fraud. Claimants have the right to challenge surveillance findings if they believe their disability status has been misrepresented.

Understanding the role of surveillance in LTD insurance can help claimants navigate the claims process effectively, ensure transparency in their interactions with the insurance company, and seek legal advice if they have concerns about the handling of surveillance activities in relation to their disability claim.

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How Much Money Can I Get From My Long-Term Disability Benefits?

The amount of money you can receive from Long-Term Disability (LTD) benefits in Ontario is influenced by various factors, including the terms of your specific LTD policy, your pre-disability earnings, and the duration of your disability. Here are key points to consider regarding LTD benefits in Ontario:

• Percentage of Pre-Disability Earnings: LTD policies typically provide a percentage of your pre-disability earnings as benefits. This percentage can vary but commonly ranges from 50% to 70% of your pre-disability income.
  
• Maximum Benefit Amount: Most LTD policies have a maximum monthly benefit amount, which caps the total benefits you can receive each month. This maximum amount is determined by the terms of your policy.
  
• Duration of Benefits: The duration for which you can receive LTD benefits varies and is specified in your policy. Some policies provide benefits until retirement age, while others have a limited benefit period (e.g., two years, five years).
  
  
• Integration with Other Benefits: LTD benefits may be integrated with other disability benefits you receive, such as Canada Pension Plan Disability (CPP-D) benefits or workplace pensions. The total amount you receive from all sources may be subject to offsets or reductions.
  
  
• Tax Considerations: LTD benefits in Ontario are generally considered taxable income. However, if you paid the premiums for the LTD policy with after-tax dollars, a portion of the benefits may be tax-free.
  
  
• Cost-of-Living Adjustments: Some LTD policies include cost-of-living adjustments to account for inflation, ensuring that the purchasing power of your benefits is maintained over time.
  
• Return-to-Work Provisions: Many LTD policies include provisions for partial disability benefits if you can return to work on a part-time basis or in a reduced capacity. These provisions may affect the amount of benefits you receive.

To determine the specific amount of money you can receive from LTD benefits in Ontario, it is essential to review your LTD policy documents, understand the terms and conditions of the policy, and consult with the insurance provider or a legal expert specializing in disability insurance claims. They can provide detailed information on benefit calculations, limitations, and any additional factors affecting the amount of LTD benefits you are eligible to receive.

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What Medical Conditions Qualify for Long-Term Disability?

Long-Term Disability (LTD) insurance typically covers a wide range of medical conditions that significantly impact an individual's ability to work and perform daily activities. While the specific criteria for qualifying for LTD benefits may vary depending on the policy and insurance provider, here are common medical conditions that often qualify for Long-Term Disability coverage:

1. Musculoskeletal Disorders: Conditions affecting the muscles, bones, joints, and connective tissues, such as chronic back pain, arthritis, osteoporosis, and fibromyalgia.
   
   
2. Mental Health Disorders: Including depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), schizophrenia, and other psychiatric conditions that impair daily functioning.
   
   
3. Neurological Disorders: Such as multiple sclerosis (MS), Parkinson's disease, epilepsy, Alzheimer's disease, and other conditions affecting the brain and nervous system.
   
   
4. Cardiovascular Disorders: Including heart disease, congestive heart failure, arrhythmias, and other cardiovascular conditions that impact physical functioning.
   
5. Cancer: Various forms of cancer, including leukemia, lymphoma, breast cancer, lung cancer, and other malignancies that require extensive treatment and cause disability.
   
6. Autoimmune Disorders: Such as lupus, rheumatoid arthritis, Crohn's disease, ulcerative colitis, and other autoimmune conditions that result in chronic symptoms and limitations.
   
7. Chronic Pain Syndromes: Conditions leading to persistent pain and discomfort, such as migraines, complex regional pain syndrome (CRPS), and neuropathic pain disorders.
   
8. Respiratory Disorders: Including asthma, chronic obstructive pulmonary disease (COPD), emphysema, and other lung conditions that impact breathing and physical exertion.
   
9. Endocrine Disorders: Such as diabetes, thyroid disorders, adrenal insufficiency, and hormonal imbalances that affect overall health and functioning.
   
10. Degenerative Diseases: Conditions like osteoarthritis, degenerative disc disease, muscular dystrophy, and other progressive diseases that result in physical decline over time.

It's important to note that each LTD policy may have specific definitions, limitations, and exclusions regarding covered medical conditions. To determine if your medical condition qualifies for Long-Term Disability benefits, consult your policy documents, speak with your insurance provider, and consider seeking guidance from a healthcare provider or legal expert specializing in disability insurance claims.

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Can You Dispute Your Denied Disability Claim?

Yes, you can dispute a denied Long-Term Disability (LTD) claim if you believe that the denial is unjustified or incorrect. Disputing a denied LTD claim involves challenging the decision made by the insurance company and presenting additional evidence or arguments to support your claim for disability benefits. Here are steps to effectively dispute a denied LTD disability claim:

1. Understand the Reasons for Denial: Review the denial letter from the insurance company to understand the specific reasons for the denial. This will help you address the issues raised in your dispute.
   
2. Gather Additional Evidence: Collect any new medical records, test results, physician statements, or other relevant documentation that strengthen your case for disability benefits. Ensure that this evidence directly addresses the reasons cited for the denial.
   
3. Consult with Legal Counsel: Consider seeking advice from a lawyer specializing in disability insurance law. A legal expert can assess your case, provide guidance on disputing the denial, and represent you in negotiations with the insurance company if needed.
   
4. Prepare a Detailed Dispute Letter: Craft a comprehensive dispute letter outlining the reasons why you believe the denial is incorrect. Clearly present the additional evidence, explanations, and arguments supporting your claim for disability benefits.
   
5. Submit the Dispute: Send your dispute letter and supporting documentation to the insurance company within the specified timeframe outlined in your policy. Use a method that provides proof of delivery to ensure your dispute is received.
   
6. Engage in Dialogue: Stay in communication with the insurance company throughout the dispute process. Be prepared to provide further clarification, answer questions, or provide additional information as requested.
   
7. Consider Alternative Resolution: If direct negotiation with the insurance company does not lead to a resolution, explore alternative dispute resolution methods, such as mediation, to seek a mutually acceptable outcome.
   
8. Legal Action: If all attempts to dispute the denial prove unsuccessful, you may consider taking legal action against the insurance company by filing a lawsuit. Your legal counsel can guide you through the litigation process and represent your interests in court.

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How Do I Appeal Long-Term Disability Denial?

When faced with a denial of your Long-Term Disability (LTD) claim, appealing the decision is a crucial step to seek reconsideration and potentially secure the benefits you are entitled to. Here are the steps to effectively appeal a Long-Term Disability denial:

1. Review the Denial Letter: Carefully review the denial letter from the insurance company to understand the reasons for the denial, the policy provisions cited, and any additional information or documentation required for the appeal.
   
2. Gather Supporting Documentation: Collect all relevant medical records, test results, physician reports, and any other evidence supporting your disability claim. Ensure that this documentation addresses the reasons for denial outlined in the letter.
   
3. Understand the Appeals Process: Familiarize yourself with the specific appeals process outlined in your LTD policy. Note any deadlines for submitting an appeal and follow the prescribed procedures to ensure your appeal is considered.
   
4. Draft a Comprehensive Appeal Letter: Prepare a detailed appeal letter addressing each reason for denial, providing additional evidence, explanations, and arguments supporting your claim for disability benefits. Be clear, concise, and organized in presenting your case.
   
5. Seek Legal Advice: Consider consulting with a lawyer experienced in disability insurance law to guide you through the appeals process, review your appeal letter, and provide legal representation if needed.
   
6. Submit the Appeal: Send your appeal letter and supporting documentation to the insurance company within the specified timeframe. Use certified mail or another method that provides proof of delivery to ensure your appeal is received.
   
7. Follow Up and Maintain Communication: Keep track of your appeal timeline, follow up with the insurance company to confirm receipt of your appeal, and maintain open communication throughout the appeals process.
   
8. Consider Alternative Dispute Resolution: If the appeal is unsuccessful, explore alternative dispute resolution options, such as mediation or arbitration, to resolve the dispute outside of litigation.
   
9. Legal Action: If all appeals are exhausted and your claim remains denied, you may consider pursuing legal action against the insurance company through a lawsuit with the assistance of legal counsel.

By following these steps and seeking professional advice where necessary, you can navigate the appeal process effectively and increase your chances of overturning a Long-Term Disability denial.

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What is Disability?

Disability is a broad term that encompasses physical, cognitive, sensory, or mental impairments that may limit an individual's ability to engage in certain activities or perform tasks compared to the general population. Disabilities can be temporary, permanent, or episodic, and they vary in severity and impact on daily functioning.

Disabilities can result from various factors, including congenital conditions, illnesses, injuries, accidents, or age-related changes. The effects of a disability can manifest in limitations related to mobility, communication, cognition, sensory perception, or self-care, affecting an individual's independence and quality of life.

In the context of insurance, such as Long-Term Disability (LTD) coverage, disabilities are typically assessed based on their impact on an individual's ability to work and earn income. Insurance policies define disability criteria to determine eligibility for benefits, considering factors such as medical evidence, functional limitations, and the individual's capacity to engage in gainful employment.

Understanding the nature of disabilities, their diverse manifestations, and the challenges they pose to individuals is crucial for creating inclusive environments, providing appropriate support and accommodations, and promoting equal opportunities for individuals with disabilities in various aspects of life.

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