Question 1

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

Accepted Answer

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.

Question 2

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

Accepted Answer

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.

Question 3

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

Accepted Answer

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.

Question 4

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

Accepted Answer

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.

Question 5

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

Accepted Answer

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.

Question 6

What other expenses are involved in an LTD claim?

Accepted Answer

Apart from legal fees, every case requires that the law firm incur certain expenses. Most expenses in an LTD claim are incurred in obtaining necessary information, including medical records, expert assessments, and reports from physicians and other healthcare providers. Other expenses will include court filing fees, process serving fees, and mediator fees. At the conclusion of a successful claim, we will seek to recover the above-mentioned expenses, known as ‘disbursements’, from the insurer. You will be responsible for the portion of expenses that are not recoverable from the insurer. Those expenses will be charged against your settlement or judgment. If we are unable to recover compensation for you, you will not be charged expenses.

Question 7

How much will my LTD claim cost me?

Accepted Answer

We will make reasonable efforts to resolve your long-term disability claim as quickly and cost-effectively as possible. Our team of  lawyers will review your long-term disability insurance policy when handling your LTD claim. We will also check your collective agreement if you are a union member. Additionally, we will look at the insurer’s claim file. We will examine the medical evidence and other facts supporting or weakening your long-term disability claim. We will also address the legal issues that need consideration. You usually pay fees, and applicable HST on fees, after the LTD claim ends. Whether you are required to pay fees will depend on the outcome of your claim. If you recover compensation through a settlement or judgment, a money fund will exist and legal fees will be payable out of that fund. If we are unable to recover compensation for you, no legal fees will be payable. If you are successful with your claim, the insurance company will pay a part of your legal bill as ‘costs’, effectively reducing the amount of fees that you owe to our firm.

Question 8

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

Accepted Answer

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.

Question 9

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

Accepted Answer

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.

Question 10

Can I claim punitive damages in an LTD case?

Accepted Answer

It is common for LTD claimants to feel angry, frustrated, disrespected, and mistreated by the insurer that has denied their benefits. They may feel strongly about suing the insurer not only for the denied benefits but for additional damages intended to ‘punish’ the insurer for harsh, harmful or egregious conduct in the way it has handled the claim. Those additional damages are commonly referred to as ‘punitive damages’.However, our courts rarely award punitive damages in LTD insurance cases. This is because of laws relating to contracts. Even if they seem wrong, insurer's actions generally do not rise to the level required for punitive damages. Moreover, insurers will rarely, if ever, pay punitive damages as part of a settlement of a long-term disability insurance claim.

Question 11

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

Accepted Answer

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.

Question 12

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

Accepted Answer

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.

Question 13

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

Accepted Answer

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.

Question 14

What possible remedies do I have if my LTD benefits get denied?

Accepted Answer

LTD lawyers can pursue different remedies for you. These will depend on your particular situation, the LTD contract terms, and what the law allows. If your insurer denies your LTD claim at the very outset and you do not receive benefits, it must provide you with reasons. We will need to consider those reasons. The same is true if you received LTD benefits for a period of time and the benefit payments were then terminated. If we have serious questions or concerns about how and/or why the insurer responded to your claim in the way that it did, we will discuss next steps with you. This includes the possibility that our firm will be retained by you to investigate a potential legal claim. We will inform you if we believe the insurer had a valid reason to deny the LTD claim. We will also let you know if in our opinion the insurer had a valid reason to discontinue your LTD benefits. We may also try to assist by providing helpful advice about any options you may have.

Question 15

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

Accepted Answer

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.

Question 16

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

Accepted Answer

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.

Question 17

Can I apply for disability insurance without a lawyer?

Accepted Answer

Yes, you can apply on your own. When you do, however, be certain that your application is supported by strong medical evidence, preferably coming from a medical specialist if possible. If the insurer denies your claim, talk to an experienced lawyer. Getting help from someone experienced is essential. This will allow you to better understand the reason for the denial and, if the lawyer takes your case, the plan will be to examine the shortfalls in your application with a view to building a stronger case.

Question 18

What is the difference between "own occupation" and "any occupation" tests?

Accepted Answer

Every long-term disability insurance policy is different in certain respects. Most policies require that you satisfy the requirements of the “own occupation” test in order to qualify for the first stage of benefits. This stage usually extends over one or two years. You will satisfy the occupation test if you cannot perform most of the essential tasks of your regular job, and there is sufficient medical evidence to support your claim in that regard. After one or two years, the test to qualify for long-term benefits usually changes, and the requirements to satisfy this stage of benefits will depend on the particular policy. Insurance companies call this the “any occupation” test. You may still receive benefits if you can prove, with sufficient medical evidence, not only that you cannot do your own job but also any other job for which you might be suitable by reason of your education, training, or experience. It is not uncommon for claimants to lose their benefits when the policy changes from the "own occupation" to "any occupation” stage. It is essential to speak to a lawyer as soon as you receive notification for your disability insurer that your benefits are being terminated because you do not satisfy the requirements under the “any occupation” provisions of your policy.

Question 19

Do my long-term disability benefits also cover things like medications and dental treatment?

Accepted Answer

Most insurance companies do not pay such additional benefits under a long-term disability plan. However, your employer’s group benefits plan will often cover eligible drugs and dental. If you are off work for a lengthy period or time, your employer may stop your coverage or ask you to pay or contribute to the premiums. If your employment ends, you may lose these benefits unless extended by arrangement with the employer.

Question 20

Is long-term disability insurance the same as employment insurance (EI) sick benefits?

Accepted Answer

No, it is not. Employment insurance is a short-term program for people who have paid into it. It helps those who cannot work because of an injury or medical issue. The “waiting period” for long-term disability insurance is the period of time that you must wait in order to receive long-term disability benefits. This period is often several months and will vary by policy. Moreover, long-term disability plans may cover you for many years and often provide coverage through age 65.Employment Insurance has a two-week waiting period. EI sickness benefits may be available up to 26 weeks for financial assistance if you cannot work for medical reasons. As it currently stands, you may be eligible to receive 55% of your earnings up to a maximum of $695 per week.

Question 21

Is long-term disability insurance the same as the Canada Pension Plan Disability?

Accepted Answer

No, long-term disability insurance, usually provided through private insurers, is not the same thing as the Canada Pension Plan disability insurance. Private insurance companies typically pay benefits based on a set percentage of your wage while disabled. The federal government offers the Canada Pension Plan (CPP) disability insurance program. The benefit amount will depend upon the period of time over which you have paid into the CPP program, in addition to meeting the CPP disability criteria.To qualify for CPP benefits, you must prove a mental or physical disability. The disability must prevent you from doing the essential tasks of your employment, and must be considered severe and prolonged.

Question 22

How long do I have to file a lawsuit after an airplane crash?

Accepted Answer

After a plane crash, victims typically have up to 2 years to file a lawsuit, though this may differ by province.

Question 23

When should I file an injury claim after a plane accident?

Accepted Answer

You typically have two years from the accident to file a plane injury claim, though this varies by province. If the accident was concealed, the period starts upon discovery. Ultimate limitation deadlines are 10 years in Alberta, 15 in British Columbia and Ontario, and 30 in Manitoba.

Question 24

What types of compensation are available after an aircraft accident?

Accepted Answer

Victims of airplane accidents may receive compensation for medical expenses, lost income, pain and suffering, and other damages. For fatal accidents, this may include funeral costs and loss of companionship.

Question 25

Who can be held responsible for an airplane accident?

Accepted Answer

Responsibility for an airplane accident can rest with multiple parties, such as the airline, the aircraft manufacturer, maintenance providers, or air traffic control.

Question 26

What should I do if I or a loved one has been involved in an airplane accident?

Accepted Answer

If you or a loved one has been in an airplane accident, prioritize immediate medical care, report the incident to the Transportation Safety Board of Canada (TSB), and consult an aviation lawyer to explore your rights and potential compensation.

Question 27

What are some examples of airplane accidents that can cause injuries?

Accepted Answer

Under personal injury law, plane accidents can involve crashes, mid-air collisions, or incidents on the ground. Injuries may result from turbulence, hard landings, fires, slips or falls, or violence caused by unruly passengers.

Question 28

What are the potential causes of plane accidents?

Accepted Answer

Aviation accidents stem from various factors, with pilot error being most common. Other causes include weather, equipment failure, maintenance issues, and airline negligence.

Question 29

How do I start a Depo-Provera lawsuit?

Accepted Answer

To begin, contact the experienced team at Gluckstein Lawyers for a free consultation. Our lawyers will review your medical history and Depo-Provera use to assess whether you may be eligible to file a claim.

Question 30

Are meningiomas linked to Depo-Provera treatable?

Accepted Answer

Meningiomas are generally treatable, but it's important to consult a healthcare provider for advice tailored to your situation. Treatment options may include monitoring, surgery, or radiation therapy. However, some patients may experience long-term effects even after treatment, which can be an important factor when pursuing compensation.

Question 31

What should I do if I think my brain tumour is linked to Depo-Provera?

Accepted Answer

First, consult your healthcare provider to address your symptoms and ensure proper medical care. Next, collect your medical records and prescription history for Depo-Provera. An experienced lawyer can review this information to determine if there is a connection between your condition and Depo-Provera use.

Question 32

What is the deadline for filing a lawsuit related to Depo-Provera?

Accepted Answer

Lawsuits for drug-related injuries, like those involving Depo-Provera, are subject to statutes of limitations, which may differ by province. The countdown typically begins when you are diagnosed with a tumour or when the condition can reasonably be linked to Depo-Provera.

Question 33

What compensation can you claim in a Depo-Provera lawsuit?

Accepted Answer

In a Depo-Provera lawsuit, compensation may include coverage for medical expenses (both past and future), lost wages, and non-economic damages such as pain and suffering. If the condition has caused significant or permanent impairment, you may also be entitled to compensation for a reduced quality of life.

Question 34

Am I eligible to file a Depo-Provera lawsuit?

Accepted Answer

Depo-Provera lawsuit eligibility usually requires a history of using the drug and a subsequent diagnosis of meningioma or symptoms indicating tumuor growth. Factors such as dosage, duration of use, and timing of the diagnosis can affect your case.

Question 35

What symptoms should I watch for after using Depo-Provera?

Accepted Answer

If you've taken Depo-Provera, watch for ongoing symptoms like severe headaches, vision changes, balance problems, memory issues, or hearing loss. These may signal pressure on the brain from a meningioma.

Question 36

How are meningiomas related to Depo-Provera?

Accepted Answer

Research suggests that the hormonal components of Depo-Provera may be linked to a higher risk of developing meningiomas, especially with long-term or high-dose use. However, not everyone who uses Depo-Provera will experience this risk.

Question 37

What are meningiomas?

Accepted Answer

Meningiomas are tumours that develop on the membranes surrounding the brain and spinal cord. Although most are non-cancerous (benign), they can grow large enough to cause significant symptoms and may need to be removed through surgery.

Question 38

What to Do If Someone Hits Me and Flees the Scene of a Car Accident in Toronto?

Accepted Answer

If you're in a car accident in Toronto and the other party flees, stay calm and act quickly. Ensure everyone's safety and move to a safe location. Call the police and detail the fleeing vehicle. Gather witness information and document the scene with photos. Get the police report and notify your insurance company for assistance with claims and uninsured motorist coverage. Consulting a car accident lawyer can help manage your claim and ensure fair compensation.

Question 39

Do I Have to Report My Car Accident in Toronto?

Accepted Answer

In Toronto, you must report a car accident under certain conditions. According to the Ontario Highway Traffic Act, report to the police if there are injuries or property damage over $2,000. Notify your insurance company promptly to facilitate claims and support. Document key details like time, location, and circumstances for police and insurance reports.

Question 40

Should I consult a lawyer for my car accident claim?

Accepted Answer

It is highly recommended to consult with an experienced car accident lawyer in Ontario. They offer valuable insights, help you understand your rights, and ensure you pursue the maximum compensation possible for your specific case.

Question 41

Should I seek medical attention after a car accident even if I am not injured?

Accepted Answer

Yes, it's advisable to seek medical attention after a car accident, even without immediate injuries, as symptoms can appear later. A medical exam documents your health status, crucial for insurance or legal proceedings. Prioritizing your well-being ensures underlying issues are identified and treated promptly.

Question 42

How much can someone sue for a car accident in Ontario?

Accepted Answer

The amount you can sue for in a car accident varies based on numerous factors, including the severity of your injuries, the impact on your daily life, and any resultant economic losses. Compensation can cover medical expenses, lost income, pain and suffering, and other damages.

Question 43

What is Surveillance in Long-Term Disability Insurance?

Accepted Answer

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.

Question 44

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

Accepted Answer

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.

Question 45

Why Do Insurance Companies Deny LTD Claims?

Accepted Answer

Insurance companies may deny Long-Term Disability (LTD) claims for various reasons, some of which are legitimate while others may involve errors, misinterpretations, or disputes. Here are common reasons why insurance companies deny LTD claims:Insufficient Medical Evidence: If the medical documentation provided does not sufficiently support the severity or duration of the disability, the insurance company may deny the claim due to a lack of evidence.Pre-Existing Conditions: Some policies exclude coverage for pre-existing conditions or conditions that existed before the policy came into effect. If the disability is deemed to be related to a pre-existing condition, the claim may be denied.Policy Exclusions: Certain policies have specific exclusions for certain types of disabilities, treatments, or conditions. If the disability falls under an exclusion listed in the policy, the claim may be denied.Failure to Meet Criteria: Insurance policies often have specific criteria that must be met to qualify for LTD benefits. If the claimant does not meet these criteria, such as the definition of disability or waiting period requirements, the claim may be denied.Incomplete Documentation: If the required documentation, forms, or information are incomplete, missing, or not submitted within the specified timeframe, the insurance company may deny the claim due to insufficient information.Discrepancies in Information: Inconsistencies between the claimant's statements, medical records, and other documentation can raise red flags and lead to the denial of the claim.Failure to Follow Treatment Plans: If the claimant does not follow prescribed treatment plans, attend medical appointments, or comply with rehabilitation efforts, the insurance company may deny the claim on the basis of non-compliance.Occupational Duties: If the disability does not prevent the claimant from performing the essential duties of their occupation as defined in the policy, the claim may be denied.Surveillance Results: Insurance companies may conduct surveillance to investigate the validity of a claim. If the surveillance results suggest that the claimant's reported limitations are inconsistent with their activities, the claim may be denied.Fraud or Misrepresentation: If the insurance company suspects fraud, misrepresentation of facts, or intentional withholding of information by the claimant, the claim may be denied.Understanding these reasons for denial can help claimants navigate the LTD claims process more effectively, address any issues proactively, and seek recourse if they believe the denial is unjustified. It's advisable to consult with legal counsel specializing in disability insurance claims to explore options for disputing a denied LTD claim.

Question 46

What Medical Conditions Qualify for Long-Term Disability?

Accepted Answer

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

Question 47

Can You Dispute Your Denied Disability Claim?

Accepted Answer

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: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.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.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.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.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.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.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.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.

Question 48

How Do I Appeal Long-Term Disability Denial?

Accepted Answer

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: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.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.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.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.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.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.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.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.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.

Question 49

What Types of LTD Claims Can I Sue For?

Accepted Answer

In Ontario, individuals with Long-Term Disability (LTD) claims may have legal options to pursue lawsuits in various situations. Some potential types of LTD claims that individuals in Ontario can sue for include:Wrongful Denial of Benefits: If your LTD claim is wrongfully denied by the insurance company, you may have grounds to sue for a breach of contract or bad faith denial. This can involve challenging the denial based on policy provisions, medical evidence, or procedural errors in the claims process.Termination of Benefits: If your LTD benefits are terminated unfairly or prematurely, you may have a basis to sue for wrongful termination. This could include situations where benefits are cut off without proper justification or where the insurance company fails to provide adequate reasons for ending payments.Breach of Fiduciary Duty: In cases where the insurance provider fails to fulfill its fiduciary duty to act in the best interests of the insured individual, leading to harm or financial loss, a lawsuit for breach of fiduciary duty may be pursued.Disability Discrimination: If you believe you have been discriminated against based on your disability status in the context of your LTD claim, you may have legal grounds to sue for disability discrimination. This can include situations where you are treated unfairly, denied benefits, or subjected to adverse actions due to your disability.Violation of Human Rights: If your rights under human rights legislation in Ontario, such as the Ontario Human Rights Code, are violated in relation to your LTD claim, you may have the option to bring a lawsuit for human rights violations.Bad Faith Insurance Practices: In cases where the insurance company engages in bad faith practices, such as unreasonably delaying or denying valid claims, acting in a discriminatory manner, or failing to adhere to legal obligations, a lawsuit for bad faith insurance practices may be pursued.When considering legal action related to LTD claims in Ontario, it is advisable to seek guidance from a lawyer specializing in disability law to assess the specifics of your case, understand your rights under Ontario laws, and determine the appropriate course of action to seek redress for any injustices related to your LTD claim.

Question 50

What is Disability?

Accepted Answer

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.

Question 51

What is Hypoxic Ischemic Encephalopathy (HIE)?

Accepted Answer

Hypoxic Ischemic Encephalopathy (HIE) is a brain injury caused by oxygen deprivation (hypoxia) and reduced blood flow (ischemia) to the brain, typically occurring around the time of birth. HIE can be caused by factors such as complications during childbirth, umbilical cord issues, placental abruption, maternal infections, fetal distress, or other conditions that restrict oxygen supply to the baby's brain.

Question 52

What are the long term effects of birth injuries?

Accepted Answer

Birth injuries can have lasting effects on a child's health and well-being, leading to various long-term consequences such as: Physical Disabilities: Birth injuries like cerebral palsy, Erb's palsy, or brain damage can result in long-term physical disabilities that may affect mobility, coordination, and overall physical function. Cognitive Impairments: Some birth injuries can impact cognitive development, leading to learning disabilities, developmental delays, or intellectual impairments that persist into adulthood. Emotional and Behavioral Challenges: Children who experience birth injuries may face emotional and behavioral challenges such as anxiety, depression, attention deficit hyperactivity disorder (ADHD), or other mental health conditions. Chronic Health Conditions: Certain birth injuries may predispose individuals to chronic health conditions like epilepsy, respiratory problems, vision or hearing impairments, and other ongoing medical issues. Social Impact: Birth injuries can influence social interactions and relationships, potentially leading to feelings of isolation, difficulties forming connections, or challenges in social integration.Educational Needs: Children with birth injuries may require specialized educational support, individualized learning plans, or assistive technologies to accommodate their unique needs and facilitate academic progress. Financial Burden: The long-term effects of birth injuries can impose a significant financial burden on families due to healthcare expenses, therapy costs, assistive devices, and ongoing care requirements. Understanding the potential long-term effects of birth injuries is essential for parents, caregivers, and healthcare providers to ensure early intervention, appropriate treatment, and necessary support to help children thrive despite the challenges they may face. If you suspect that your child has suffered a birth injury, seeking medical evaluation and legal guidance promptly can help address the long-term implications effectively.

Question 53

Who can be sued for a birth injury caused by medical negligence?

Accepted Answer

In cases of birth injury resulting from medical negligence in Ontario, various entities may face legal action, including:Healthcare Providers: This category encompasses obstetricians, midwives, nurses, and other healthcare professionals directly engaged in prenatal care, labor, or delivery services. Hospitals or Medical Facilities: The institution where the birth injury occurred could be deemed liable, particularly if their policies, practices, or inadequate equipment contributed to the negligent circumstances. Medical Staff: Individual healthcare workers whose actions or oversights led to the birth injury can be held accountable. Pharmaceutical Companies: If medication or medical devices played a role in the birth injury due to defects or improper use, pharmaceutical companies might be implicated in the legal proceedings. Third Parties: External entities such as medical equipment manufacturers, maintenance contractors, or other involved parties in the birthing process that contributed to the negligence leading to the birth injury. To ascertain responsibility in cases of birth injury caused by medical negligence, a comprehensive investigation, legal acumen, and collaboration with medical experts are essential. If you suspect that your child has suffered a birth injury due to medical negligence, seeking guidance from a specialized birth injury lawyer in Ontario is recommended. They can assess your situation, identify the responsible parties, and assist you in navigating the legal process to pursue rightful compensation

Question 54

Why should I hire an Ontario birth injury lawyer?

Accepted Answer

Hiring a birth injury lawyer in Ontario can be crucial for several reasons: Legal Expertise: Birth injury cases can be complex, and an experienced lawyer specializing in this area understands the laws and regulations specific to birth injuries. Maximizing Compensation: A skilled lawyer can help you seek the maximum compensation you deserve for medical expenses, ongoing care, pain and suffering, and other damages.Investigation and Evidence Gathering: A lawyer can conduct a thorough investigation, gather evidence, and consult with medical experts to strengthen your case. Navigating the Legal Process: The legal process  can be overwhelming, but a lawyer will guide you through each step, ensuring your rights are protected. Peace of Mind: By entrusting your case to a knowledgeable lawyer, you can focus on your family while knowing that your legal matters are in capable hands.

Question 55

What is the deadline for filing a birth injury claim?

Accepted Answer

In Ontario, there are limitations on how long you have to file a birth injury lawsuit, known as the statute of limitations. It's crucial to consult with a lawyer promptly to understand your legal options and ensure timely action is taken to protect your rights. For personalized guidance on your specific situation, we recommend reaching out to a reputable birth injury lawyer in Ontario for a consultation.

Question 56

What type of cases do birth injury lawyers take on?

Accepted Answer

Birth injury lawyers in Ontario handle a wide range of cases, including but not limited to:Cerebral Palsy Erb's Palsy Brachial Plexus Injuries Brain DamageShoulder Dystocia Hypoxia Bone Fractures

Question 57

What is a birth injury lawyer?

Accepted Answer

A birth injury lawyer is a legal professional who specializes in cases where an infant has been injured during the birthing process due to medical negligence or malpractice. These lawyers have a deep understanding of the complex medical and legal issues involved in birth injury cases and work to help families receive compensation for the physical and emotional damages suffered. Birth injury lawyers can assist with cases involving various types of birth injuries.If you're considering a medical negligence lawsuit following a birth injury, a specialized lawyer in this field can provide meaningful advice and direction after reviewing the medical records and the specifics of the case.

Question 58

What Are My Legal Options if My Municipality’s Water Supply Is Contaminated With PFAS?

Accepted Answer

If your municipality's water supply is contaminated with PFAS, you may have several legal options to seek compensation, remediation, or injunctive relief from the parties responsible for the contamination.Potential defendants may include the manufacturers of PFAS, such as 3M and DuPont, the users of PFAS, such as military bases, airports, and industrial facilities, and the entities that disposed of PFAS, such as landfills and wastewater treatment plants.Some of the potential causes of action may include negligence, nuisance, trespass, strict liability, breach of contract, and violation of federal or state environmental laws. Potential remedies may include monetary damages, medical monitoring, cleanup costs, injunctive relief, and punitive damages.However, pursuing legal action against PFAS polluters can be complex, costly, and time-consuming, and may involve multiple jurisdictions, statutes of limitations, and evidentiary issues.

Question 59

How Can I Find out if My Municipality’s Water Supply Is Contaminated With PFAS?

Accepted Answer

The best way to determine if your water supply is contaminated with PFAS is to test it. You can contact your local environmental agency, or a certified laboratory, to conduct the testing.You can also check the Federal Contaminated Sites Inventory website for a list of public water systems that have reported PFAS detections.If you suspect that your water supply is contaminated with PFAS, you should notify your residents and advise them to use alternative sources of water for drinking, cooking, and brushing teeth, such as bottled water or filtered water.

Question 60

What are PFAS and Why Are They a Problem?

Accepted Answer

PFAS are a group of synthetic chemicals that have been widely used in various industries and consumer products since the 1940s. They are also known as "forever chemicals" because they do not break down easily in the environment or the human body.PFAS can contaminate drinking water sources, soil, air, and food, and can cause adverse health effects such as cancer, liver damage, immune system disorders, and developmental problems. They are regulated by the Environmental Protection Agency (EPA) under the Safe Drinking Water Act, but the current standards are not legally enforceable and may not be protective enough for public health.

Question 61

What constitutes teacher sexual abuse?

Accepted Answer

Teacher sexual abuse involves any form of sexual misconduct, harassment, or exploitation perpetrated by a teacher towards a student. This can include inappropriate behavior, grooming, assault, or any unwanted sexual advances.

Question 62

Can schools be held liable for teacher sexual abuse?

Accepted Answer

In some cases, a school board may also be found vicariously liable for sexual abuse committed by a teacher (i.e. the school board would be held responsible for the misconduct and abuse committed by the teacher, even if the school board did not know of the abuse.)

Question 63

If I'm a member of the Crown Ward Class Action case, can I still sue for the sexual abuse I suffered while in the care of Children's Aid?

Accepted Answer

Yes, you can. Since the Crown Ward Class Action case is only against the Ontario government for its failure to pursue legal action, you are still able to sue Children's Aid for the sexual abuse that happened to you while in its care. You might be entitled to compensation through both the class action as well as your individual lawsuit. One does not prevent the other.

Question 64

What Happens if I Get Into a Cross-Border Motor Vehicle Accident?

Accepted Answer

Your insurance coverage extends to the U.S. Under the terms of your valid Ontario automobile insurance policy, you have the same protection if you get into an a cross border accident in Niagara Falls, N.Y., as you have if that collision had occurred in Niagara Falls, Ont.If you get into an accident with an at-fault, underinsured driver in Ontario, you are entitled to make a claim and bring a lawsuit against your insurance provider under the OAP-1 and OPCF-44 provisions discussed above. The same thing applies if that accident occurs in the United States.

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