Long-term disability (LTD) insurance provides a safety net of replacement income when you are unable to work because of a disability or injury. You may have group coverage from your employer, your own disability insurance, and/or you have disability insurance through a professional association and business group such as a Chamber of Commerce or university alumni group. For severe and prolonged conditions, you can apply for LTD under the Canada Pension Plan (CPP) and if the injury occurred at work, you may have coverage under the Workplace Safety and Insurance Board/Workers’ Compensation Board (WSIB/WCB).
It all seems straightforward, but often insurance carriers fail to pay out disability insurance benefits when there is need. In fact, many people who are eligible find their claims rejected on the initial request, which is discouraging. A disability insurance lawyer can help with your LTD claim.
When you hire an LTD lawyer, you are able to get answers to your questions and you will learn about your rights and how LTD plans work. We can review your individual policy and medical information to advise you if you should receive LTD benefits. We will help you through the litigation process if it becomes necessary.
We will provide advice that you need for your case and make recommendations. For example, we advise that you keep copies of all documents relating to your LTD claim, including a copy of the forms submitted, medical reports, correspondence with the insurance carrier or your employer, notes of telephone conversations, and so on. Records of income received, including from sources other than the disability payments is recommended in the event that the insurance carrier claims the right to reduce its payments to you based on other income. You should also keep documents relating to any attempt to return to work, including your doctors’ recommendations for any modifications to your job when you return and agreements with the carrier. In addition, keeping a chronological diary of major events surrounding your illness and your claim as they occur can be helpful.
It is also recommended that you follow your doctor’s recommendations; if your doctor advises the need for medical supervision and treatment, you will need to comply for all conditions that are contributing to your disability. If you have doubts about the treatment being provided, it is best to discuss it with your doctor. If your health status changes during or after the assessment, report this to your physician immediately. If you refuse to comply with treatment recommendations, you could be denied disability insurance payments.
We can also give you recommendations if you sense that someone is following and observing you. The insurance carrier can legally hire a private investigator and, while you cannot insist otherwise, you can approach the individual and can expect to be provided with identification and the individual’s credentials.
The benefit filing process can be complex, so we can help to complete the insurance forms, including those through the CPP and Workplace Safety and Insurance Board/Workers’ Compensation Board (WSIB/WCB) programs where applicable. Your insurance carrier has the right to require you to apply for benefits from the sources and to appeal the denial if the application is denied.
As part of filing your insurance claim, we work with you and your doctors to gather all the medical information that supports your entitlement so that your claim is not rejected. It may not be enough that the doctor provides an opinion about what you can and cannot do and therefore, it may be necessary to complete medical tests, provide the results of treatment and assessments, and to show how your diagnosis and symptoms cause a disability that functionally prevents you from working.
We will correspond with your insurance carrier and advise you if the insurance company asks that you attend a medical examination or assessment. They can periodically ask for additional medical evidence to show you are still entitled to receive LTD benefits and to find out your prognosis for improvement. You will need to comply with the request unless your doctor directs you not to in writing, with clear, strong medical reasons for his or her advice.
We will advise you if your insurance carrier requests that you participate in an approved rehabilitation program. You will need to comply to the best of your abilities unless your doctor directs you not to in writing, with clear, strong medical reasons for his or her advice. An opinion that the rehabilitation will not be successful is not sufficient.
You may have already been denied a claim that you submitted and received a reply from the insurance carrier that there is not sufficient evidence of a disability or that your specific condition should not make you totally disabled. In this case, we can issue a demand letter or provide the insurance carrier with additional medical evidence.
Usually there is resolution at this point, but if benefits continue to be refused, we can take action before the court. By bringing the matter to court, we have great negotiation power. We have been highly successful in negotiating settlements at the mediation stage of litigation and can bring the matter to trial, if necessary, including any appeals and proceedings of judicial review where applicable.
If you were receiving LTD benefits and have complied with all requests for treatment and assessments, and were suddenly cut off, we may be able to help get your LTD benefits re-instated. We can work with you to obtain and submit written documentation of your continuing disability from your doctor instead of waiting for the insurer to change its decision on appeal.
If you are improperly terminated while you were receiving LTD, your employer could face a significant legal matter. We can seek to have your LTD reinstated and inform your employer of the need to prove the claim with medical evidence prior to terminating you on the basis that there is no reasonable prospect of ever returning to work.
If your individual policy allows for it, we can help you access retraining while you are disabled and receive LTD. Your insurance carrier may approve retraining as it has the objective of giving you the education, skills, training and experience needed to obtain gainful employment.
In some cases, if your disability benefits are not reinstated, we can negotiate with your insurance carrier to help get you a lump sum settlement of your LTD claim. That being said, courts are less likely to award lump sum amounts.
As outlined above, a lawyer’s role in a LTD claim can be multi-faceted. We provide you with information, legal advice, can handle insurance forms, and can advocate on your behalf to receive or reinstate disability benefits. We can also help access retraining where it is applicable, and obtain an insurance settlement if the insurance carrier fails to cooperate. Disability insurance litigation is a hybrid of contract, employment and insurance law, involving parties with unequal bargaining power. A lawyer is often necessary to level the playing field.
At Howard Yegendorf & Associates, we have the experience and knowledge of the law to help you obtain your LTD entitlement. We work tirelessly to ensure that insurance companies live up to their financial obligations. If you are seeking the services of an experienced long term disability lawyer, contact us at Howard Yegendorf & Associates in Ottawa.