Disability insurance policies were created with the intention of providing a safety net of financial income for workers who sustain an injury, or disability, that prevents them from doing their jobs. While the Canada Pension Plan (CPP) provides coverage for some injured workers, insurance-company-issued policies are generally marketed to workers who are not offered disability insurance through their employers.
However, despite being created to help workers in their time of need, the benefit filing process can be quite difficult, with many eligible policyholders being rejected on their initial request. Unfortunately, this discourages many individuals that are genuinely eligible to receive these benefits and prevents them from obtaining the assistance they require.
Have you or someone you love had a benefits application rejected? Perhaps you are unsure if you qualify for benefits that may be available for an injury that prevents you from working. Our experienced and highly-trained Windsor disability benefits lawyers can help you. We have recovered more than $150 million for injury victims and are committed to pursuing the fair compensation you are entitled for your disability.
Common Causes of Long-Term Disability
While there can be many different factors that can cause a serious personal injury, in most cases long-term disability (LTD) injuries result from common ailments that many people suffer from.
Some of these include:
If your condition meets the definition of a disability in your disability insurance policy, you may be entitled to compensation for a portion of the wages you lose when you miss work. However, there is no standard definition of a disability that different policies use.
The definition of a disability often varies between insurance companies, and even policies from the same company. You will need to check with your insurance agent or insurance plan administrator to determine what qualifies as a disability under your plan.
Some policies may exclude certain illnesses or medical conditions. There may also be exclusions if your medical condition entitles you to compensation by filing a Workplace Safety Insurance Board (WSIB) claim.
Test to Determine Total Disability
According to the Supreme Court of Canada, an individual is totally disabled if he or she is in a situation where a reasonable person would recognize he or she should not take part in activities of his job even though he or she is physically unable to do so.
This means he may be able to transact some kind of business pertaining to his or her job, but his or her injuries are of a type that common care and prudence require him or her to stop working to heal. In other words, the individual will not be able to heal unless he or she stops working.
In general, if you cannot do your current job, you may qualify for benefits. However, some policies (“any occupation” policies) do not pay benefits unless you can prove you cannot do any other job you are qualified to do, in addition to your current job. You may be considered qualified for another job based on your training, experience and education. These policies often state that policyholders receive compensation if they cannot perform any occupation.
If your disability insurance plan says you must be unable to perform your “regular or own occupation,” you will likely receive benefits if you cannot do the job you were doing when your disability started. This means you could still receive benefits if you can do a different job. Likewise, if your LTD insurance is bundled with short-term disability coverage, you may be eligible to receive benefits even if you are not totally disabled.
If you have a group policy, they are often regular or own occupation plans for a certain period of time. Then, once that time passes, the policy usually changes to “any occupation.” Own occupation plans are typically purchased for individuals and cost more than any occupation plans.
If you are suffering from an injury or illness that prevents you from working, you could be entitled to disability benefits. The Windsor disability benefits lawyers at Greg Monforton & Partners can review your situation and your insurance policy and help you pursue the benefits you deserve.
Contact our firm right now by calling us at (866) 320-4770.
Filing a Claim for Long-Term Disability Benefits
When you file a claim for disability benefits, there is a variety of information you will need to provide, such as:
- The injury or disease you are suffering from
- How, when and where you contracted the disease
- Symptoms of your condition
- The date you stopped working because of your medical condition
- Dates you received treatment
- Your job duties
- Reasons you cannot work because of your disability
- Other sources of income besides your job
- The types of treatment you are receiving
Your doctor will probably be required to fill out the form to describe what you are suffering from and your long-term prognosis. Your employer may also be required to fill out sections of your application.
It is crucial to remember the burden of proof for a long-term disability claim is quite high, and it is on you. You need to provide strong evidence, not just from doctors. If your friends or family members can vouch for the severity of your disability, it can be powerful evidence. You can also keep a pain journal describing the pain you suffer on a daily basis.
You also need to take all reasonable steps to demonstrate the severity of your condition, such as attending every doctor’s appointment – if you cannot make an appointment, call the doctor to reschedule right away. You should avoid posting on social media about your disability or anything that could make it look like you are not really disabled.
It is important to note that the primary purpose of most insurance agencies is to provide an annual return to their investors. The well-being of their policyholders is generally much further down their list of priorities. This means claims that seem completely valid could be denied, and your only hope of obtaining benefits may be to appeal or file a lawsuit. You should not automatically assume the insurance company will pay your claim.
Your disability insurance policy likely has deadlines for filing claims – often a certain length of time after discovering you are disabled. If you miss the deadline, you will likely miss your opportunity to pursue disability benefits.
Meeting with an Insurance Company Doctor
Disability insurance policyholders often wonder about whether they must meet with a doctor chosen by the insurance company. They may be suspicious of these requests, thinking the doctor is more likely to reach conclusions or determinations that are against their best interests.
While you are right to be suspicious, your policy may require you to be examined by a doctor of the insurance company’s choosing. However, the doctor should be reasonably qualified to give an opinion about your disability and you should be given a professional exam. If those things do not happen, you should consider talking to a disability benefits lawyer in Windsor about the situation.
Can the Insurance Company Conduct Surveillance of My Activities?
The idea of being followed around by a private investigator probably makes you very uncomfortable. You may even be wondering if it is legal for insurance companies to do this. Unfortunately, the insurance companies are allowed to do this, so they can attempt to determine whether your claim is valid. They need to determine if the claimant is misrepresenting his or her illness and engaging in fraud.
If a private investigator is hired, he or she will likely photograph or film you throughout the day. He or she may also interview your neighbors and former coworkers.
You have nothing to worry about if you are being honest throughout the process. This means being truthful with doctors and the insurance company. If you are being honest, any information collected by the investigator should serve to corroborate your assertions about your disability.
However, investigators do not have the right to engage in any illegal conduct, such as trespassing, invading your privacy, or putting you in danger. If anything like this happens, you should contact the police. You should also discuss the situation with your lawyer.
Contact the Windsor disability benefits lawyers at Greg Monforton & Partners right now by calling (866) 320-4770.
Common Questions About Receiving Long-Term Disability Benefits
Disability claimants often have many questions about receiving benefits, including when they will be paid, how much they will receive, and if benefits are taxable.
Here are some frequently asked questions about disability benefits:
When Will I Receive Benefits?
Your waiting period before receiving benefits depends on your policy. For example, if you have a short-term disability plan, the waiting period is usually just five days. However, it may take several months before you can collect benefits from an LTD policy. This is also known as the elimination or qualifying period, which can go from 90 to 180 days.
How Much Compensation Will I Receive?
If you are applying for benefits from your employer’s long-term disability insurance, you can receive compensation for 50 to 80 per cent of your pre-disability salary. Typically, the policy pays 66-and-two-thirds per cent of your pre-disability wages. If you have a private policy, the benefit amounts are outlined in the policy and you can figure this out when you purchase the policy.
How Long Will My Benefits Last?
The answer to this question depends on the terms of the disability policy. Some policies pay out benefits until the claimant turns 65 years old. Some policies may have a set time period, such as 5 or 10 years. There are even policies that continue paying benefits after you turn 65, but you receive less money after you turn 65 than you did before.
Will I Pay Taxes on Disability Benefits?
If you are being compensated from a policy you purchased on your own, your benefits are probably not taxable. However, if you are being compensated from an employer-sponsored plan, the benefits will be taxable.
What Happens if I am Receiving Other Benefits at the Same Time?
Generally, long-term disability policies have provisions requiring a reduction of your monthly benefits if you are receiving compensation from:
- WSIB or other workers’ compensation benefits
- Canadian Pension Plan benefits (some disability insurance policies force you to apply for these benefits)
- Ontario Disability Support Program payments
- Criminal Injuries Compensation Act benefits
- Criminal Injuries Compensation Act Benefits
- Severance pay
- Other wages or renumeration from an employer
- Employment insurance (such as sickness benefits)
A Windsor disability benefits lawyer at our firm can answer your questions about receiving disability compensation. We can also guide you through the process of appealing a denied disability insurance claim.
Contact us today by filling out a Free Case Evaluation form.
What to Do When Your Claim is Denied
Even the strongest claims can be rejected by the insurance company. You may have had a lot of evidence, from your doctor and friends, relatives or coworkers. However, the insurance company could cite a variety of reasons for a claim denial:
- Missing the deadline for submitting a claim
- Not being examined by doctors approved by the insurance company
- Failing to disclose a pre-existing illness or injury
- Surveillance footage contradicts statements you made
- You did not properly document your injury
- You failed to continue treatment
- Your employer did not come up with the required documentation
There are times where claimants simply need to come up with more documentation and they will be approved for benefits. They may have failed to fill out a form correctly, which could easily be fixed.
However, there are many other times when you should strongly consider hiring a lawyer to represent you as you appeal the decision by the LTD insurer. An experienced Windsor disability benefits lawyer from our firm has in-depth knowledge of the relevant laws and how to interpret LTD insurance policy provisions.
We can carefully review your denial letter to determine precisely why you were denied and what steps we can take to reverse the decision. For example, some policies do not require objective evidence of a disability. However, insurers may say you provided no objective evidence even though the policy did not require objective evidence. Our lawyers can examine policy documents to determine what the insurance company requires to award benefits.
Contact a Windsor disability benefits lawyer right now by calling (866) 320-4770.
Why Were My Benefits Terminated?
The letter you receive from the insurance company terminating your benefits should explain the reasons why. If it is something simple, such as providing more documentation, you may be able to get the decision reversed very quickly.
However, if the insurance company says you are no longer disabled enough to be entitled to benefits, it could be much more difficult to have your benefits reinstated.
Your policy may require evidence that you are still unable to do the job you used to do after you receive benefits for two years. This means you need more evidence from doctors and others about your inability to work.
If your policy is like this, it is a good idea to meet with a lawyer before the two years are up to help avoid a disruption in your benefits. A lawyer can help determine if you need more evaluation by a doctor to help prove you are still unable to do the job you used to do.
Fill out our Free Case Evaluation form right now.
How We Can Help
At the law offices of Greg Monforton and Partners, our law firm has successfully sued numerous Canadian disability insurers and forced them to live up to their obligations. We can provide the experience to help guide applicants through the entire litigation process and the determination to help fight for their rights.
With the combined effort of our legal staff, we work to make insurers:
- pay all wrongfully denied payments with interest; and
- reinstate the disability payments
In many instances, we are able to negotiate a lump sum cash settlement for all past and future disability payments.
Schedule a free, no obligation legal consultation right now to learn about your legal options.
Have Questions? Contact Our Windsor, ON Disability Benefit Lawyers
The process of requesting disability payments can be frustrating and time-consuming, particularly because many legitimate claims are denied. If you are struggling with this process, our compassionate lawyers may be able to help you obtain the benefits you need and deserve.
At our firm, we understand the pressure that can be placed on families and other dependents when an individual is unable to provide a source of income due to a disability. With this in mind, we strongly believe that insurance companies must be held accountable for the policies that they issue and will fight for the MAXIMUM compensation amount for our clients. We have detailed knowledge and understanding of Canada’s laws on disability insurance and how to review and interpret individual disability insurance policies.
Our office is located in Windsor, Ontario, and we proudly provide contingency-based legal counsel to injury victims throughout the province including:
.... and almost all of the towns and suburbs that surround these areas.
For free answers to your questions about disability insurance claims, contact us today at (866) 320-4770. A member of our intake staff will answer your call and after some initial questions about your inquiry you will be quickly connected to one of our highly skilled lawyers.
For those that would prefer to start immediately, click "here" to reach us via this website.
Learn more about your legal options by calling (866) 320-4770. We are here to help.
Greg Monforton & Partners
Suite 801, 1 Riverside Drive West,
Windsor, ON N9A 5K3