According to a Toronto long-term disability lawyer at Verkhovets Law, if your bid for long-term disability (LTD) is denied, you’re not alone – insurers turn down 60 per cent of these claims in Ontario. According to the 2017 Canadian Survey on Disability, one in five Canadians (6.2 million) said they have disabilities that hinder their daily activities. The World Health Organization (WHO) notes 15 per cent of the globe’s population lives with a disability or more than one billion people. While they’re not all classified as long-term disabilities, it’s a stunning picture.
A Toronto long-term disability lawyer at Verkhovets Law notes that long-term disability benefits are meant to be your suit of financial armour if you become totally disabled and cannot work. Disability benefits are supposed to replace the lost income with monthly insurance payments up to a pre-determined percentage of your full wage (usually 60-70%). But these days, it’s typical for an applicant to receive the dreaded letter denying coverage for a technicality in the LTD contract.
So, is that the end of the road? Not by a long shot. A Toronto long-term disability lawyer will tell you that a denied disability claim is a contractual dispute that focuses on the language in your policy and how both sides interpret it. Generally, the insurer isn’t on your side, no matter what they said when they signed you up. But that’s when the next stop in the journey is an appeal before the Superior Court of Justice.
A Toronto long-term disability lawyer at Verkhovets Law adds that most of the time the denial is based on a loophole in the policy. An appeal will focus on having benefits reinstated and seek damages for past denied benefits, stress, legal costs, pre- and post-judgment interest, and possibly a punitive award.
Toronto long-term disability lawyer defines what conditions qualify for LTD
A Toronto long-term disability lawyer at Verkhovets Law explains that various conditions qualify as long-term disability, which can vary depending on how your insurer defines what they are. But the stats are clear: the odds of becoming disabled before retirement are one in three. One thing in common is that to qualify, the condition must prevent you from not only performing your job, but any work that you are trained to do.
What’s one of the leading conditions that pass muster for LTD? Arthritis. In fact, about 6 million Canadians suffer from the more than 100 types of arthritis—some 20 per cent of the population. And, 60 per cent of arthritis suffers are women.
A Toronto long-term disability lawyer says claims are made around two years after the disability starts and short-term disability benefits end. And an independent medical examination is crucial to the process.
An insurer may deny coverage for a condition covered in Ontario by WSIB, while some may exclude illnesses that others include. But a Toronto long-term disability lawyer at Verkhovets Law says many conditions qualify for long-term disability, including mental disorders, musculoskeletal, cancer, circulatory, nervous system, and accident-related severe injury.
A Toronto long-term disability lawyer says some specific conditions include: heart disease; back issues; chronic pain; disorders like Lupus, Fibromyalgia or Lyme disease; paralysis; depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD); and other disabilities that render you unable to work.
Long COVID is now becoming the latest struggle for those suffering crushing disabilities to access their LTD benefits, says a Toronto long-term disability lawyer.
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What is total disability? A Toronto long-term disability lawyer explains
A Toronto long-term disability lawyer at Verkhovets Law says being declared with a total disability doesn’t mean you must be lingering in a coma or completely paralyzed. But you have to be designated with a total disability to get LTD benefits paid.
The legal definition of total disability – while specifics vary between insurers – is essentially that your condition prevents you from reasonably being able to perform the essential duties of the work you do, as laid out in the 1983 Supreme Court of Canada decision Paul Revere Life Insurance Co. v Sucharov.
A Toronto long-term disability lawyer notes the court said it’s not an “absolute physical inability to transact any kind of business pertaining to one’s occupation.” It’s about not being able to do the core duties of your occupation. As opposed to partial disability which means you can still work to some degree.
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Toronto long-term disability lawyer warns how to avoid denied or cancelled benefits
A Toronto long-term disability lawyer at Verkhovets Law says given the high rate of claims denials from insurance companies, it’s a good idea to know some of the red flags that can lead to being turned down.
The first thing to be aware of is that an insurance company’s private investigator could monitor your social media. And if you what you post contradicts what you’ve reported to the insurer, it’s not a stretch to see a claim denied.
A Toronto long-term disability lawyer at Verkhovets Law advises that you shouldn’t inadvertently cause your own disqualification by doing some common things that can trigger it. That includes not having all the documentation; relying on a biased medical expert hired by the insurer; providing insufficient medical evidence; not showing up for the independent medical exam; not complying with rehab treatments; running a side hustle to make money; misrepresentations on the policy form; and missing time limit deadlines.
There is also typically a list of exclusions and limitations in policies, and a pre-existing condition clause can exclude or restrict you from LTD, notes a Toronto long-term disability lawyer at Verkhovets Law.
Can you claim LTD benefits for work-related burnout/stress?
Yes. Suppose you have developed workplace stress/burnout to the degree that you cannot work. In that case, you can apply for long-term disability benefits, says a Toronto long-term disability lawyer. But it’s complicated.
In 2019 the Employment Standards Act opened the door, having been updated to include conditions like stress and burnout, notes a Toronto long-term disability lawyer at Verkhovets Law. According to a Mental Health Commission of Canada report, one in five workers is going through a mental health issue, including stress.
A Toronto long-term disability lawyer cautions that while stress leave is available for shorter periods, to qualify for long-term disability, the condition must be a severe one like depression rendering the employee “totally disabled.”
Burnout, in some cases, can cause conditions that can render someone unable to work. During the COVID-19 pandemic, health care workers’ disability claims were largely based on stress/burnout, with 75 per cent of nurses reporting higher levels of anxiety, depression, stress, and burnout. A Toronto long-term disability lawyer at Verkhovets Law says while these long-term disability claims are justified because it’s an invisible illness, insurers are inclined to deny which is why it’s essential to have competent counsel at your side.
Learn more about how mental health can impact your LTD claim, Toronto Mental Health Lawyers
Call or email us now, and Toronto long-term disability lawyers will start your claim
Our Toronto long-term disability lawyers at Verkhovets Law have experience appealing insurers’ denials of LTD benefits claims and know how to handle the techniques they use to avoid paying: deny, delay and discount. We understand how frustrating it can be to have paid for the insurance premium only to be denied when you need it most over an obscure technicality. The temptation can be to take less because it’s better than nothing. But we will appeal that denial for your peace of mind – and the money you deserve.