You are suing for the payment of the disability benefits to which you are entitled, under your long-term disability policy. You are suing because your insurer declined to pay those benefits. An LTD lawyer at Verkhovets Law can help you file a lawsuit against your insurer.

If you and your LTD lawyer at Verkhovets Law decide that the insurance company acted unfairly when they denied your claim, you can also sue for ‘bad faith.’ Your LTD lawyer at Verkhovets Law will also make a claim for pre- and post-judgment interest on the amounts claimed.

Here’s some good news: Most long-term disability lawsuits reach successful settlement during negotiation and mediation with your LTD lawyer at Verkhovets Law acting on your behalf. LTD lawsuits typically do not end up going to trial. Settlement will result in a lump sum payment which is meant to compensate you for any past LTD benefits that were not paid, as well as benefits for future anticipated disability which is likely to result due to your inability to work.

LTD benefits are paid monthly, at 60 to 75 per cent of your basic salary.

To start, it is important to understand that an employee in Ontario cannot be fired because of their disability, or “for cause” in the language of Employment Law. Specifically, employers cannot fire employees for having a disability, being on disability leave, or receiving disability benefits. The Ontario Human Rights Code says that every person has a right to equal treatment with respect to employment without discrimination of disability.

If you are already receiving long-term disability (LTD) benefits and you are fired, your benefits cannot be terminated before the end date for LTD coverage specified in the disability policy, as long as you continue to be “totally disabled.”

Being fired should not impact the LTD disability benefits you are already approved for and/or receiving. Be aware that any termination or severance payments may be deducted from your long-term disability payments. Your LTD lawyer at Verkhovets Law can advise you on this.

It is also important to note that if the LTD insurer denied your long-term disability, you are most likely entitled to dispute the denial, including initiating a lawsuit, even if your employer ended up firing you after the onset of your disability, or for failure to return to work.

The important day is the day on which your disability developed or deteriorated to the level where it affected your ability to continue with your employment duties.

If you are fired just before becoming disabled in Ontario, and had LTD coverage under your employer group plan, your employer is required by law to continue your LTD coverage for a minimum of 1 week for every year of employment, up to an 8-week maximum.

Yes, it is. The Employment Standards Act was updated in 2019 to include stress/burnout.

To apply for long-term disability (LTD) benefits due to burnout can be complicated, however. There is wisdom in hiring an LTD lawyer at Verkhovets Law to help you.

Your employer’s group policy will provide information on how long the long-term disability (LTD) benefits can last; this is entirely dependent on what the contract between your employer and the insurance company says. Insurers offer LTD benefits to employers for 24, 60, 120 months and up to age 65 (retirement).

First, your employer must have an LTD policy in place for their employees with an insurance company. These are so-called group policies. If you or your employer only has an insurance policy for short-term disability (STD) benefits, then you will not receive LTD benefits. In that eventuality, there are no LTD benefits to be had by any employee.

Second, just because your STD benefit were approved, your LTD claim may not be approved. Because LTD benefits are paid out for a longer period of time, insurance companies need convincing proof that you need the benefits.

It is a good idea to retain an LTD lawyer at Verkhovets Law, to help you with an LTD claim, especially if it has been already denied by an insurance company.

Once you receive a denial letter, we do not recommend taking any steps without consulting an LTD lawyer at Verkhovets Law. Engaging in internal appeal or review process may interfere or even disentitle you from bringing a lawsuit against the insurance company.

Most LTD policies have a “recurrence clause” for the same injury/reason for disability. Typically, it is within six months of your initial attempt to return to work. However, every policy is different and something that was the case for your neighbour or friend may not be applicable to you.

If you return to work and need to go back on LTD after the expiry of the allowable time period, you may have to submit a new long-term disability (LTD) claim or even start the whole process again with first applying for STD benefits. Your LTD lawyer at Verkhovets Law can advise you on this. Review your own specific LTD policy for the time limit.

It is important to know that independent medical examinations (IMEs) or independent medical assessments (IMAs) are paid for by the insurer or LTD plan administrator. It is widely known that insurers generally select assessors who tend to provide assessment reports with conclusions that benefit the insurer, not the claimant (you!).

That said, yes, it is necessary for you to attend an independent medical examination if your insurance company requests it. If you do not attend an IME, your insurer can discontinue or deny long-term disability (LTD) benefits. Every LTD lawyer at Verkhovets Law will tell you that it is not a good idea to not cooperate for IMEs.

However, your insurance company may request medical assessments they are not entitled to under the policy. That’s why it is extremely important to consult LTD lawyer at Verkhovets Law. Attending assessments that you are not required to attend allows the insurance company an opportunity to obtain medical reports that may not favour you and eventually will be used to undermine your case.

If you have difficulty attending the IME (you are paralyzed, in a wheelchair, or your mobility is limited and so on), explain this to your insurance company in writing/email. Your LTD lawyer at Verkhovets Law can give you tips on what to do, what not to do, what to say, how to say it at the independent medical examination.

No, it’s not mandatory most of the time.

It is not advisable to return to work without clearance from your doctor. Returning to work prematurely may aggravate your condition and strain the employment relationship, too, because it will cause an even greater delay in your return to productive work.

If a gradual return to work makes your symptoms worse, advise both your doctor and your insurance company as well as your LTD lawyer at Verkhovets Law.

More importantly, when a person returns to work, even partially, it usually disentitles them from LTD benefits. It’s one of the tactics that insurance companies will use deny paying out LTD benefits. To an insurance company, a gradual return-to-work program is “proof” that you are not severely injured, even if you are in pain and not performing at 100 per cent, or substantially less.

While employees on LTD need their extended medical and dental benefits more than regular employees, this decision belongs to the employer. The employer decides how extended health care and dental benefits are handled for those on LTD. It mainly depends on the type of group policy that the employer purchased from the insurance company—does the policy offer extended health care benefits for those on LTD?

Generally, long-term disability (LTD) policies are designed to only provide wage replacement, not extended medical and dental coverage. However, some employers continue to pay either partially or fully for extended heath benefits even during disability period, or they may offer an employee to maintain their plan by taking over the monthly payments.

One important thing to keep in mind: If you settle your LTD lawsuit in a lump sum buyout (or surrender), you will likely lose your medical or dental benefits if they were included in your LTD policy. If you fail to consider this before settling, it could be a very serious and costly mistake, advises an LTD lawyer at Verkhovets Law at Verkhovets Law.

If you or a family member relies on your benefits to cover an expensive medication they absolutely need to live, you could be stuck paying for it out-of-pocket. If the medication is very costly, you could end up putting most of your LTD benefits towards covering the medicine, forever.

If you are in the middle of a legal battle, your LTD lawyer at Verkhovets Law will remind you that your lawsuit is against the insurance company that denied your LTD claim. You are not suing your current or former employer.

This question is more for WSIB situations, not LTD situations.

But having said that, the work hardening program is an individualized program focused on returning employees back to work from injuries or illnesses. The program is designed to minimize risk to and optimize the work capability of each employee.

The work hardening program integrates work, health, and rehabilitation needs of each individual. Further, a work hardening program can include physiotherapists, chiropractors, occupational therapists, and more.

If a work-hardening program makes your symptoms worse, advise both your doctor, your insurance company and your LTD lawyer at Verkhovets Law.

A waiver of premium rider [contract clause] is an extra benefit that you can add to your insurance policy for a small fee. Waiver of premium for disability is a provision in an insurance policy contract that states the insurance company will not require the insured to pay the premium if they are seriously injured.

This allows you to keep your insurance coverage even if a serious injury or illness forces you out of work. Keeping your insurance coverage is a good thing, says an LTD lawyer at Verkhovets Law at Verkhovets Law.

The definition of “totally disabled” or “total disability” is when: the employee is unable to perform substantially all their essential and material job duties because of an illness or injury.

A Non-Evidence Maximum (NEM), sometimes also referred to as a Non-Evidence Limit (NEL) is the highest amount of coverage a plan member [an individual or an employee] can receive without having to complete a medical questionnaire to apply for an LTD policy.

“Basic earnings” is the term used to describe your regular salary received from your employer, excluding any overtime, bonus pay, or incentives.

Own occupation means the employee is totally disabled and unable to perform the essential job duties of their current position.

Any Occupation means the employee is totally disabled and unable to perform any occupation or job that they are reasonably qualified for, based on their training, education, or experience.

When you first apply for long-term disability benefits, the assessment of “total disability” is based on whether you can perform the duties and responsibilities of your own occupation. The assessment by an insurance company of what they consider “totally disabled” changes over time. An LTD lawyer at Verkhovets Law can give you advice on this.

After 2 years of receiving long-term disability benefits, however, the insurer will assess whether you can perform the duties of “any occupation.” This is frequently the case, but each policy is different and should be considered separately.

Long-term disability (LTD) insurance provides financial assistance when an employee who works for an employer has an LTD policy in place for their employees, is unable to work due to an accident, illness or injury that prevents them from completing their job duties.

Depending on the nature of the disability, the benefit can provide income replacement up to age 65.

Long-term disability typically pays benefits equivalent to 60-75 per cent of your income, says an LTD lawyer at Verkhovets Law at Verkhovets Law.

In the language of the insurance world, “filing a claim” means “making an application for LTD benefits,” says an LTD lawyer at Verkhovets Law.

Get an application package from either your employer or the insurance company. The application package usually has three forms:

• Application Form (you fill out and send to the insurance company)
• Medical Report Form (your doctor fills out and sends directly to the insurance company)
• Employer’s Report (your employer fills out)

Once all the documents are received, the insurance company will assign a claim representative. They will open a “claim file” and assign you a claim number.

Once the insurance company has all your forms and documents, the claim representative will make a decision to approve—or deny your claim. This process can take months, depending on how long it takes to get them all the forms and documents they request. Many claimants find this part of the process the most stressful, says an LTD lawyer at Verkhovets Law at Verkhovets Law.

If your claim has already been denied by an insurance company, you should really retain an LTD lawyer at Verkhovets Law. Denied claims are particularly tricky for non-lawyers to get to a successful benefits payout.

Yes. As of January 2015, the Canada Revenue Agency (CRA) updated its disability benefit tax regulations. Now, both STD and LTD benefits are taxed at the time the payments are issued. Because this can get confusing, it is a good idea to ask your LTD lawyer at Verkhovets Law about this and how your taxes might be affected.

However, taxation depends on who is paying the insurance premiums for the LTD policy:

1. is the employer [under a group plan] paying the monthly premiums or
2. the individual [paying the premium from his/her own pocket]?

If the employer pays a portion of the premium, and the employee pays the balance with post-tax dollars, then the benefits are taxable in the same proportion as the percentage of the premium paid by the employer. For instance, if you paid for 50 per cent of your premium with post-tax dollars, you would only be taxed on 50 per cent of the benefit that your employer had been paying.

If the employer pays a portion of the premium, and the employee pays the balance with pre-tax dollars, then benefits received are 100 per cent taxable to the employee. An LTD lawyer at Verkhovets Law at Verkhovets Law says it is critical to know this; when you cannot work, you need to budget more carefully.

If an employee pays their entire premium with zero contribution from the employer with post-tax dollars, then any benefits they receive are non-taxable, meaning you get to keep the entire benefit amount.

One option is for clients to sign a contingency fee retainer agreement with the LTD lawyer at Verkhovets Law at the outset of the case. With this type of retainer, the client pays no fees unless and until the LTD claim is successfully resolved [you receive compensation from the insurance company]. Contingency fees are tightly regulated by legislation and the Law Society of Ontario (LSO).

Your LTD lawyer at Verkhovets Law will pay for all the expenses of the lawsuit until settlement. When the case is settled, fees are a percentage of the total benefits recovered, plus HST and disbursements [out-of-pocket costs]. The compensation the client gets is credited for the portion of legal fees paid by the insurance company, if any.

If you would prefer a different type of fee agreement, other options are available to you.

Normally, employers provide LTD for their employees through a group plan which is provided by an insurance company. LTD is a benefit in addition to your regular pay.

Individual employees can also buy their own LTD insurance policy if their employer does not provide one.

To decide what level of coverage you would need, an LTD lawyer at Verkhovets Law at Verkhovets Law can assist you to calculate your monthly expenses and consider additional medical bills you may have to pay if seriously sick or injured. You will then need to speak to an insurance agent at an insurance company to get a quote for your long-term disability insurance.