Toronto Long-Term Disability (LTD) Lawyers

Our Toronto long-term disability lawyers have four words for you if you’re wrangling with an insurance company over long-term disability (LTD) benefits: “read the fine print.” Or better yet – you focus on taking care of yourself, and we’ll get out the magnifying glass. We know it’s frustrating; you paid for your insurance either through work or privately. Then, the worst happened. You need the replacement income, but the insurer won’t pay. Two words: contact us.

Verkhovets Law, Toronto long-term disability lawyers know that LTD is supposed to be your safety net. The reality is it’s more like the roadrunner yanking the net away from the coyote. LTD is meant to financially cover you if an illness or injury stops you from working. Frequently, insurers complicate matters and use delays as a stall tactic. This is why you need Toronto long-term disability lawyers to advocate on your behalf.

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Why our Toronto long-term disability lawyers?

Verkhovets Law, Toronto long-term disability lawyers will tell you litigating disability claims is an extremely complicated process: many specialists to see, many forms to fill out, much waiting time in between. Talking to us before you make a claim is the best way to avoid being denied in the first place. We’re used to decoding policies written in such a deliberately convoluted language it’s no wonder they’re often misunderstood.

Insurance companies are in it to make money – not pay you – even if you make an honest mistake completing a claim form.

Would your insurer really deny your claim based on a technicality?

Yes, they would.

And, yes, they do.

Toronto long-term disability lawyers have gone to battle with insurers who lick their chops at the prospect of an individual slipping up on their claim and denying them their coverage. It’s estimated more than half of the claims in this country are turned down at the application stage. If that happens don’t try and go it alone; it’s important to have a lawyer involved who will appeal and, if they have to, sue the insurer as a civil matter in the Superior Court of Justice.

When your long-term disability claim has been dismissed by an insurance company, don’t get angry and don’t give up. The Toronto long-term disability lawyers at Verkhovets Law can help. We have helped hundreds of people with their denied long-term disability claims.

 

Don’t assume you understand everything the policy is saying. Our Toronto long-term disability lawyers will translate it for you into plain English. We know how insurance companies think and act. And what we need to do, to help you with your denied long-term disability claim.

Here are some interesting, if not frightening, facts about long-term disability in Canada, according to the 2017 Canadian Survey on Disability (CSD).

  • An estimated one in five Canadians aged 15 years and over have one or more disability that limits them in their
  • The prevalence of long-term disability increases with age.
  • Women are more likely to have a disability than men, according to the report.
  • More than four in 10 Canadians with disabilities are classified as severe or very severe.

It’s tragic how many people needlessly live with the dire consequences of a denied long-term disability claim. Call or email the Toronto long-term disability lawyers at Verkhovets Law, to get the help you need.

Long-Term Disability (LTD)

the Toronto long-term disability lawyers at Verkhovets Law,
to get the help you need.

Toronto long-term disability lawyers outline
which conditions qualify

Toronto long-term disability lawyers outline which conditions qualify

Toronto long-term disability lawyers will tell you when it comes to LTD policies, it’s not an “if it quacks like a duck” situation. For example, they all have their own definitions of what is a disability. Some long-term insurance policies cover you no matter the type or severity of condition so long as you are unable to perform all or the core duties of your job. But others exclude some illnesses. And some may deny conditions covered by Workplace Safety and Insurance policies – in Ontario it’s the WSIB.
If it’s established your illness or injury type is covered, the insurer will typically arrange an Independent Medical Examination which you are required to attend if you want to collect LTD benefits. This medical professional’s role is to give an objective opinion on your level of disability, possible treatment, and prognosis – not to treat you. Verkhovets Law, Toronto long-term disability lawyers, will strongly advise you to be co-operative and honest as everything goes in the report. It’s not unusual for a claim to be denied if the IME finds you aren’t or are no longer disabled.

While your policy’s checklist is the one that applies, there are common injuries and illness that usually satisfy insurers as a disability:

  • Arthritis, Rheumatoid Arthritis
  • Back injuries
  • Brain injuries
  • Cancer
  • Cardiovascular disease and Stroke
  • Diabetes
  • Fibromyalgia and Chronic Fatigue Syndrome
  • Fractures
  • Gastrointestinal illness (Crohn’s, Colitis, Diverticulitis, Irritable Bowel Syndrome)
  • Infection
  • Lupus
  • Mental health problems
  • Medical Equipment
  • Mood disorders, including Bipolar, Anxiety, or Depression
  • Multiple Sclerosis
  • Nervous System disorders (ALS) and Seizure

 

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Toronto long-term disability lawyers define key LTD terminology

Total disability – Toronto long-term disability lawyers see this all the time; an insurer is chomping at the bit to deny your LTD benefits, so they claim you’re not totally disabled. The Supreme Court of Canada set out the definitive meaning of the term in Paul Revere Life Insurance Co. v Sucharov that you are unable to reasonably perform the essential duties of the work you do. 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 for two years.
Own occupation – This means you are unable to perform the essential duties of the job that you did before the onset of an illness or injury. Toronto long-term disability lawyers use the example of an orthopaedic surgeon who crushes his hand. Cutting into a patient and repairing their spine is his own occupation – and he can’t do that anymore. This is the ‘own occupation’ test. So, he qualifies to collect benefits for the next two years, the own occupation period, even though he can work as a doctor performing other duties.
Any occupation – Toronto long-term disability lawyers warn this hurdle comes after two years and the definition changes. Now a claimant is totally disabled if they can’t perform the essential duties of any job for which they are reasonably suited. So, the example of the surgeon in the preceding paragraph – who still can’t operate but works as a doctor, would have to be disabled to the point of not being able to work as a doctor due to an injury or illness. This is the ‘any occupation’ test. If you qualify, payments end if you can work; die; or hit 65 when you move to the Canada Pension Plan (CPP).
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Toronto long-term disability lawyers explain
why LTD gets denied or cut off

Toronto long-term disability lawyers explain why LTD gets denied or cut off

The message from our Toronto long-term disability lawyers about insurance companies is clear: just because you paid for benefits through insurance premiums and qualify to collect, doesn’t mean that’s what actually happens.

There are many reasons for a denied long-term disability claim, or a cancelled one. It is not uncommon for insurance companies to hire a private investigator to verify that you indeed need long-term disability benefits. In the same vein, some people tell the insurance company one story and a different story appears on Facebook. Your credibility is key.

Verkhovets Law, Toronto long-term disability lawyers, make sure their clients know it’s important not to disqualify yourself without realizing the ramifications of one of the following:

  • Absence of documentation
  • Bad adjuster
  • Biased medical expert assigned by the insurance company
  • Caught by a private eye doing something that affects your credibility
  • Change of definition
  • Insufficient medical evidence beyond just a diagnosis.
  • Not showing up to the independent medical examination
  • Not showing up to or complying with rehabilitation or treatment
  • Operating a small business at home under the radar
  • The M word: misrepresentations in a claim, including not revealing everything about a condition or any pre-existing issues
  • Unmet time limits for forms submissions including proof of claim or notice clauses
  • Wrong documentation supplied by employer Your lack of communication with the insurer

Our Toronto long-term disability

lawyers handle these types of

disability claims:

Our Toronto long-term disability lawyers handle these types of disability claims:

Our Toronto long-term disability lawyers handle these types of disability claims:

Our Toronto personal injury lawyers

also handle these types of claims:

Our Toronto personal injury lawyers also handle these types of claims:

Verkhovets Law, Toronto long-term disability
lawyers, know how to set the record straight.
Call or email us today.
Verkhovets Law, Toronto long-term disability lawyers, know how to set the record straight. Call or email us today.

Our Toronto long-term disability lawyers know how insurance companies work

Verkhovets Law, Toronto long-term disability lawyers, have seen all the maneuvers LTD insurers use to avoid paying benefits. The main one is that time is on their side. So, they delay, delay, and delay some more. When they do finally agree to pay, most typically provide a monthly benefit at rates of 80%, 70%, or 66% of your net pre-disability income. 

Insurance companies aren’t in any hurry to cut your cheques either. Without Toronto long-term disability lawyers to press your case, delays tend to continue. Delays can sometimes drag on for months (or even years) before you see any money. Insurance companies stall even if you cleared all hurdles.

Here is a mistake that many people make when they don’t hire Toronto long-term disability lawyers: they settle for pennies-on-the-dollar. It plays out like this: if you have not been able to work due to a disability and have exhausted your savings, your inclination might be to accept less than the amount you’re entitled to on the grounds that some money is better than none. Insurance companies know this, too.

The tortoise approach is also in their favour if you sue them. The Ontario civil court system is notoriously slow, so time is in the insurer’s favour because they don’t have to pay while you wait. When our Toronto long-term disability lawyers handle the matter successfully, you could have your benefits reinstated and awarded past denied benefits, damages for stress, some of the legal fees, and punitive damages on top.

Meanwhile, most insurers demand you apply for CPP Disability (CPP-D) after the first two years of LTD payments. They can deduct that amount from the gross of your CPP-D monthly payment. If CPP-D is halted, LTD payments will increase back in full.

Most LTD policies will do the same with any other benefit payments you are receiving including from:

A helping hand from our Toronto
long-term disability lawyers

A helping hand from our Toronto long-term disability lawyers

All experienced car accident lawyers will tell you that, unlike the U.S., there isn’t a personal injury magic fairy in Canada doling out massive cash awards. Nor is there a handy dandy guideline to consult. We’ll figure out what your claim is worth by keeping the upper limit in mind, and knowing the ranges awarded in previous personal injury cases. But there are common elements that come into play: the type of action, negligence factors, and the nature and extent of your damages.

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Contact our Toronto long-term disability lawyers today

Our Toronto long-term disability lawyers know it’s a nightmare scenario – you have an illness or injury and can’t work. But your insurer wrongfully denied your claim, and you don’t understand why.

Contact us now and we’ll start work on your behalf.

Plain English Guide to Long-Term Disability (LTD) in Ontario: 19 questions, answered


Long-term disability (LTD) insurance is a form of financial protection when you lose your income because you cannot work. Instead, you receive monthly insurance payments. But many insurance companies find reasons to deny your LTD claim, which is why you need an LTD lawyer at Verkhovets Law. With monthly insurance payments, you have money to pay bills and maintain a lifestyle similar to what you had while working. LTD payments do not replace 100 per cent of your salary, however.

According to a 2019 Group Long-Term Disability Termination Study published by the Canadian Institute Actuaries, each year 53,000 Canadians get approved for group long-term disability (LTD) benefits. One in six Canadians will be disabled for three months or longer by the age of 60. It is helpful to retain an LTD lawyer at Verkhovets Law who is experienced at handing LTD claims—and dealing with insurance companies.

The reasons for disability may include mental illness (depression, anxiety), chronic medical conditions (chronic pain, fibromyalgia, chronic fatigue syndrome, back pain, etc.) and injuries (car accidents, falls), and many other health conditions.


Long-term disability (LTD) benefits and human rights, employment law


What am I suing for, if I file a lawsuit against my LTD insurer?

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.


I was fired. Can I still file for long-term disability (LTD) benefits?

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.

Is it possible to file a long-term disability (LTD) claim for work-related stress, or burnout?

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).

I didn’t receive full short-term disability (STD) benefits, so do I qualify for LTD benefits?

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.

Do I have to file a new claim if I return to work after receiving LTD benefits and become disabled again?

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.

Independent medical examinations, returning to work after LTD


Is it necessary for me to attend an independent medical examination (IME)?

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.

Is it necessary for me to take part in a gradual return-to-work program? What if it aggravates my symptoms?

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.

What happens to my extended health care benefits if I’m on long-term disability (LTD) or in the middle of a legal battle?

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.

Is it necessary for me to take part in a work-hardening program? What if it aggravates my symptoms?

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.

Terminology used in Long-Term Disability (LTD) insurance policies


What is a “premium waiver”?

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.

In a long-term disability (LTD) claim, what does “totally disabled” mean?

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.

What does “non-evidence maximum” (NEM) mean?

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.

What do you mean by “basic earnings”?

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

What are the differences between “own occupation” and “any occupation”?

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.

What’s covered under Long-Term Disability (LTD) insurance policies, how to file a claim


What does a long-term disability (LTD) insurance policy cover?

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.

How do I apply for a long-term disability (LTD) claim?

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.


Are long-term disability (LTD) insurance benefits payments taxable in Canada?

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.


How does an LTD lawyer at Verkhovets Law get paid when a long-term disability (LTD) claim is approved by the insurance company?

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.

How much does long-term disability (LTD) insurance cost to buy?

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.