Long-Term Disability Claim Denied? What You Should Know

The courage to come forward

Denied long-term disability benefits? Are you refusing to take no for an answer?  Congratulations.

Fully one third of all people who are cut off LTD benefits don’t even bother with a letter of complaint, let alone start a lawsuit. Insurers know this. So they play the odds and often it works. After all, if you cut off 100 people and if a third of those don’t even complain, just right there you have saved a ton of money. So, again, we commend you for contacting our office. As I see it, we have one job. We seek to level the playing field, we strive to force the insurer and its legal team to take notice of you. And, if we say so ourselves, we are really good at it.\

How long will this take?

This is actually a good news story. Years ago, these claims took years. No more. Insurers have smartened up. Once sued, they see your claim in a new light. Once served with our medical assessments, they often change their minds and negotiate.
They may negotiate informally or through a formal “mediation” involving a third party mediator. We mediate these claims all the time, all throughout the province and have used hundreds of mediators, depending on who we think will get the best result for our particular client.
Please know this: Our firm aggressively moves these files at all times. We don’t put up with stonewalling. We don’t tolerate delays. Your disability benefit is often your grocery money; we remember that at all times.

What kinds of clients do you act for?

We take on long term disability claims of those from all walks of life. We have acted for hundreds of teachers, first responders, factory workers, senior management, heavy equipment operators – you name it. Our claims are also from all around southern Ontario. We have acted for those from North Bay, Collingwood, Port Elgin, Orangeville, Kitchener, Kincardine and all over the GTA. Technology has shortened the distances between ourselves and our client and we travel to you and your courthouse as needed. No issues at all.

What insurance companies have you sued?

We have routinely litigated against all of the big companies and a lot of the smaller ones. Manulife, Sun Life, SSQ, Industrial Alliance, Canada Life, Cooperators – you name it and we have claimed against it. We understand the culture of these companies and how to negotiate against them. Again, we have been in the trenches against them for over 30 years.

What types of disabilities have you seen in your practice?

All kinds. We have acted for a Collingwood truck driver who suffered from permanent nerve damage in his hands, to a factory labourer in Dundalk with herniated discs. Orthopaedic injuries, fibromyalgia, severe post-concussive symptoms – you name it and we have had that disability assessed and described by our medical experts.

We have noticed in recent years a real trend towards mental health disabilities. We call these the invisible impairments and our clients know that that they are as disabling as a broken back. Anxiety, chronic fatigue, panic attacks, clinical depression – these and other conditions have profound effects on your ability to do your job. We work with counsellors, psychologists and others to present as full and fair a picture of your impairment to the insurer as possible. Such treatment helps your case but it also helps your life.

How do I know if a lawsuit makes sense for me?

If you think you can get back to your old job and if your doctor agrees, go for it. If you think you cannot do your old job but maybe can do another one that pays around the same, again, you should go for it. Long term disability claims only makes sense where you honestly don’t think you could be a reliable employee at any job. That is a very hard thing to admit to yourself.

But if you are at that place and if you have medical support, this is exactly why you paid for LTD benefits all those years. You need not feel bad about making the claim and about suing when it is denied. Once we give the green light to your case, we will be with you every step of the way. No fee of any kind unless and until we collect compensation.

What kinds of compensation might I expect?

Good and fair question.

These claims are claims for breach of contract. You have a contract which entitles you to a certain monthly payment and we are suing over that payment. This means that you cannot sue for pain and suffering. Under most policies, you cannot sue for rehabilitation or re-training expenses. Also, you cannot sue for a lump sum of future income losses. This is important to keep in mind.

If the matter goes to trial and if a judge sides with us, the most you can get is payment of past benefits and a declaration that you are entitled to future benefits as of that date. The insurer can turn around and deny you again a year later, and you would begin the entire lawsuit all over again.
Since a court cannot order a lump sum, our goal instead is to obtain such sum by way of settlement: a fair lump sum of money which may not equal all the benefits to which you would be entitled by age 65 (no insurer would pay that), but which would be a sum which would represent payment today of those benefits deep into the future.

In rare cases, the insurer is guilty of “bad faith” conduct and you can sue for “moral” or “punitive” damages. We had one case where the caseworker admitted that she did not understand the disability claimed, where she had the wrong kind of expert assess our client and where, generally, she mishandled the entire file from top to bottom. We got extra compensation for this incompetence or bad faith. It does not happen often, but when it does…