Long-Term Disability Claims
When a person finds that they are unable to work, they should submit their disability claim to their carrier without delay. A lot of it is based on dates of denials. It is what is outlined within the policy. Generally, a person has two years from the day of the denial, but that person should be pursuing their denial right away as opposed to waiting until two years because of course things can change.
A person’s medical condition can get worse and that person may want to try to obtain the benefit as soon as possible. It is important to have the assistance of a Toronto long-term disability lawyer who might be able to help their client understand the scope of long-term disability claims in Toronto when beginning their case.
Types of Claims
The most common types of long-term disability claims in Toronto are disability insurance and life insurance. The scope of coverage is based on the ability to do any job, but it also depends on the amount of money that a person can get for insurance. A larger benefit means that that person has to pay higher premiums as a result.
Premiums can range from $25 to $200 a month, as an estimate, but a person would need to speak with a professional who offers these policies.
Unique Aspects of Claims
There are lots of unique aspects of long-term disability claims in Toronto. What is very important for a claimant is that they have the duty to mitigate their damages. When applying for any type of insurance that they may have access to, i.e., Canadian Pension Plan Disability, a person should know the insurance companies often get a credit from the government for accepting that an individual is long-term disabled. If the claim is accepted, the government is going to give them a certain amount of money.
This decreases the amount the insurance company has to pay per month. There are a lot of provisions within these policies requiring people to make certain applications and the lawyer could help the individual claimant with those applications as well. The application also needs to be completed by a physician that has been caring for the person for an extended period of time. It is important that a person finds a lawyer that navigates or has the ability to navigate these sometimes interrelated policies. There is a lot of interplay between government sources and the policies of which a disability lawyer needs to be aware of.
Duty of the Insurance Company
The duty of insurance company is to consistently review all documents that come into their possession. They need to review them and keep an open mind and really try to match the abilities of the individual now versus their capabilities from before their disability set in.
Insurance companies can deny a qualified claim if there is a misrepresentation. They might state that in a person’s application that individual did not note a preexisting injury or that an individual was on benefits before, or they did not disclose that they were involved in a car accident when that individual made their application. A denial can be based on these types of misrepresentations.
Bad Faith Claims
If there is a bad faith claim, if for example, the medicals have not changed and somebody missed something that is imperative, someone can seek a punitive award against the insurance company for purposely denying their claim. A person would probably need to go to trial in that case as proving bad faith is very difficult to do.
For example, in a case where a truck driver gets a leg amputated. Clearly that person cannot drive a truck without a prosthetic if they do not have the training, so the insurer denying that coverage would be something that is considered bad faith.
Pre-Existing Injury Exclusion
If a person has a preexisting medical issue that that person did not disclose to the insurance company, the insurer would have the right to exclude that person from coverage. Policies are granted to new employees based on their medical history.
If an individual misinformed the insurance company, the company may not want to give that person insurance based on the application. If that person forged the application or omitted something they might exclude them based off of that.
Working with a Lawyer
After signing with the lawyer, the next step of dealing with a long-term disability claim in Toronto is to obtain all the medical records from all the treating physicians that the person or the client has seen and then writing a notice letter to obtain the employee’s complete file from the insurance company.
Reviewing those documents will enable the long-term disability lawyer to assess the claim and to carry out a strategy in order for the person to obtain the long-term disability. An attorney will also send a notice letter to the company saying that they have been retained to represent this person based on the denial.