Ontario Personal Injury Lawyers
Call 1-888-404-5167
Preszler Injury Lawyers

Recovering LTD Benefits for Invisible Injuries and Illnesses


Certain medical conditions may not be accompanied by observable physical symptoms. Instead, the severity of the condition will be a subjective experience, entirely unique to the person afflicted by it and impossible to gauge using objective medical evidence. Although these conditions cannot be easily observed or objectively quantified, they could substantially impact a person’s ability to perform routine activities and may even prevent them from working.

When so-called “invisible” injuries, illnesses, or other unobservable medical conditions prevent someone from performing the duties of their job, provided they have the proper insurance coverage, this person may be able to recover long-term disability (LTD) benefits. LTD benefits are designed to supplement an insurance policyholder’s income when their medical condition makes it impossible for them to work for a substantial period of time. Typically in Canada, LTD plans usually replace between 60-70% of a recipient’s regular wages.

Although each insurance policy has different eligibility requirements for LTD benefits, generally speaking, in order to qualify for them, policyholders must be able to prove that they are currently receiving ongoing medical treatment and have been receiving treatment for a significant period of time. They must also be able to illustrate how their condition prevents them from performing the duties of their occupation. Additionally, to qualify, they generally must have already used up all other options for compensation available to them. These compensatory options may include paid sick leave, vacation time, Employment Insurance (EI) benefits, and short-term disability benefits.

After eligible policyholders submit an application for LTD benefits, it is up to their insurance provider to decide whether or not the claimant’s medical condition entitles them to collect benefits. The insurance company will use the supporting medical evidence provided by the applicant in order to make their determination.

Many claims for LTD benefits are denied, even when the applicant provides their insurer with quantifiable proof of their medical condition’s affect on their ability to work. It is even more difficult to successfully convince insurance providers to provide policyholders with the compensation they’re entitled to when the symptoms of their condition are “invisible.”

Invisible medical conditions may manifest themselves through unmeasurable pains, experienced both physically and mentally. Some examples of invisible medical conditions may include:

  • Whiplash
  • Soft tissue injuries
  • Arthritis
  • Chronic pain
  • Fibromyalgia
  • Traumatic brain injuries (TBI)
  • Depression
  • Post-Traumatic Stress Disorder (PTSD)
  • And more

Since the experience of internal pain and/or mental anguish is subjective, a policyholder’s claim that their condition prevents them from working can easily be dismissed by their insurance provider as false or embellished.

If you suffer from a medical condition that prevents you from performing your job, but your insurance provider unfairly denied your claim for LTD benefits, an Ontario long-term disability lawyer may be able to help recover the compensation you’re rightfully owed.

Talk With Our Legal Team



If you have any questions and would like to schedule a call with our legal team for a FREE no-obligation consultation, contact us now. During this call you can ask any questions as it relates to your accident and/or claim and we'll discuss your options and possible outcomes.

Regardless of where you're located in Ontario – we may be able to help you. Don't delay - call us. Our lines are open 24/7.

How to File a Long-Term Disability Claim for Invisible Injuries

Many people qualify for LTD coverage through their employer’s group insurance plan, or through a privately held insurance policy that they pay into individually. If you have the appropriate level of insurance coverage and have sustained an injury or developed a chronic physical or mental illness that prevents you from returning to work, you may be eligible to submit an application for LTD benefits.

If the symptoms of your medical condition cannot be quantified through traditional evidence, such as diagnostic examinations or medical imaging, it is important to compile as thorough an application as possible to substantiate your claim.

Your application for LTD benefits may be subject to certain deadlines or time limits. If you have questions about the limitations your application may be subject to, or whether or not your condition qualifies you to collect benefits, consulting with a lawyer before completing your application may provide you with beneficial advice.

After consulting with a lawyer, in order to apply for LTD benefits, you must:

  • Obtain a claim form from your employer or private insurance provider.
  • Compile all medical records and supporting documents from your health care providers.
  • Obtain a medical certificate from your health care provider in support of your application.
  • Complete all required application forms (additional information from your health care providers and employer may be required).
  • Submit the completed application to your insurance provider.

Your application for LTD benefits should also include evidence proving that you have a disabling medical condition, and that you have been receiving ongoing treatment for it. This may be difficult to do if the symptoms of your condition are not easily observed through traditional medical examinations. Nevertheless, it is important to compile as much medical proof of your condition as possible, including:

  • Medical records
  • Results of medical examinations
  • Statements from your attending physicians
  • A detailed description of your job duties
  • A statement from your plan sponsor (i.e. your employer)
  • Other documentation proving that your medical condition prevents you from performing the duties of your job
Call 1-888-608-2111 for available options or Book a Consultation

What Percentage of LTD Claims Are Denied?

Even after presenting a thorough portfolio of evidence, including testimonies from medical experts, insurance companies often deny claims for LTD benefits to people suffering invisible injuries or illnesses.

Insurance companies are not required to share statistical information about how many LTD claims they deny each year, but by looking at information regarding the Canada Pension Plan (CPP) disability benefits, it can be assumed that most Canadian insurance claims for LTD in Canada are not approved. This determination is based on both anecdotal evidence and the fact that approximately 60% of claims for CPP disability benefits are denied.

Oftentimes, it can be difficult to understand why an insurance company would deny an application for benefits, especially if the claimant was able to supply ample evidence supporting their claim.

If your claim for LTD benefits was denied even though your condition should entitle you to compensation, an Ontario lawyer may be able to review your policy and advise you of legal options that may be available.

How a Lawyer May Be Able to Help Appeal a Denied Long-Term Disability Claim

When patients suffering from invisible injuries or illnesses submit claims for LTD benefits, their insurance providers often cite insufficient medical proof as the primary reason for denying their applications. In these situations, a lawyer may help their client compile additional evidence proving their condition’s severity and its impact on their ability to work. Doing so may help overturn the insurance provider’s initial decision. There is a limited window of opportunity in which denied benefits applicants are eligible to file an internal appeal, and so getting in touch with a lawyer immediately could be crucial.

That said, once the internal appeals process begins, it can take a long time for the insurance company to review the newly submitted medical evidence. More often than not, people who are unable to earn a paycheck because they are suffering from chronic medical conditions likely do not have the luxury of time. Plus, even after filing an internal appeal and providing additional medical evidence, the insurance company may still decide to deny an applicant’s claim for LTD benefits.

For that reason, a long-term disability lawyer may advise you to file a lawsuit against your insurance provider for unfairly denying your benefits claim. If the lawsuit is resolved in your favour, you may be awarded payments for:

  • Previously denied benefits payments
  • Legal fees
  • Damages for mental stress experienced
  • Punitive damages
  • And possibly more

Call Preszler Injury Lawyers Today

If a medical condition prevents you from earning a living, even though the symptoms of that condition may not be observable to other people, you may still qualify for LTD benefits. If your claim for LTD benefits has been unfairly denied, a long-term disability lawyer may be able to appeal or litigate the insurance company’s decision on your behalf.

To discuss the details of your claim in a free, initial consultation, contact Preszler Injury Lawyers today or call us at 1-800-JUSTICE.

related videos


 

Disabilities That May Warrant Disability Claims
 

Filing a Disability Claim
 

What to do If Denied Disability Benefits
 
Call us now at
1-800-JUSTICE
®

151 Eglinton Ave W,
Toronto, ON
M4R 1A6
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
4145 N Service Rd
Burlington, ON
L7L 4X6
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
2 County Ct Blvd #400,
Brampton, ON
L6W 3W8
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
105 Consumers Drive
Whitby, ON
L1N 1C4
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
92 Caplan Ave #121,
Barrie, ON
L4N 0Z7
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
380 Wellington St Tower B, 6th Floor,
London, ON
N6A 5B5
Toll Free: 1-888-608-2111
2233 Argentia Rd Suite 302,
East Tower Mississauga, ON
L5N 6A6
Toll Free: 1-888-608-2111
1 Hunter St E,
Hamilton, ON
L8N 3W1
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
459 George St N,
Peterborough, ON
K9H 3R9
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
22 Frederick Street,
Suite 700
Kitchener, ON N2H 6M6
Fax: 1-855-364-7027
Toll Free: 1-888-608-2111
116 Lisgar Street, Suite 300
Ottawa ON
K2P 0C2
Toll Free: 1-888-608-2111
10 Milner Business Ct #300,
Scarborough, ON
M1B 3C6
Toll Free: 1-888-608-2111
*consultation offices

DISCLAIMER: Please be advised that the header image and other images throughout this website may include both lawyer and non-lawyer/paralegal employees of Preszler Injury Lawyers and DPJP Professional Corporation and unrelated third parties. Our spokesperson John Fraser, or any other non-lawyer/paralegals in our marketing is not to be construed in any way as misleading to the public. Our marketing efforts are not intended to suggest qualitative superiority to other lawyers, paralegals or law firms in any way. Any questions regarding the usage of non-lawyers in our legal marketing or otherwise can be directed to our management team. Please also note that past results are not indicative of future results and that each case is unique and that case results listed on site are from experiences across Canada and are not specific to any province. Please be advised that some of the content on this website may be out of date. None of the content is intended to act as legal advice as each situation is independent and unique and requires individual legal advice from a licensed lawyer or paralegal. For legal advice on your individual situation – we can provide legal guidance after you have contacted our firm and we have established a lawyer-client relationship contractually. Maximum contingency fee charged is 33%. Finally, our usage of awards and logos for awards does not suggest qualitative superiority to other lawyers, paralegals or law firms. All awards received from third party organizations have been done so through their own reasonable evaluative process and do not include any payment for these awards except for the use of the award logos for our marketing assets. We are also proud to service additional provinces like Alberta, British Columbia and Nova Scotia.