Hamilton Long Term Disability Lawyer

Applying for long-term disability (LTD) benefits in Hamilton can feel like an uphill battle, especially if an insurance company has already denied your claim. A Hamilton long-term disability lawyer can provide the guidance and support you need during this process. If you depend on LTD benefits to replace lost income and keep your household stable, delays or wrongful denials may create serious financial strain.

Preszler Injury Lawyers helps people in Hamilton challenge insurers and pursue the benefits they’re owed under their policies. Reach out to us for a free consultation if you’re struggling with an LTD application or a denied claim.

Key Takeaways About LTD Benefits in Hamilton

• Long-term disability benefits in Canada typically replace 60-70% of your pre-disability income and require medical evidence proving you cannot perform your job duties
• Insurance companies often deny valid LTD claims through aggressive tactics, including surveillance, independent medical examinations, and selective interpretation of policy language
• The definition of disability in your policy changes over time, shifting from “own occupation” to “any occupation” after 24 months in most cases
• You have strict limitation periods to appeal a denial or file a lawsuit, typically two years from the denial date in Ontario
• Legal representation significantly increases your chances of securing benefits, as lawyers understand policy interpretation, medical evidence requirements, and negotiation strategies that maximize settlements

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Since 1959, we’ve helped thousands of Canadians get the compensation they deserve with their long-term disability claims. One of Canada’s oldest personal injury law firms, personal injury law is exclusively what we do. Book a free consultation today with our top-rated personal injury lawyers.

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What Is Long-Term Disability Insurance in Canada?

Long-term disability insurance is a form of income replacement coverage. It’s meant to support people who can’t work for an extended period due to illness or injury. Policies vary, but most require strict proof that your condition prevents you from carrying out the duties of your job.

Some policies are offered through employer packages, while others are purchased individually. LTD insurance differs from other government-based support programs.

Group LTD Insurance Through Your Employer

Many workers in Hamilton receive LTD coverage as part of a workplace benefits package. Employers typically pay part or all of the premiums. Coverage usually continues as long as you remain employed, but once you leave the company, benefits may end unless conversion rights apply.

Individual LTD Policies

Some people purchase individual policies directly from an insurer or through a broker. These policies give more control over coverage terms but often come with higher premiums. They follow you regardless of your employment status.

How LTD Benefits Differ from CPP Disability and WSIB

Other programs provide income replacement, too. They function differently from LTD insurance:

• CPP Disability: A federal program that requires proof of a severe and prolonged disability preventing any substantial gainful work.
• WSIB: Covers workplace injuries in Ontario and pays wage loss benefits only if the condition relates to employment.
• LTD: Broader than WSIB and sometimes easier to qualify for than CPP, though insurers frequently dispute claims.

Who Qualifies for Long-Term Disability Benefits in Hamilton?

Eligibility for LTD benefits depends on policy terms, medical evidence, and how insurers interpret disability definitions.

The Own Occupation Test

For the first 24 months, most policies use the own occupation standard. You qualify if your condition stops you from doing the key duties of your regular job, even if you could work in another field.

The Any Occupation Test

After 24 months, many policies switch to an any occupation test. To keep receiving benefits, you must prove your disability prevents you from working in any job that reasonably fits your training, experience, or education.

Medical Evidence Requirements for Approval

Insurance companies demand strong proof of disability. They often require:

• Doctor’s reports: Records from your treating physician explaining restrictions and limitations.
• Specialist assessments: Opinions from neurologists, psychiatrists, or other professionals when needed.
• Objective test results: Imaging, lab results, or functional assessments supporting your claim.

Pre-Existing Condition Limitations

Policies may exclude benefits if your disability relates to a condition diagnosed or treated within a set period before coverage began. Insurers sometimes use this clause to deny claims even when the disability worsens later.

What Does Long-Term Disability Insurance Cover?

An LTD policy doesn’t just provide monthly payments. It may also include other forms of support.

Monthly Benefit Amounts and Calculation

Most policies replace 60-70% of your pre-disability income. The exact figure depends on your contract, whether benefits are taxable, and whether other benefits like CPP reduce the amount.

Duration of Benefits Coverage

Coverage continues until age 65 in many policies, though some limit payments to two, five, or ten years. Benefits usually end if you return to gainful employment.

Rehabilitation and Return-to-Work Programs

Insurers often encourage gradual return-to-work programs. These might include vocational training, physical therapy, or part-time duties designed to help you transition back into the workforce.

Cost of Living Adjustments

Some policies include annual adjustments to keep pace with inflation. This protection helps preserve the value of your benefits over time.

Why Do Insurance Companies Deny LTD Claims?

Even strong claims may be denied. Insurers often protect their financial interests at the expense of policyholders.

Insufficient Medical Evidence

Insurers sometimes argue that medical records don’t prove disability. They may claim your symptoms are “subjective” or not supported by test results.

Surveillance and Social Media Monitoring

Insurance companies hire investigators who record claimants in public places such as Gore Park or watch for social media posts. A short video clip or photo may be misinterpreted as evidence that you’re not disabled.

Independent Medical Examinations (IMEs)

Insurers may require you to attend an IME with a doctor they choose. These doctors often minimize conditions and recommend claim termination.

Policy Exclusions and Limitations

Policies contain exclusions for self-reported conditions, substance use, or certain mental health diagnoses. Insurers frequently rely on these clauses to deny payment.

Late Filing or Missed Deadlines

If you don’t submit forms or medical evidence within set time limits, insurers may deny your claim regardless of its validity.

How Do I Appeal a Long-Term Disability Denial in Ontario?

Denied LTD claims aren’t the end of the road. You have options to challenge the insurer’s decision.

Understanding Your Insurer’s Internal Appeal Process

Insurers often require one or more internal appeals before you can file a lawsuit. These appeals involve submitting additional documentation for the insurer’s review.

Gathering Additional Medical Documentation

During the appeal, you may need updated reports from doctors, specialist opinions, or functional assessments. The more comprehensive the medical evidence, the stronger your case may be.

The Role of Functional Capacity Evaluations

These evaluations measure physical and cognitive ability through structured testing. They provide objective data that may counter the insurer’s claim that you can return to work.

Limitation Periods for Legal Action in Ontario

Ontario law gives you two years from the date of denial to sue the insurer for acting wrongfully. Missing this deadline can permanently prevent you from pursuing a claim.

The Role of Contract Law in LTD Disputes

Your policy is a contract. Courts interpret ambiguous terms in favour of the insured, but insurers often dispute wording until a judge rules.

Court Remedies Available to Canadian Claimants

If you succeed in court, you may recover retroactive benefits, interest, and legal costs. Courts in Canada don’t typically award punitive damages unless insurer conduct is especially harsh.

Can I Work While Receiving Long-Term Disability Benefits?

Some people wonder if they can try working without losing benefits. Policies allow this in limited ways.

Partial Disability and Residual Benefits

If you can work part-time but not full-time, your policy may provide partial benefits. Payments usually decrease based on your income.

How Income Affects Your LTD Payments

Policies offset benefits by the amount you earn. For example, if your benefit is $2,000 per month and you earn $800 from part-time work, the insurer may reduce your payment to $1,200.

Reporting Requirements to Your Insurer

Most policies require you to report any work attempt or income. Failing to disclose earnings could result in termination of benefits.

How Long Does It Take to Resolve an LTD Claim?

Timelines vary depending on how insurers handle your case.

Timeline for Initial Claims

Initial claims may take several months to process. Delays occur if insurers request additional records or assessments.

Appeal and Litigation Timeframes

Appeals may take months to a year. If a lawsuit becomes necessary, resolution may take several years, depending on court scheduling.

Factors That Impact Resolution Speed

Factors include insurer cooperation, how quickly medical providers supply records, and whether settlement negotiations progress.

How Our Hamilton Long-Term Disability Lawyers Can Help

Our Hamilton long-term disability lawyers support clients who need LTD benefits. We understand how insurers operate and work to hold them accountable.

Reviewing Your Policy and Assessing Your Claim

Every disability policy is written differently. Even small variations in wording can affect whether your claim qualifies. Our lawyers review your entire contract, including definitions, exclusions, and deadlines. We explain what your policy covers, where potential challenges might arise, and what documentation will help address insurer pushback. A clear understanding of your coverage is the foundation for building a strong case.

Gathering and Organizing Medical Evidence

Medical evidence often determines whether an insurer approves or denies benefits. We work with your treating physicians and specialists to obtain detailed records, test results, and professional opinions that show why you cannot perform your work duties. We also organize this information into a clear package that highlights the extent of your limitations, so the insurer cannot easily dismiss or misinterpret your condition.

Negotiating with Insurance Companies

Insurers frequently deny or delay claims in hopes that people will give up. We step into that role on your behalf, handling all communication and negotiations. By presenting medical evidence, policy language, and legal arguments in a persuasive way, we push back against tactics such as surveillance footage or selective interpretation of records. Our goal is to create pressure on insurers to resolve your claim fairly and promptly.

Representing You in Litigation

If an insurer refuses to pay despite strong evidence, court action may become necessary. Our lawyers prepare your case from the start with litigation in mind, so we’re ready to move forward if needed. We represent you through every stage of the process, from filing a claim in court to presenting evidence before a judge. Taking a case to court often leads insurers to reconsider their position and enter meaningful settlement discussions.

Maximizing Your Settlement or Award

A successful LTD claim isn’t just about getting monthly payments reinstated. Many cases resolve through settlements that provide lump-sum compensation for past and future benefits. We evaluate settlement offers carefully to ensure they reflect the financial impact of your disability, including lost wages and long-term needs. While outcomes can never be guaranteed, our role is to fight for results that provide security and peace of mind.

Frequently Asked Questions About LTD Claims in Hamilton

Why do I need a lawyer to file an LTD claim?

Insurers often delay or deny benefits. A lawyer increases your chance of success by strengthening your evidence and holding insurers accountable. A lawyer can file all the paperwork completely and on time, reducing delays. They can also advocate for you throughout the process to help you obtain the full benefits you need.

How much does a long-term disability lawyer cost in Hamilton?

Most LTD lawyers work on a contingency fee basis, meaning they only charge if your case resolves in your favour. Fees are explained upfront in a written agreement.

Can my insurer cut off my benefits if I’m approved?

Yes, insurers regularly review ongoing claims. They may cut benefits if they believe your condition has improved, if you miss medical appointments, or if they claim you can perform another job.

What happens if I’m denied both LTD and CPP Disability?

You may appeal both decisions separately. LTD and CPP have different standards, so being denied one doesn’t automatically mean the other will fail.

How does a settlement affect my future benefits?

Settlements usually close your LTD claim entirely. You receive a lump sum in place of ongoing monthly benefits. This decision requires careful consideration.

Contact Our LTD Benefits Lawyers in Hamilton Now

Time limits apply to LTD claims. Waiting too long may close off your legal options. If you live in Hamilton and your disability stops you from working, don’t let an insurer delay or deny your benefits without challenge. Call Preszler Injury Lawyers at (888) 608-2111 or contact us online for a free case evaluation.

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LONG-TERM DISABILITY BENEFITS DENIED OR CUT-OFF IN HAMILTON?