Long Term Disability Lawyer Toronto
Through no fault of their own, countless Ontarians develop medical conditions or sustain severe injuries that make it impossible for them to carry out the tasks associated with their jobs. In these unfortunate circumstances, injured or ill Ontarians who can no longer perform the duties of their chosen occupation may find themselves worrying about how they will be able to continue earning a living wage.
If you have sustained a long-term disability and are unable to continue working in your current occupation, you may be entitled to long-term disability (LTD) benefits. This insurance coverage could provide you with monthly income replacement payments to help you stay financially secure during a difficult time.
What is Long-Term Disability?
Certain physical and mental conditions can make it impossible for people to carry out the tasks of their jobs. Chronic illnesses, physical injuries, and mental disorders can prevent people from returning to work for a prolonged period of time. These various maladies could be so severe that injured or ill individuals are no longer able to work in any occupational field.
If the symptoms of these disabling medical conditions persist for a prolonged period of time, forcing an insured individual to exhaust all benefits available to them – including short-term disability and employment insurance (EI) – they may be able to collect LTD benefits from their insurance company.
Understanding Long-Term Disability
Different insurance policies provide different levels of coverage. They also have different definitions of what constitutes a disabling medical condition. Before submitting a claim for disability benefits, it might be advisable to review your insurance plan’s eligibility requirements to make sure your medical condition could qualify you to receive disability benefits.
Definition and Eligibility
Each insurance policy is subject to its own terms and conditions, but generally speaking, the definition of “disability” is determined by the impact a physical or mental injury or illness has on an insured individual’s ability to work. The definition often changes after a certain amount of time has elapsed.
Most insurance policies that offer long-term disability benefits consider a “disability” to be any medical condition that prevents the insured person from completing the tasks associated with their own occupation. If a policyholder is unable to return to their own job because of a disabling injury or illness, they might meet their insurance plan’s definition of “disability” and, therefore, qualify for disability benefits.
In most instances, however, this definition is adjusted after two years of receiving LTD benefits, when stricter guidelines are imposed on the policyholder. At this time, the definition of “disability” changes. After this limitation period, a recipient of LTD benefits must be able to prove that their disabling medical condition makes it impossible for them to engage in any occupation in order to continue qualifying for disability benefits.
Generally speaking, qualifying medical conditions are not limited to physical injuries or illnesses. Mental health plays an important role in the workplace. People experiencing severe mental health issues may find it impossible to continue carrying out the duties of their job. In fact, 30% of disability claims nationwide are attributed to mental health conditions.
Although eligibility requirements for LTD benefits vary between policies, conditions that may entitle an insurance policyholder to receive them often include:
- Heart disease
- Back problems
- Chronic pain or complex regional pain syndrome (CRPS)
- Lupus or Lyme disease
- Psoriatic arthritis or fibromyalgia
- Bipolar mood disorder
- Post-traumatic stress disorder (PTSD)
- And possibly more
Toronto Long-Term Disability Benefits
Depending on the coverage available to them through their insurance plan, people whose newly acquired medical conditions prevent them from working may be eligible to collect disability benefits. LTD benefits are designed to help workers manage their monthly expenses when their physical injuries, chronic illnesses, and/or disabling mental health conditions prevent them from returning to work.
Long-term disability benefits could be available through an employer’s group insurance plan or through a privately held insurance policy, provided the respective plans include an appropriate level of coverage. Most LTD plans provide recipients with between 60-70% of their regular wages.
Although LTD benefits do not replace a recipient’s total regular salary, they often provide injured or ill workers with much-needed financial assistance during an extraordinarily difficult time in their lives. However, for a number of reasons, insurance providers may decide to deny a policyholder’s claim for LTD benefits. Furthermore, even those workers who initially qualified for LTD benefits may have their income replacement payments prematurely terminated, even though their medical conditions still prevent them from doing their jobs.
Insurance policyholders or their employers pay monthly premiums to insurance companies so that, should they be unexpectedly waylaid by a severe medical condition that prevents them from working, they will be able to collect the benefits payments they are rightfully owed. The terms and conditions of insurance policies can be confusing, but generally speaking, if your plan includes LTD benefits coverage and your medical condition makes it impossible for you to do your work, you should be entitled to the coverage for which you have paid.
Common Challenges in Obtaining Benefits
Unfortunately, it is not always easy for qualifying policyholders to obtain the coverage to which they should be entitled. Insurance companies often look for reasons to withhold payments from disability claimants, even if their medical conditions make it impossible for them to continue performing the duties of their jobs.
Even after submitting thorough evidence proving the severity of their medical condition and the preventative impact it has on their ability to work, an insurance provider may decide to deny a person’s disability claim. In these disheartening and frightening scenarios, a disabled individual whose LTD benefits claim has been denied may face legitimate anxieties about continuing to support themselves and their families in the face of financial insecurity.
Denials and Delays
Insurance companies can deny LTD claims for a number of reasons, all of which can be frustrating to try and comprehend.
Some policies may have specific exclusions for certain medical conditions. Insurance companies may deny disability claims related to medical conditions excluded from their coverage.
Often, insurance companies try asserting that a claimant’s medical condition does not fit their definition of disability. Since most insurance plans update their definition of “disability” after a two-year period and, in doing so, impose stricter eligibility criteria on disabled policyholders, people who had been receiving LTD benefits may find their monthly payments suddenly terminated. In many scenarios, insurance companies decide to cut off recipients’ benefits even when their disabilities continue to make it impossible for the claimant to return to work.
Providers may suggest that the applicant’s current medical complaint was caused by a pre-existing condition and, therefore, should not qualify them to receive LTD coverage. A pre-existing condition generally refers to a medical condition that the insured person was diagnosed with, received treatment for, or had symptoms of before the date their insurance policy took effect.
After most insurance policies go into effect, there is often a waiting period (or, “exclusion period”). The purpose of this exclusion period is to prevent individuals from purchasing insurance only after they know they need it. Disability claims submitted for pre-existing conditions during this exclusion period will almost always be denied. However, if a person maintains continuous coverage with the same insurance provider for a certain length of time, the exclusion period for pre-existing conditions may be satisfied and the disabled policyholder should be entitled to benefits.
In some cases, insurers even base their determinations on the material shared by benefits claimants on social media. Status updates, pictures, videos, inspirational quotes, and other social media posts can be misconstrued or taken out of context to be used against the benefits claimant.
Insufficient Medical Evidence
One of the most common reasons for a disability claim’s denial is insufficient evidence.
In order to apply for LTD benefits, claimants must include supplementary evidence along with their application to prove to their insurance provider that their medical diagnosis does, in fact, make it impossible for them to continue carrying out the duties of their jobs. Therefore, it is prudent for claimants to submit the following types of evidence along with their applications for LTD benefits:
- Medical records
- Results of medical examinations
- Statements from attending physicians
- A detailed description of job duties
- A statement from plan sponsor (i.e. employer)
- Other documentation
However, not all long-term disability benefits claimants have access to evidence that might satisfy their insurance provider. Claimants suffering from so-called invisible injuries are often denied their benefits due to a lack of objective, observable evidence.
Whereas certain disabling conditions can be easily substantiated through scientific testing and medical imaging (such as X-rays, CT scans, and MRIs), others cannot be quantified objectively. Instead, the severity of these injuries is subjective. The symptoms of these so-called invisible injuries are entirely unique to the person afflicted by them. As a result, they are impossible to gauge using objective medical evidence.
That is why so many disability claims related to mental health conditions are denied. Without objective, quantifiable evidence of the applicant’s disability, insurance providers often summarily deny these claims for LTD benefits by citing insufficient evidence.
Mental health conditions are not the only disabling medical conditions that might lack objective evidence to substantiate an applicant’s claim. Other examples of subjective medical conditions that could make it impossible for a person to continue working include:
- Chronic pain
- Soft tissue injuries
- Complex Regional Pain Syndrome (CRPS)
- Chronic Fatigue Syndrome (CFS)
- And more
Just because a medical condition cannot be easily observed through traditional medical testing does not mean a person suffering from that condition should be denied LTD benefits if they are unable to work as a result. By appealing an insurer’s unfair determination, a denied claimant may be able to overturn the initial decision and recover the benefits they are rightfully owed.
However, doing so without assistance from a long-term disability lawyer can feel like an insurmountable challenge.
Legal Framework in Toronto
Even if a claimant has submitted thorough medical evidence proving the severity of their condition and the impact it has on their ability to perform the duties of their jobs, they often find themselves facing denied LTD claims. In these all-too-common situations, legitimately disabled insurance policyholders often find themselves wracked with anxiety over their ability to continue supporting themselves and their loved ones.
For many severely injured or seriously ill citizens, collecting LTD benefits is the only option available to them. Once denied, they could find themselves struggling to make ends meet.
Receiving a denied claim for LTD benefits can be more than demoralizing. For those with extremely limited options, the inability to collect disability may make their situation feel hopeless.
However, by working with our long-term disability serving Toronto, unfairly treated policyholders may be able to fight their insurance provider’s decision to withhold the benefits they are rightfully owed. Our Toronto long-term disability lawyers are familiar with the unfair tactics often used by insurance companies to deny, delay, or prematurely terminated LTD benefits payments and leverage this experience to help deserving members of the community get the coverage to which they should be entitled.
The Role of a Long-Term Disability Lawyer
In Toronto, a long-term disability lawyer can play a crucial role in helping people who are facing challenges in obtaining or maintaining their LTD benefits. Depending on the symptoms of their injuries and other personal obligations, the process of appealing a denied disability claim may feel like an impossibility for a disabled insurance policyholder. That is why our long-term disability lawyers serving Toronto handle all aspects of our clients’ claims on their behalf, standing up for their rights and fighting for their best interests when they are unable to do so.
The terms and conditions of insurance policies are often written in language that can be difficult to understand. If you are unsure of whether your medical condition should qualify you to receive LTD benefits, our Toronto long-term disability lawyers may be able to review your insurance plan and advise whether you might be eligible to submit a claim.
If your claim for LTD benefits has been denied or if your monthly payments have been prematurely terminated, you should receive written notice as to the reasoning behind this decision from your insurance company. By contacting our long-term disability lawyers serving Toronto to take advantage of a free consultation, you may be able to gain some clarity as to why your claim was denied.
Our Toronto long-term disability lawyers should then be able to evaluate your case and discuss options for legal actions that may be available to you. If you are able to do so, our disability lawyers may be able to help you begin the process of appealing your insurer’s unfair decision.
Negotiating with Insurance Companies
Our Toronto long-term disability lawyers have a history of standing up to unfair insurers and fighting on behalf of the clients we represent. By building and presenting your case and engaging in negotiations with your insurance provider, our long-term disability lawyers may be able to help you get the LTD benefits you deserve.
If your claim for benefits was denied and the payments you should be entitled to were withheld, our long-term disability lawyers serving Toronto may be able to help you appeal their decision. Doing so can be a lengthy process, but our Ontario long-term disability lawyers are committed to standing up for our clients’ rights throughout all stages of mediation and litigation, if necessary.
Beginning a legal battle against an insurance company may seem like an impossible task. However, if successful, our Toronto long-term disability lawyers may be able to help you recover compensation for:
- Previously denied benefits payments
- Legal fees
- Damages you have incurred as a result of your claim’s initial denial
- Punitive damages
- And possibly more
Our Legal Process
The idea of pursuing legal action against a large insurance company may seem like a difficult – and expensive – process. We appreciate that most LTD benefits claimants rely on their insurance coverage because they are unable to continue earning the wages to which they had become accustomed. That is why our Toronto long-term disability lawyers strive to remove financial barriers to accessing our legal services.
Our disability lawyers in Toronto work on a contingency-fee basis. That means you are not required to pay for our legal services unless we win your case. There are no upfront costs and no hidden fees.
To learn more about how Preszler Injury Lawyers may be able to assist you, schedule a free consultation with our long-term disability lawyers serving all of Ontario by contacting us today.
In addition to working on a contingency-fee basis, our Toronto long-term disability lawyers offer all prospective clients a free initial consultation. If you are unsure of whether you may be eligible to appeal your insurer’s decision, you can still take advantage of personalized, case-specific legal advice by contacting Preszler Injury Lawyers.
During your free initial consultation, you can review the circumstances of your claim’s denial and learn about options for legal actions you might be entitled to pursue. There is no cost associated with this initial consultation and no obligation to continue working with our personal injury lawyers afterward.
To receive your cost-free, no-obligation initial consultation with our disability lawyers in Toronto, contact us today.