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This is not the end. If you’ve been denied or cut off your long-term disability benefits you still have the right to talk to an attorney and pursue legal action to get the denial overturned.

If you’ve been denied long term disability benefits anywhere in Ontario, our Hamilton disability lawyers can help. We serve disability claimants from anywhere in Ontario and in fact, all over Canada. We understand that being denied long-term disability benefits can send a claimant and his or her family rocketing into debt – and put into an aggravating position that causes finanical distress.  If you or a family member has had your disability benefits denied call us today. Hamilton Disability lawyer Matt Lalande has specialized in litigating disability cases for claimants province-wide since 2003 and has represented disability claimants against every major disability insurance company throughout the Province. Our firm uses the top orthopedic surgeons, pain doctors, psychiatrists, psychologists and vocational experts to prove your case and spares no expense or effort until we bring your case to conclusions. Unlike those who dabble, we specialize.

If I have been denied, do I have a right to my own lawyer to help me?

Absolutely, you have the right to retain your own lawyer to appeal your denied long-term disability benefits. Since 2003, our Hamilton disability lawyers have been representing long-term disability claimants who have been wrongfully denied their long term disability benefits. You have the right to hire your own disability lawyer who, with the help of clinicians and vocational specialists, will fight to recover the benefits that you deserve.

Understanding Long Term Disability Insurance

Typically disability policies are purchased by an individual or be part of a group employment package that is negotiated between employer and broker. Premiums are paid in one of three ways, by the policyholder individually, the employer solely or the employer and employee.

What is the qualifying period?

There is usually a qualifying or elimination period, which can range from 90 to 180 days, during which no benefits are paid but the person may cover their lost wages by drawing on an STD policy, EI or government sickness benefits, which may provide an additional 15 weeks of sick benefits. STD policies are sometimes paid for by your employer and cover income replacement for the first 120 days of injury or illness. For more information on qualifying periods, contact our Hamilton Disability Lawyers today.

When does long-term disability end?

A long-term disability policy generally pays a portion of your usual salary or income as a monthly benefit until you either are able to return to work,  youno longer meet the definition of being disabled or reach retirement age (age 65), so long as you continue to meet the policy requirements.  Some policies only pay for a defined period (such as 5, 10 or 15 years). Other policies cover the person for life.

How do I qualify for long-term disability benefits?

The claimant has the responsibility to prove on a balance of probabilities that he or she qualifies for the disability benefits. In order to qualify for long-term disability benefits, a disability policy usually requires that a claimant be totally disabled from their own occupation (known as the “own” occupation test). This test usually applies during the first 24 months of disability payments. Thereafter, the policy usually stipulates that payments are only made to the claimant if they are totally disabled from performing any occupation within their training, education or background (known as the “any” occupation test). It is out Hamilton disability lawyer that can assist in helping you discharge your onus

Have you been denied or cut-off your long-term disability benefits?

Whether you paid premiums on an individual policy or you are provided long-term disability benefits through your employer’s group policy, you should be able to count on your disability carrier to help support you financially if you are unable to work due to a chronic illness or injury.  There is no two ways about this.

Despite this, long-term disability insurance companies routinely deny disability benefits for many different reasons, such as

  •  the claimant not providing enough medical evidence
  •  the claimant not following a proper treatment plan or their doctor’s advice
  •  you waited too long to apply for disability benefits and now you’re out of time
  •  your medical records do not describe your condition very well
  •  your medical records are not updated or the insurance company does not have a full clinical file
  • your doctor may not support your disability
  •  the claimant does not properly cooperating with the insurance company and the requests

Often times however, long-term disability insurance companies wrongfully deny the claimant’s disability benefits even with a proper investigation. It is not uncommon for insurance company adjusters simply deny a claimant because they “feel” that the claimant is not disabled, or they deny claimants based on their own personal judgment – and not based on a proper medical review or understanding of medical records or of the claimant’s medical condition. Other times, benefits are denied based on the fact that an insurance company doctor did a paper review and simply felt that the claimant was not disabled.

Obtaining long-term disability benefits is often a lengthy and complicated process. You certainly have the right to your own legal representation after your benefits have been formally denied. Our Hamilton disability lawyers represent claimants all over the province, and in fact, have represented claimants throughout Canada. If you been denied your long-term disability benefits it’s important that you contact the disability lawyer sooner rather than later.

What is the “own occupation” provision in a disability policy?

For the first 24 months, the definition of total disability generally means that you are unable to work or, more specifically, unable to carry out the substantial duties f the individual?s usual job.

After 24 months there is typically a “Change of Definition” – meaning the test for total disability changes from your own occupation to any occupation. This change of definition requires you to be disabled from performing any occupation for which you are reasonably suited by reason of education, training or experience.

What is the “any occupation” provision in a disability policy?

After receiving long-term disability benefits for 24 months, the claimant normally must demonstrate that he or she is disabled from any occupation within their training, education or background (“any” occupation test). In order to determine whether a new job is within the claimant’s training, education or background, we must look at reasonably comparable alternatives to the pre-disability employment. The alternative work must be reasonably comparable to his or her former job in terms of status and reward.

Has your disability insurance company denied or cut-off your long term disability benefits?

There are a variety of reasons why an LTD claim may be denied or terminated:

  • Insufficient investigation on the part of the insurer.
  • Lack of forms and necessary documentation.
  • Biased Insurance Company Doctor Medical Opinion.
  • Employer did not provide the proper documentation.
  • Missed time limit for submitting claim.
  • Failure to participate in treatment regimen.
  • Misrepresentations on claims forms
  • Not mentioning pre-existing conditions
  • Failure to have the injury or condition properly documented by the client’s doctors
  • Surveillance evidence contradicting the client’s claimed level of disability

If you have been denied long-term disability benefits we can help. We have successfully represented disability claimants who have suffered;

  • serious injuries, fractures and bone breaks
  • brain injuries
  • breast cancer
  • cancer in general
  • schizophrenia
  • schizo-affective disorder
  • bipolar disorder
  • mental illness
  • depression
  • anxiety
  • chronic pain
  • chron’s disease
  • rheumatoid arthritis
  • meniere’s disease
  • severe nerve pain, disc bulges and sciatica
  • ptsd
  • complex regional pain syndrome
  • stroke
  • cardiomyopathy
Sometimes you can resolve the LTD claim for a reasonable amount without resorting to litigation – and we try out best to do this.  Typically, when a claim is denied, most policies provide for a right of appeal by submitting a written request for appeal within a certain amount of time, usually within 60 days. The insurer will then review the appeal and provide a decision by letter. If this decision fails, then you may commence an action against your LTD insurer for payment of past benefits and seek a declaration form a Judge that you are disabled and that your disability benefits should be reinstated.

How have Judges determined the meaning of “any occupation” in the long-term disability policy context?

Firstly, it’s important to understand that law is clear that the onus is on you, as the claimant, to prove your are eligible for disability benefits by establishing on a balance of probabilities under both definitions of total disability (“own” occupation and “any occupation”) – which is something that we as your disability lawyers will take charge of.

In addition, when determining whether a claimant suffers a total disability under the “any occupation” definition of total disability, the courts have clearly stated that the test is subjective in the sense that your background and personal characteristics are taken into consideration. The subjective nature of the test of the “any occupation” definition of disability was considered in a case called Plouffe v. Mutual Life Assurance Co. of Canada in BC, where the Judge held that the “any” occupation test was subjective and related to the background and education of the disabled person. On appeal, the Court held that the trial Judge erred in rejecting medical evidence of expert doctors finding that the insured was not disabled from engaging in sales work, and in imposing an onus on the insurer to show that an occupation existed that the plaintiff was able to perform; however, the subjective nature of the test was not questioned.

If I can Perform Some Work Functions – am I still disabled from “Any” Occupation?

The law is clear that a claimant will not be disentitled to benefits under the “any” occupation category because he or she can perform some work functions.

A prime example of this is taken from a well known case called Liesch v. Standard Life Assurance. In this case, the disability claimant was severely depressed and suffered from an adjustment MATT LALANDE DISABILITY LAWYERdisorder. The disability insurer denied his long-term disability benefits because he had not discharged the onus of showing that he was disabled from his own occupation or from any occupation. The insured sued Standard Life and asked a Judge to declare that he was disabled within the meaning of his long-term disability policy. The Judge found that the insured was severely depressed and suffered from an adjustment disorder. The insured’s job as regional sales manager was particularly demanding. Despite the fact he might have been able to manage one or two functions of his regular employment sporadically, this was not sufficient to deem him capable of doing his job. Without any true analysis, it went on to conclude that he was also unable to perform any remunerated function or work for which he was reasonably fitted by training, education or experience. As he had held a demanding job as a sales manager previously, the Judge decided that it was insufficient that the insured might be able to manage one or two functions of his regular employment sporadically. He was unable to perform any remunerated function or work for which he was reasonably fitted by training, education or experience.

So the answer is yes, a disability claimant may be declared disabled, even if he or she can perform some aspects of his or her work functions.

What if I am at the appeal stage, can I still contact a disability lawyer to help me?

Yes – you are fully entitled to take legal action at any stage of the disability process – after your formal first denial. In our experience, the internal appeal process very rarely results in a disability carrier overturning a formal denial unless they become apprised of new medical issues that were not known at the time of your formal denial.

What are the first steps that we take when you retain our firm after your disability benefits have been denied?

Once you retain our disability lawyers, we will send you out a summary of what you should expect and explain the disability claims process with you. We will then place your disability company on notice that we will be proceeding with a legal claim and ensure that the adjuster that denied your case is named in our notice of examination. We will then make comments on the dangers of social media than the risk that Facebook and Instagram poses to your case.

Our firm will ask you for a victim impact statement, or a narrative about your situation. We will then proceed to order a full and complete clinical file and schedule your assessments with our various medical experts and vocational specialists. We have the onus of proving your claim, and we go to whatever expense necessary to ensure that the onus is met.

Contact a Hamilton Disability Lawyer Today

Did your long-term disability insurance carrier wrongfully deny or cut-off your long-term disability benefits? The long-term disability lawyers at Lalande Employment & Disability Lawyers can help. Do not delay – schedule your free disability consultation today by filling out a contact form. We have been litigating disability claims since 2003. We will retain the appropriate doctors, specialist, vocational specialists, psychiatrists, economists and any other professional required to discharge your burden of proving your total disability and make sure that you get the benefits you deserve.


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Common Questions about Denied Disability

If your disability benefits are provided as a part of a group policy, you need to speak your benefits administrator to obtain the appropriate application, attending physician statement and member statement.

Normally long-term disability policies in Ontario replace 66.6% of a claimant’s income. However this varies between group policies and individual long-term disability policies. We have seen income replacement as high as 75% of the claimant’s income. You need to speak to your benefits administrator to get a copy of your long-term disability policy.

Yes, for disability matters. In fact, many unions refer disability cases to us given the complexity and expense of litigating these types of cases. We cannot represent you if it’s an employment matter.

Short-term disability starts immediately on the date of onset of your disability – if your group policy provides short-term disability. Often times employers do not provide short-term disability policies to their plan members and instead, you would need to apply for EI or employment insurance sick benefits. Short-term disability is often provided during the waiting period, or elimination period. Most short-term disability policies provide hundred and 20 days of coverage. At that point you would be able to apply for long-term disability.

The change of definition happens at the two-year mark in most long-term disability policies. At this point, your insurance company may expect that you can do some type of employment. The put into perspective, for the first two years of disability you must be totally disabled from performing the substantial duties of your own occupation. After two years, the definition of most disability policies change from own occupation to any occupation, meaning you must be totally disabled from performing any occupation for which you are reasonably suited by education training and experience.

You need to contact our law firm immediately. The longer you wait to contact a disability lawyer, the longer it will take to get your benefits back on track. We can provide you with proper legal advice to inform you of your rights.

We never charge consultation fees. Talking to us is always free.

Our firm works on contingency, meaning that if we are not successful in resolving your claim either by settlement or verdict, you will not be paying legal fees. You only pay legal fees if we are successful. Your legal fees will be negotiated well in advance.

If you suffer a chronic illness, debilitating disease or traumatic injury you may not be able to complete  the substantial duties of your own occupation. In that case, you should speak to your family doctor or specialist to determine if you should continue to remain employed. If not, then you should speak your benefits administrator about applying for long-term disability.

It depends on a variety of factors. In some situations, we are able to negotiate getting claimants back on claim (or back in receipt of their disability benefits) or settle the disability file sooner rather than later. All of this depends on the complexity and seriousness of the disability, whether it’s life altering, permanent and there is no realistic possibility of returning to work. In other situations, cases may take longer. There is no good answer to this. In our experience cases could take anywhere from six months to three years.


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