Long-Term Disability: Who’s Affected?

woman applying for long-term disability insurance

Did you apply for long-term disability benefits and had your benefits denied?

Long-term disability insurance is purchased by individuals as income protection in the case that they become sick or disabled and lose the ability to work. Individuals pay a premium every month to maintain their LTD insurance policies. While most people never need to use long-term disability benefits, some do.

When it comes time to apply for LTD benefits, it is not uncommon for insurance companies to make this process difficult and deny claims. Enlisting the help of a long-term disability lawyer can be key to making sure that you get the insurance benefits that you are entitled to.

Insurance companies in Canada that offer long-term disability plans include:

  • Sun Life Insurance
  • Great West Life Insurance
  • Manulife Insurance
  • Canada Life Insurance
  • RBC Insurance
  • Desjardins Life Insurance
  • SSQ Insurance
  • Standard Insurance
  • Equitable Life Insurance
  • OTIP Insurance
  • Blue Cross Insurance
  • Maritime Insurance
  • London Life Insurance
  • BMO Insurance
  • Empire Life Insurance
  • Cigna Insurance

How to Get Help

A long-term disability lawyer who practices in Ontario can help you in the following situations if you are a resident of Ontario and:

  • If your claim was denied;
  • If your benefits are delayed; or
  • If you were approved for benefits but your insurer wants to place you in a return to work program with the goal of terminating your benefits.

Long-term disability lawyers can help you file a lawsuit against your long-term disability insurer.

Fill out the form on this page for a free case evaluation by a long-term disability insurance lawyer.

Get Help – It’s Free

Get Help With Your Long-Term Disability Insurance Denial

To get help, fill out the form below or call (343) 308-TCA2

If you qualify, a lawyer will contact you to discuss the details of your potential case at no charge to you.

E-mail any problems with this form to:
Questions@ca.TopClassActions.com.

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What is Long-Term Disability Insurance?

Long-term disability (LTD) insurance provides monthly income-replacement payments if you are unable to work because of a disability.

To be eligible for disability benefits, you must be covered under a disability insurance plan. LTD payments can be based on a fixed amount or may be calculated as a percentage of your salary, depending on your insurance plan.

In order to receive benefits, you must be continuously unable to work for several months to qualify. During this waiting period, you may be eligible to receive short-term disability benefits or employment insurance (EI) benefits until you are approved for LTD benefits by your disability insurance company.

LTD benefits can either be paid for a fixed number of years, or benefits may continue until you reach a certain age (usually 65 years old).

How Does Long-Term Disability Work?

Insurance companies in Canada are regulated provincially. Every province has its own insurance laws that govern the legalities of insurance practices. Although insurance laws are largely similar among provinces, there may nevertheless be certain differences from province to province.

LTD insurance benefits will typically start when short-term disability insurance, sick leave benefits from your employer, or EI benefits end. On most occasions, LTD plans will replace 60 to 70 per cent of your usual income, depending on your disability insurance plan.

What Does Long-Term Disability Cover?

Individuals may become disabled due to a serious injury, but long-term disability claims may also involve common medical conditions that affect many people, such as:

  • Arthritis
  • Heart disease, stroke, and other cardiovascular problems
  • Cancer
  • Depression and mental health problems
  • Diabetes
  • Nervous system disorders
  • Back injuries
  • Traumatic brain injuries
  • Fibromyalgia
  • Chronic pain
  • Infection
  • Chronic Fatigue Syndrome
  • Multiple Sclerosis
  • Orthopedic injuries
  • And possibly more

While individuals who file for long-term disability insurance benefits may have injuries and illnesses that prevent them from working, insurance companies may make it difficult for them to obtain benefits by questioning the legitimacy of their injuries.

This is why it is beneficial to have a long-term disability lawyer in Canada on your side who has previous experience with fighting LTD claim denials.

Do I Qualify for a Long-Term Disability Appeal?

You may qualify for legal support with your long-term disability insurance appeal in the following circumstances:

  • You have a long-term disability insurance policy through a workplace group policy provided by your employer or an individual disability insurance policy you bought yourself (not CPP, provincial disability income program, union plan, or EI);
  • You applied for long-term disability benefits;
  • You received a denial letter in the mail; and
  • You are within one to two years of the date on the long-term disability denial letter.

LTD insurance wooden letters

How Do I Get Long-Term Disability Insurance Benefits?

Applying for LTD benefits is a lengthy process, but one that is the same regardless of your disability insurer. Typically, you will need to do the following:

  • Be continuously unable to work during the waiting period
  • Get the form(s) to apply for LTD
  • Send in the application form(s)
  • Send in any supporting medical documents
  • Wait for a decision from the insurance company

The first requirement, namely, the disability waiting period, refers to the minimum time you must be continuously disabled in order to be eligible for benefits. Under most plans, you must wait 17 weeks, but some can make you wait up to 52 weeks. During the waiting period, you can be eligible to receive short-term disability benefits or EI sickness benefits.

Once the waiting period is over, you will need to send in one or more forms to apply for LTD benefits. If the same insurer administers the short-term and long-term disability payments, you may need to file a transition form instead.

How Do I Appeal a Long-Term Disability Denial?

LTD denials are very common in the insurance industry, and it is almost just as common for policyholders to appeal those decisions. To start the appeal, there are certain essential steps that need to be followed.

Denial Letter

The first step to appealing your LTD decision is receiving the denial letter. The denial letter will be the most important document sent to you by your insurer in the appeals process. This letter is the insurance company’s refusal of your application for LTD benefits.

You may receive a “termination letter” instead, which is another type of denial for policyholders who were receiving LTD benefits that were subsequently terminated. Both types of letters can be appealed.

The denial letter will provide you with information crucial for your lawsuit/appeal:

  • Definition of “disability”
  • What your policy covers
  • The insurer’s reason for denying your LTD benefits
  • Information from your medical reports to substantiate the denial
  • A date

Although seemingly inconsequential, the last bit of information in your denial letter might be the most important. The date on which the denial letter was written marks a critical point in time for your appeal. It starts the clock on the deadlines you will need to meet should you file an appeal.

These deadlines are largely regulated by the Limitations Act in force in your province, which determines how long you have to bring a lawsuit for certain claims. For LTD insurance denial appeals, you will generally have two years from the date printed on your denial letter to commence a lawsuit.

However, time limits can vary based on your specific claim and depending on your province. In Ontario, for example, LTD lawsuits may have shorter time limits. Therefore, your safest bet would be to seek legal help to ensure your lawsuit is filed well in advance of the limitation period.

Long-Term Disability Appeal Steps

Regardless of the appeal method you choose, whether it be a formal written appeal or lawsuit, the following steps need to be taken:

  • Find your denial letter or request a copy
  • Get a copy of your insurance policy
  • Request a copy of your file from your insurer
  • Decide whether you want to hire a lawyer
  • Determine why your claim was denied
  • Identify any gaps in the information provided with your claim
  • Hire independent experts, which will entail:
    • Ordering a functional capacity report
    • Ordering a vocational expert report
    • Ordering a medical expert report to support your disability
  • Gather evidence for your case to fill information gaps, such as:
    • Missing medical records
    • Additional medical tests
    • Written testimonies/opinions from your doctor(s)
    • Written testimonies from non-medical experts (such as family, friends, co-workers, vocational experts, etc.)
  • Clarify parts of your original claim, where necessary

There are a lot of steps that need to be taken to successfully dispute a denial, which is why enlisting the help of a long-term disability lawyer can make a difference.


Legal services to appeal LTD insurance claim refusals

Do I Need a Long-Term Disability Lawyer if My Claim was Denied?

Filing an appeal against your insurer can be intimidating and confusing which is one reason why hiring a lawyer may help.

With a disability lawyer on your side, your insurer will know that they will be held accountable for the benefits that are owed to you as well as for any bad faith practices that the company may have engaged in.

Additionally, hiring a lawyer may simplify the appeals process for you. If eligible, your lawyer will assist as much as they can to help you meet your legal requirements, take care of all the necessary procedural steps outlined above, and will ensure that your appeal is filed in a timely manner.

How Will a Long-Term Disability Lawyer Help?

An LTD insurance lawyer will take charge of your case and support you throughout the entire litigation process. Namely, your lawyer will:

  • Help file insurance forms
  • Evaluate your insurance claim
  • Help you understand relevant laws and regulations
  • Help you understand your options
  • Review medical records
  • Suggest additional medical testing to ensure your appeal is successful
  • Obtain medical reports and expert opinions about your disability
  • Obtain evidence from vocational experts
  • Ensure the disability appeal is filed on time
  • Ensure your benefits are calculated correctly
  • File a legal brief on pertinent medical, vocational and legal issues
  • File the lawsuit (if necessary)
  • Defend your appeals case

At What Stage Can an LTD Insurance Lawyer Help You?

An LTD insurance lawyer can provide guidance at any time. However, there are certain ideal stages during which a lawyer can provide the most beneficial support, namely:

  • Once your claim has been denied and before you file an appeal;
  • If you were approved for benefits and were subsequently cut off from your benefits;
  • If you were approved for benefits but your insurer wants to place you in a “return to work program” and terminate your benefits; or
  • If you have not yet been officially diagnosed, or are still in the diagnostic stage.

Get Help From an LTD Lawyer

If your LTD insurance claim was denied, you may qualify to appeal your insurer’s decision. 

Fill out the form on this page for a free case evaluation by an LTD insurance lawyer to increase your chances of a successful outcome. 

Get Help – It’s Free

Get Help With Your Long-Term Disability Insurance Denial

To get help, fill out the form below or call (343) 308-TCA2

If you qualify, a lawyer will contact you to discuss the details of your potential case at no charge to you.

E-mail any problems with this form to:
Questions@ca.TopClassActions.com.

  • We tell you about cash you can claim every week! Subscribe to our free newsletter today.

After you fill out the form, a lawyer from Preszler Injury Lawyers will contact you if you qualify to
let you know if you may be eligible for a lawsuit.

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