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Woman in wheelchair regarding information on long term disability laws in Canada

Long term disability insurance is a way for Canadians to protect themselves and their families if a disabling injury removes them from the workforce. However, the laws regulating these plans can be complex and sometimes workers find themselves on the end of a denied claim.

If your long term disability claim has been denied, you may be considering legal action. Read on to learn more about long term disability laws and how they may affect your claim.

What are the Long Term Disability Laws in Canada?

There are several ways Canadians can access long term disability benefits, including through their employer, independently through an insurance company, as well as through the Canada Pension Plan. There is also Workers Compensation that covers injuries an employee may suffer while on the job, as well as short term plans that cover workers for illnesses or injuries that keep them out of the workforce temporarily.

While some workers are not provided long term disability insurance, some employers offer options through a comprehensive benefits package. It is important that you understand the terms of these policies before attempting to make a claim under your employer’s long term disability insurance plan.

The exact definition of “disability” varies from plan to plan, but, according to the Government of Canada, long term disability insurance includes health conditions that leave you unable to work for an extended period of time.

When you can file a claim will also vary as well, but long term disability generally kicks in after a period of short-term disability and possibly support under the Employment Insurance (EI) program.

What are the Long Term Disability Requirements?

As noted above, long term disability requirements will vary from plan to plan, including what health conditions constitute a disability as well as when a claim can be made.

Other factors that may determine whether or not you qualify for long term disability include your occupation, and offsetting benefits, and your medical condition.

Further, various deadlines will apply to long term disability claims. It is also important to note that long term disability payments are not automatic; you will need to make a long term disability claim to access your benefits.

Was Your Long Term Disability Claim Denied?

There are any number of reasons why a long term disability claim may be denied. It is important to review the terms of your policy and possibly bring your claim to a long term disability lawyer before submitting it to ensure you meet all the requirements and provide all necessary documentation on time.injure woman looking upset regarding information on long term disability claims in Canada

Common reasons insurance companies deny long term disability claims include missed deadlines, errors in the application, pre-existing medical conditions, missed premium payments, failed medical assessments, failure to meet the definition of “disability,” refusal of medical treatment, and failure to follow up with a medical doctor. In addition, insurance companies may do their own investigation and say they have evidence that you are not truly disabled. This evidence may even include pictures on social media.

Further, your policy may specifically exclude claims based on health conditions that resulted from certain activities, such as drinking or drug use. Your doctor or employer may also submit information that is inconsistent with your claim, which the insurance company may use to demonstrate that you can go back to work. Your claim may also be denied if you have become incarcerated or are in a similar institution.

However, you do have the right to appeal a long term disability insurance denial.

When Should You File a Long Term Disability Insurance Lawsuit?

If you feel your long term disability claim was wrongly denied, you may need to consider legal action to continue with your claim. A long term disability lawyer can help you understand the insurance company’s appeal process and when it might be beneficial to consider filing a long term disability lawsuit.

Have Any Long Term Disability Insurance Lawsuits Been Filed?

Yes, according to Benefits Canada, a number of long term disability insurance lawsuits have been filed by policyholders alleging their benefits were wrongly denied. Other lawsuits have been filed over allegations that the policyholder’s employer or insurer forced them into an unfair settlement or even tricked them into agreeing to drop their coverage.

Long term disability lawsuits have also been filed alleging that employers are discriminating against older employees by kicking them off of long term disability plans or refusing to offer them once they reach a certain age.

What Should You Consider Before Agreeing to a Long Term Disability Settlement?

Entering into a long term disability settlement means that you and the insurance company have agreed that you will drop your insurance claim in exchange for an amount of money that is likely less than you would have received had your claim been successful. It is important to take the following factors into consideration when an insurance company proposes a settlement;

  • If you need money urgently
  • How long you expect to be disabled
  • Your current and future medical costs
  • Whether you understand the terms of the long term disability settlement agreement
  • Your other options

Insurance companies prefer to settle claims and insurance disability lawsuits out of court to avoid steep legal fees. They may offer one of two types of settlements – a one-time lump sum or reinstatement settlement.

A lump sum settlement is a single payment offered by the insurance company and is meant to end the claim between you and the insurance company. Generally, the lump sum payment is less than what you would get if your long term disability claim was successful; however, opting for the lump sum settlement can help avoid the delay and expense of a trial.

In a reinstatement settlement, an insurance company will pay the long term disability benefits you were denied in the past; however, this settlement does not guarantee any future payment. In addition, the insurance company may terminate your policy after the settlement.

If you are considering a long term disability lawsuit, it may be helpful to consult a long term disability lawyer who can help you navigate your options when filing an initial claim, if your long term disability claim gets denied, legal action, and settlement offers.

Was your long term disability claim denied? Tell us what happened in the comment section below!

Fill Out the Form to Get Help with Your LTD Insurance Claim 

If your long-term disability insurance claim was denied, legal help is available. Obtaining the assistance of a lawyer will increase the chances of success. See if you qualify by filling out the form on this page or clicking the link below.

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

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Please note: Top Class Actions is not a settlement administrator or law firm. Top Class Actions is a legal news source that reports on class action lawsuits, class action settlements, drug injury lawsuits and product liability lawsuits. Top Class Actions does not process claims and we cannot advise you on the status of any class action settlement claim. You must contact the settlement administrator or your attorney for any updates regarding your claim status, claim form or questions about when payments are expected to be mailed out.