In Ontario, long term disability (LTD) insurance provides financial protection for individuals who become unable to work for an extended period due to an injury or illness. With long term disability benefits, you can ensure continued income during extended periods of inability to work. A long term disability lawyer can play a critical role in navigating the often complex and challenging process of making a claim or, if a long term disability claim is denied, they can handle appeals and potentially litigate to overturn the decision.
If you are managing a long term disability claim, it’s important to know how a specialized lawyer can help. Our article explains the crucial support a long-term disability lawyer provides, from starting your claim to dealing with insurance companies and appealing denied claims. It’s a must-read for anyone in this unfortunate situation, offering key insights and advice to improve your chances of a successful claim.
Why is it important to talk to an experienced disability lawyer?
When health takes a downturn, and work becomes an uphill battle, long term disability benefits can be a financial lifeline. However, claiming these benefits is often a complex process, fraught with bureaucratic hurdles and legal jargon. This is where the expertise of long term disability lawyers becomes invaluable. They bring their expert knowledge to the table, helping to increase the chances of success for disability claims by taking on the daunting task of paperwork, negotiations, and legalities, allowing claimants to focus on what matters most – their health and well-being.
Facing an insurance company alone can be intimidating, especially when they employ tactics like unreasonable wait times, excessive information requests and shifting disability requirements. Having a lawyer who specializes in disability insurance law by your side becomes a valuable asset in navigating these challenges.
A claim denial doesn’t have to be the end of the road, especially if you’ve been wrongfully denied disability benefits. A long-term disability lawyer can appeal the decision, potentially overturning it, or even proceeding with litigation if necessary. Engaging a lawyer early in the claim process can fortify your case with added medical evidence and expert witness testimony, possibly expediting claim approval.
Understanding Long Term Disability in Ontario
Long-term disability (LTD) in Ontario is an insurance plan designed to provide a continuous income to individuals who are unable to work due to a severe or prolonged disability. Typically, LTD insurance covers between 60% to 80% of an individual’s pre-disability gross income, subject to monthly benefit caps and policy terms.
Eligibility for LTD benefits in Ontario is determined by the severity of the medical condition and the definitions stipulated by the insurance policy. There is a waiting period, often called the elimination period which usually lasts from 90 to 120 days depending on your policy. While you’re in this waiting period, you won’t get LTD benefits, but short term disability benefits might provide some financial support in the interim.
LTD benefits in Ontario may continue until the individual either no longer meets the policy’s definition of disability or reaches the end of the specified coverage period, often until the age of 65. In Ontario there are a variety of disability insurance benefits available, such as:
Group Disability Insurance
Many employers offer long term disability insurance as part of their benefits package. With group insurance, the premium costs are typically shared between the employer and employees and sometimes fully covered by the employer. The coverage details, including the percentage of your salary you will receive and the duration of the benefit vary depending on the specific policy provided by the employer.
Individual Disability Insurance
Individuals can purchase long term disability insurance directly from an insurance company. This option allows for more personalized coverage, tailored to the individual’s needs and financial situation. Private LTD insurance can be more expensive than group insurance, but it offers the advantage of being portable (not tied to a specific employer) and customizable.
Employment Insurance (EI) Sickness Benefits
This is a program offered by the Canadian government designed to provide temporary financial assistance (up to 26 weeks) to individuals who are unable to work because of illness, injury or quarantine but plan to return to work. Eligible recipients can receive up to 55% of their average insurable weekly earnings, up to a maximum of $668 per week.
Workers’ Compensation Insurance (WSIB)
The WSIB provides support to workers who have been injured on the job or who suffer from an occupational illness. This includes both short-term and long-term financial benefits, depending on the severity and duration of the work-related injury or illness. For long-term disabilities resulting from a workplace incident, WSIB benefits can provide continuous financial support, cover medical and rehabilitation costs and even offer retraining for those who are unable to return to their previous jobs. WSIB benefits are specific to work-related injuries and illnesses and are separate from other types of disability insurance.
Ontario Disability Support Program (ODSP)
ODSP is a provincial program designed to support individuals with disabilities who are in financial need. It provides financial assistance to help cover the costs of living and health-related expenses. While ODSP is not insurance per se, it serves as a vital safety net for those who do not have access to LTD insurance or who have exhausted their insurance benefits.
Canada Pension Plan Disability (CPPD) Benefits
The CPP Disability Benefit is a federal program that provides financial assistance to eligible individuals who have made sufficient contributions to the CPP and are unable to work regularly at any job due to a severe and prolonged disability. While CPP disability benefits offer long-term financial support, the amount received is usually less than what could be obtained through private or employer-sponsored LTD insurance.
The Role of a Long Term Disability Lawyer
The process of filing for LTD benefits in Ontario includes obtaining a diagnosis, compiling medical documents, submitting the claim and subsequently monitoring the progress of the claim. In the case of a denied claim, individuals in Ontario have the right to appeal the decision, following specific steps, including obtaining the denial in writing, meeting deadlines for appeals, and providing evidence to build their case.
Experienced disability lawyers play an indispensable role moving their clients through the insurance claim process. Those who seek legal advice, and disability claimants are often in need of professional expertise when it comes to the complexities of negotiating with insurance companies and litigating in court, if necessary. Ontario disability lawyers can offer expert guidance and representation with the following matters:
- Long term disability claims (LTD claims)
- Denied benefits/claims
- Termination of benefits
- Negotiating settlements
- Insurance appeals
- Disability benefits
- Disputes over the amount of benefits
- Understanding your disability insurance policy
- Medical disputes
- Pre-existing conditions
- Assistance with applications
Your lawyer may also represent clients in mediation and out-of-court settlements to settle disputes without needing court intervention. They will engage with medical professionals, occupational therapists and social workers on your behalf as well as compiling legal documents like briefs, statements of claim and expert reports, designed to support the merits of a case and establish the credibility of an insured’s claim.
And, if you’re wondering about the legal costs involved in seeking advice or services, most LTD lawyers work on a contingency fee arrangement – this means that they are paid only if the case is successful and typically as a percentage of the client’s recovery.
How a Long Term Disability Lawyer Can Help
Long term disability lawyers offer a comprehensive suite of services to clients, including case evaluation, liaising with insurance companies, filing appeals and potentially litigation.
Evaluation of Your Case
A primary service that long-term disability lawyers offer is:
- Case evaluation
- Helping clients understand the insurance company’s eligibility requirements for benefits
- Identifying if the insurance company has unfairly denied a client’s benefits claim
- Providing the necessary legal advice
Disability lawyers review and evaluate documents and evidence to establish a client’s disability and eligibility for benefits. They guide clients through the process of avoiding common mistakes that lead to claim denials, such as missing information or insufficient medical evidence.
Gathering Necessary Documentation
Another pivotal role of a long term disability lawyer is the compilation of essential documentation for a claim. These lawyers are skilled in obtaining and correctly presenting medical evidence to support LTD claims and appeals. They can advise clients on the evidence needed for their case and may refer them to specialists for expert opinions.
Handling requests for full copies of medical records from hospitals, doctors and healthcare professionals is more effectively done by a disability lawyer than by patients. They ensure that the patient history is detailed and objective, including:
- Diagnoses
- Symptoms
- Clinical observations
- Functional limitations
- Prognosis
- Treatment plans
- Any pre-existing conditions.
Dealing with Insurance Companies
Interacting with insurance companies can often be intimidating for claimants. However, long term disability lawyers can protect clients from the insurance companies’ delay tactics, which may involve repeated requests for additional evidence or changing adjusters. They are adept at responding to insurers’ attempts to extract information that could invalidate a claim, ensuring that clients provide detailed and precise answers.
Lawyers can also advise clients on managing their social media activity to prevent insurance companies from using it against their claims. They can coordinate with medical providers to ensure all communications with the insurer are in writing, reducing the risk of vague or inaccurate information being provided.
Filing and Managing Appeals
If your claim has been rejected, disability lawyers can aid you in initiating and overseeing appeals. They help clients understand the common reasons for claim denials and how to address them effectively in an appeal. They ensure that all necessary documentation is collected and submitted correctly to support the appeal. Your lawyer can help clients obtain additional medical examinations or expert opinions to strengthen the grounds of an appeal. They guide clients in completing and filing appeal forms with accurate and comprehensive information to meet the insurer’s requirements.
Litigation
When legal action becomes necessary, a long term disability lawyer can represent you in court, advocating for the compensation you are entitled to. They prepare legal documents, engage with medical professionals and present your case in front of a judge. An experienced lawyer will also negotiate with insurance companies and strive to get you the best possible outcome.
Choosing the Right Long Term Disability Lawyer
Selecting a long term disability lawyer can significantly influence your claim. It is important to select a lawyer who specializes in long term disability claims as they will be familiar with the complexities and technicalities of such cases. Choosing a local lawyer who understands the jurisdiction’s legal landscape can also be beneficial.
Ensure that the lawyer you choose:
- is available, responsive and offers a free initial consultation
- has a track record, credentials and reputation that you can verify
- has sufficient knowledge and access to medical, financial and occupational experts, which can be crucial for proving a disability case
Summing it All Up
At Fosters Law, our team of lawyers specializing in long term disability claims combine expertise, compassion and dedication to assist those who are unable to work due to serious health conditions. With a deep understanding of the complexities inherent in disability insurance law, we are professionals adept at navigating the intricacies of policy details, claim submissions and the appeals processes. We are committed to advocating for your rights, ensuring that each case is meticulously evaluated and pursued to secure the benefits that you deserve. Leveraging our extensive legal knowledge and negotiation skills, Fosters Law aims to alleviate the burden on individuals facing challenging times, providing tailored legal solutions and the support necessary to achieve favorable outcomes in long term disability claims.
From chronic pain to mental health, if you believe that you have a claim, contact us for a free consultation. Having a personal injury lawyer with long term disability claim expertise on your side can significantly increase your chances of securing the financial assistance you deserve and provide peace of mind for your future.
This article has taken you on a journey through the world of long term disability law, shedding light on the crucial role of lawyers in the process. Long term disability lawyers can assist you in understanding your rights, navigating the complexities of insurance claims, dealing with insurance companies and even representing you in court if necessary. So, if you’re facing a long term disability claim, remember—you don’t have to do it alone.
