Long Term Disability Case Hurdles
People with long-term disability (“LTD” or “long-term disability”) insurance probably hope they never need it, but the benefits can be life-saving. The Canadian government requires all employers and employees earning a minimum of $3,500 a year (except in Quebec, which has a separate program) to pay equal contributions to the Canada Pension Plan (CPP), covering disability and other benefits.
Though it’s not mandatory under LTD law, Ontario employers may also offer private long-term disability insurance benefits to eligible employees. Some people also opt to get private long-term disability insurance on their own, which is a good idea as well.
There’s a lot of concern about LTD because it is a significant problem for those who suffer, especially if it is due to situations they cannot control, such as a workplace accident or a medical condition. The CPP only pays up to 70% of a person’s regular income, which may not be enough to cover all medical bills and expenses related to the disability. Having a private insurance company can fill these gaps.
However, hurdles occasionally prevent the insured from making a successful long-term disability claim. Long-term disability lawyers at Diamond & Diamond have handled many LTD cases, advocating for clients who were denied their LTD benefits by insurance companies. Below are some common hurdles associated with long-term disability cases.
Long Term Disability Case Hurdle #1: The Plaintiff Has Returned to Work
The CPP and disability insurance companies often stipulate that a claimant for long-term disability must make an effort to return to work. Diamond Law encourages its clients to attempt going back to work whenever possible, even if the attempt fails. It demonstrates to the insurance company that the claimant is trying to mitigate losses and that the disability is real. Such efforts are an excellent argument against a doctor’s opinion that returning to work is possible.
A problem with LTD claims arises when clients return to work, don’t tell their lawyers about it and try to claim LTD benefits. Doing so will seriously jeopardize any hope of making a successful long-term disability claim with the insurance company. However, it’s recommended that the client at least attempts to return to work. If you hope to win your long-term disability case, make sure to keep your Diamond Law lawyer in the loop of any changes to your health, lifestyle and employment status.
Long Term Disability Case Hurdle #2: The Plaintiff Has Not Applied for Disability Benefits
Many people forget that they can apply to receive long-term disability benefits from the CPP if they are less than 65 and have contributed for at least three years to the CPP in the previous six years before their disability. Approval to receive LTD benefits from the CPP is actually evidence of a disability, so a private insurance company may find it challenging to dispute it.
However, if the claimant is not receiving CPP disability benefits, the insurer may question why that is so. They might even suggest that the claim was denied because the claimant does not have a genuine disability. Therefore, it strengthens a long-term disability claim when the client applies and receives approval for CPP disability benefits.
You should note that even if there is a denied claim for CPP long-term disability benefits, it may be due to other issues, i.e., not enough contributions paid. In that case, the client’s claim against a private insurer can still move forward.
Long Term Disability Case Hurdle #3: The Plaintiff Has Taken an Early Retirement
Most long-term disability insurance company policies stipulate that benefits will stop when the insured takes early retirement. That makes sense because it nullifies a claimant’s argument that they would be earning a regular wage but for their disability.
An early retirement is an attractive option because it is a sure thing. But, if claimants choose to take early retirement, they are no longer eligible to receive benefits under their private long-term disability insurance plan.
On the other hand, they take their chances if they decide to pursue a claim instead of taking early retirement, as there is no guarantee they will succeed in their claim.
“If your insurer denies your claim for long-term disability benefits, you should appeal it as a matter of right. But note that the appeal process lengthens the timeline for receiving your long-term disability benefits.”Pro Tip
Long Term Disability Case Hurdle #4: The Plaintiff Has Left the Country
Diamond & Diamond has handled long-term disability cases where the claimant has left Canada, which poses a significant challenge. Under most long-term disability policies, the claimant must be under the care of a duly licensed physician or other health care practitioner in Canada. A client under the regular supervision of a licensed doctor in another country does not qualify.
Depending on the case, we could argue that a client with a disability cannot return to Canada because of COVID restrictions. However, regularly consulting with a physician in Canada through virtual means should generally satisfy the residency requirements. Appropriate medical care may still be possible under these circumstances.
A case may also be made for the claimant leaving the country with the attending physician’s permission for urgent reasons, such as death or serious illness of a family member. But overall, a claimant leaving the country is a tough hurdle to overcome as it suggests a level of mobility that the insurer can use to their advantage.
For Your Long Term Disability Case, Contact Diamond Law Today!
If your insurer denies your claim for long-term disability benefits, you do not have to accept it as final. You can and should go through the appeal process to reverse their decision, regardless of whether the above hurdles apply to your case. Your best option is to have a reliable law firm handle the case for you.
Diamond & Diamond Law long-term disability lawyers can help you overcome problems related to your LTD claim. We pride ourselves in the dedicated support system our legal team provides our clients throughout the process. If you are a resident in Ontario, Alberta or British Columbia, we have the professional talent, broad knowledge and extensive experience to overcome challenging situations in long-term disability insurance cases.