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Trusted Hamilton Long-Term Disability Lawyers
Cases involving denied long-term disability benefits involve a unique intersection of personal injury law, employment law and contract interpretation. If your long-term disability claim has been denied, you need an experienced and specialized disability lawyer to fight for your past and future benefits. Ross & McBride’s personal injury lawyers are dedicated to helping people just like you with legitimate claims in Hamilton and across Ontario. We work on a contingency fee basis, so we don’t charge legal fees unless we win your case.
Long-Term Disability Insurance: What Claimants Should Know
A disability insurer will often try to deny financial support to their disability claimants by saying that the medical evidence doesn’t support your claim for benefits. You may be suffering from chronic pain, serious illness, physical injuries, mental health challenges or other long-term conditions that affect your well-being and may make it difficult to return to your job, or the workforce in any capacity.
The disability claim process can be challenging, which you’re trying to navigate despite all the medical challenges which make working impossible. Having a specialized disability lawyer in your corner can help get you the payments you deserve. We regularly represent clients who have been wrongfully denied disability benefits and make sure the insurance company treats you fairly.
We fight to have your injury classified correctly and ensure your personal injury claim reflects the true scope of your suffering.
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Who Qualifies for Long-Term Disability Benefits in Hamilton and across Ontario?
These claims are governed by an insurance contract, which, although unique to each case, tend to contain very similar terms. Generally, if you have a medical condition that prevents you from working and your employer offers long-term disability insurance as part of your employment package, you likely qualify for long-term disability benefits once you have been off for a specific period of time. Common conditions which lead to these types of claims include:
- serious illnesses and chronic conditions such as cancer, multiple sclerosis, cardiovascular disease, fibromyalgia, endometriosis, diabetes and others
- mental health conditions such as bipolar disorder, depression, anxiety, substance addiction, and post traumatic-stress disorder
- severe injuries such as a spinal cord injury, brain injury, nerve damage and others
- chronic pain including severe arthritis if it prevents you from working
This list is not exclusive, and, in fact, most policies have no limit on what conditions can qualify for benefits. In addition, you don’t need to be injured through your job to qualify for long-term disability benefits, the cause of the disability is not relevant at all. Any serious condition that prevents you from working must be considered by the disability insurance company under most of these policies.
After qualifying for benefits, if you are following appropriate medical treatment for your condition and are not ready to return to work, you should be approved by the disability insurer to remain on your benefits. Be sure to keep all of your medical records to show what types of treatments you have tried, so that it’s clear you are trying to get better and return to work, if possible.
Can Disability Insurance Be Denied?
Disability insurance companies can deny your claim for long-term disability benefits if you do not meet the requirements in your insurance policy or fail to provide sufficient information about your condition.
They can also approve your benefits at first, and then take them away for various reasons, including a maximum benefit duration that is in your policy terms.
Most disability insurance disputes occur when a claim is denied at the outset for “insufficient medical evidence of disability” or a termination after benefits are initially paid under a similar rationale.
CPP Disability Claims
Many Canadians aren’t aware that they can claim disability benefits through the Canada Pension Plan (CPP) in addition to their insurance benefits. To qualify for the CPP disability benefits you must:
- be at least 18 and under 65 years old
- have a mental or physical disability that regularly stops you from doing any type of substantially gainful work
- have a long-term disability that will remain indefinitely or likely result in your death
- have contributed enough to CPP, and specifically, have made sufficient contributions in 4 of the past 6 years
The CPP benefit is not enough to cover all your living and medical expenses. But it can provide some assistance. Your personal injury lawyer can help you decide whether it would be a good idea for your to apply, and also assist you in filling out the government paperwork.
Note that any amount you get from CPP disability benefits will probably be deducted from the payment from your insurance company. Despite this, if you are going to be off work for a long period of time, it is still a very good idea to apply, for reasons that your lawyer can discuss with you.
Common Reasons for Disability Claim Denials
In addition to “insufficient medical evidence”, there are many other reasons your insurer might deny or terminate your long-term disability claim. Here are a few of the most common reasons:
- They believe your disability is a pre-existing condition that you had before the policy went into effect. This is usually limited to those who have only been at their job for a short period of time before going off work.
- They suspect that you are exaggerating the extent of your disability because of information they have seen on social media or been given by other sources.
- They believe you have stopped following your medical treatment plan and therefore you must not be receiving “ongoing care.”
- They do not believe that your disability prevents you from gainful employment.
- They have sent you for an independent medical examination, who has provided them a report saying that you can return to some sort of employment, or even your usual job.
How Do I Appeal an Insurance Claim Denial?
When you appeal the insurance claim denial, it is important to gather the documents to support your case, including the denial letter, your medical records, invoices for your medical expenses, policy documents and any other information about how your disability prevents you from returning to work. Many denials rely on technicalities in their policy or a lack of medical evidence.
The insurance company will probably encourage you to use their internal appeals process, but these appeals are rarely successful. After all, you are simply resubmitting the same evidence to the same people who already denied your claim. Why would they change their minds?
A lawsuit is usually the best way to fight your LTD claim denial. Hiring a lawyer with an understanding of complex insurance policies and experience with similar denials gives you the best chance of changing the result.
How Long Does It Take to Resolve an LTD Claim?
It can be difficult to wait for results of the appeal while you face financial hardship from your lack of income. Insurance denial appeals can take several months to be decided, so it is important to work with a personal injury law firm as early as possible. In many cases, your lawyer will be able to negotiate a settlement with the insurance company before you case even goes to trial.
In fact, while the litigation process rarely moves quickly, long-term disability cases are among the most efficient and timely claims, for a variety of reasons that can be explained by a lawyer who specializes in this area.
Why Choose Ross & McBride Hamilton Long Term Disability Lawyer as Your Partner
- Extensive history of success, with all major insurers operating in Ontario. You’re getting the benefit of that reputation, and the millions of dollars we’ve recovered from these companies in the past.
- We’ll tailor your case to your needs, including trying to structure any settlement of your benefits to fit your particular situation. Long-term disability cases are not one size fits all.
- Although your lawyer will be a long-term disability specialist, you get the benefit of having a full-service law firm in your corner. That means any impact of your case or situation on other areas of law, such as employment, human rights or family law, can get immediate answers and rapid consultation without having to go to another firm. This benefit makes Ross & McBride particularly unique, and is rarely available at other firms.
- Your lawyer will be retained on a contingency fee agreement. That means no up-front cost to you, far less risk. You also have the peace of mind of knowing that your lawyer is going to move your case forward for the maximum possible compensation in the timeliest way possible – exactly what you want to occur.
Let Our Disability Lawyers Help You
Although based in Hamilton, we know the courts, disability insurers, medical networks and winning strategies for your LTD claim across Ontario and have experience with claims from Dryden to Ottawa to Windsor. If you reside anywhere in Ontario, and have had your benefits terminated, denied, or even feel that this is a threat, contact our disability lawyers today for a free consultation.