Understanding Long-Term Disability Claims In Ontario

Navigating long-term disability (LTD) claims can be challenging, especially while managing health issues.

This guide clarifies the medical and legal aspects of LTD claims to empower you with the knowledge you need to pursue a claim.

What is a Long-Term Disability Claim?

An LTD claim arises when and individual who cannot work due to severe illness or injury applies to their LTD insurer for coverage. Some LTD claims are processed by the insurer and go smoothly. Other LTD claims result in denials of coverage, complicated requests for records and medical opinions, technical policy provisions, and convoluted appeals processes. In Ontario, LTD claims may be filed through employer-sponsored insurance or private insurance policies.

• Employer-Sponsored Plans: Part of employee benefits covering injuries or illnesses that prevent work.
• Private Insurance Policies: Purchased independently to supplement or replace employer plans.

Common Conditions Covered Under Long-Term Disability

1. Chronic Illnesses: Conditions like cancer, cardiovascular diseases, and complications from diabetes.
2. Musculoskeletal Disorders: Severe arthritis, degenerative disc disease, and fibromyalgia.
3. Mental Health Disorders: Major depressive disorder, generalized anxiety disorder, and PTSD.
4. Neurological Disorders: Conditions such as multiple sclerosis, Parkinson's disease, and traumatic brain injuries.

Steps to Filing a Long-Term Disability Claim

1. Consult your healthcare provider: Discuss your condition's impact on your work ability and obtain detailed medical documentation. Do this at an early stage, as there is often a lengthy waiting period to see if you recover, and to allow your insurer to assess your claim.
2. Review your insurance policy: Understand terms, coverage limits, and the policy's specific definition of disability. Timing is often important to the claims process.
3. Complete Claim Forms: Fill out forms accurately and promptly and include required medical and employment documents.
4. Submit Your Application: Retain copies of all documents.
5. Follow Up: Maintain communication with the insurance adjuster and provide any additional information needed. There is a waiting period before your benefits commence.

How We Handle Denied Claims

A denied LTD claim can be disheartening, but knowing your rights and steps forward is essential.

1. We will help you understand the reason for denial: We will review the denial letter and determined whether there is a specific or provision under the policy that entitles or disentitles you to coverage. Importantly, even when to you it might seems like an air-tight, black-and-white denial, their may be a legal error in the insurer's decision making process.
2. We will negotiate with your insurer: It can be tricky to discuss issues related to LTD insurance if you do not understand your rights and obligations under the policy. At the end of the day, LTD insurance is intended to cover valid claims, and insurers have strict obligations. With our knowledge, we can shoulder your burden of dealing with your insurer.
3. Filing an appeal: in some cases, we will navigate the insurer's own appeal process. In doing so, we will marshal the right evidence, and follow the proper procedure to attempt to make the insurer reverse course.
4. Litigation: If an appeal is unsuccessful, we will advise your with respect to a lawsuit. Court's have broad discretion and even when it comes to missed timelines, in the right case, we can ask the courts to waive imperfect compliance with timelines and policy provisions.
5. Negotiation and Settlement: In some cases, a better result is demanding that the insurer continue to cover you under the LTD policy. In other cases, it is in everyone's interests for the insurer to make a lump-sum payment at a discount, relieving them of future obligations, but providing you with the certainty of the cash in hand. In addition to negotiating with the insurer, we can help you understand the value of your LTD claim, and the benefits of the different outcomes.

Our Commitment to You

At Nelligan Law, we understand the complexities of Ontario long-term disability claims. Our team is dedicated to guiding you through every step, ensuring your claim is handled professionally.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.