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Long Term Disability Claim Obligations

There are a number of ethical considerations and obligations lawyers face when representing clients. Disability Insurance Lawyers should:

  • Maintain a professional relationship
  • Protect and act in the clients' own interests
  • Reveal information for a long term claim client only when truly necessary

Our organization, where possible, may provide our long term claim clients with accomodations, personal support workers, and educational material in order to increase their healthiness, or, overall wellbeing of the individual which we represent. These resources may depend on the financial costs and administrative burdens relative to the size and liquidity of the firm, the importance of the case, or outsourced community services that may help in aiding the individual without incurring significant financial cost.

Our long term clients have the opportunity to apply for a variety of programs that may increase their wellbeing; often our clients are part of support programs such as ODSP and CPP, governmental income support where applicable. We may encourage you to contact these administrative bureaus to gain a clearer understanding of financial burdens.

Good communication between a disability insurance lawyer and long term claim client is critical to drive rights-driven cases towards a positive outcome, especially long-term disability cases. Certain circumstances are beneficial for our clients to seek large sums of financial assistance as a result of a denid claim. Unless customers have the financial means to pay for such measures, it is a difficult burden; it is near-impossible for individuals with disabilities - they will experience considerable challenges in finding a legal advisor to take their case unless it looks especially worthy from a lawful point of view. Moreover, there are cash-harms, as well as disability insurance lawyers' charges, included with parties who win. Attorneys, in any case, would be very much encouraged to unmistakably disclose this reality to potential customers before dismissing their cases.

Comparable parallels in counselor-and-customer environments may emerge in Long Term Claims, in which financial gains are the parties' essential goal. Be that as it may, this may effect the customer shares, and is dependent upon such, as well as the legal advisor's enthusiasm for seeking cases which bode well fiscally. Be that as it may, customers still may not comprehend why a case is not promising (from a money-related point of view) until the legal counselor clarifies why.

In a sense, this financial point of view is a special case to the previously mentioned rule that the legal counselor ought to permit the Long Term Claims customer to settle on the choice to bring a lawsuit to the courts. Unless the customer will pay the legal counselor straightforwardly with expectations of gaining financial harms' charges and, perhaps, disability insurance lawyers' expenses later, the legal advisor decides if the case merits seeking after on a possibility premise subsequent to evaluating the chances of being effective and what that achievement is probably going to mean as far as cash to the legal counselor and firm.

At PW Lawyers, as Disability Insurance Lawyers, we're always there for you. Contact us today for more details in regards to any Long Term Claims, long-term disability claims, short-term disability claims etc.

Long Term Disability insurance policies protect an employee from loss of income in the event that he or she is unable to work due to illness, injury, or accident for a long period of time. You have legal rights to financial and social support during such unforseen circumstances.

What is the "Waiting Period"?

A waiting period is the qualifying period the insurance company takes to clarify your policy. This period can range from 4 months to 52 weeks. However, in some claims, an employee can qualify for early intervention.

An early intervention is when the insurance company gets involved in your claim within a few days of incurring your injury.

What are time limits?

Time limits are the amount of time you have to file your claim. Each and every policy is different. If you occur any delays in your policy, it can change the outcome of your benefits.

What records should I provide?

Your insurance company will request from you a series of documentations for your application. As each insurance company is different, it is important you speak with your insurance provider for specifics. Most insurers request the following:

  • A physician statement
  • Employee's statement
  • Medical information
  • Employer's statement

*More documents may be required by your insurance company.

What types of disabilities are covered?

Each coverage varies from policy to policy. Usually, policies cover any type of injury or illness that prevents you from being able to work.

What reasons could terminate my Long Term Disability Claim?

There are many reasons you claim may be rejected or terminated.

Below is a list of the most common and possible reasons:

  • You are the age of 65 or attain the age of 65 (even though 67 is the new age of retirment)
  • You are in prison
  • You are retired or retire during the duration of the claim
  • Required documentation was not submitted
  • You recover fully before claim is processed
  • Refuse to participate in a treatment program
  • Fail to report for a medical examination
  • Start a new job
  • Refuse to continue application process
  • Death (in some cases your estate can receive a lump sum of your benefits)

My insurance company changed the definition of my disability and now I am no longer eligible to receive my benefits! What does this mean?

Since Long Term Disability is not standardized, your contract can be subjected to change. Usually, policies require that the insurance company pay for your benefits for two years, as long as you are unable to work your previous job. After the two year mark, your insurance company can stop your benefits unless you provide evidence that you are unable to work any job due to your disability.

My insurance company terminated my claim but I am not recovered to go back to work! What do I do?

Document and keep all records of your insurance company telling you about your termination. In many cases, policies require an objective tracking of evidence throughout your claim.

Objective evidence is physical evidence that supports your injury. Such evidence includes doctor visit documentation, test and imaging results, consultation documentation etc..

It is important that if your claim has been terminated and you are not ready to go back to work; you need to keep a paper trail and you will need to seek legal advice. The paper trail will act as evidence in your mounting case against your insurance company which has afterall, wrongfully terminated your claim while you are still recovering to resume employment duties

Does my age matter?

Yes.

The benefit period ends at the age of 65. With some insurance companies, if you are totally disabled at 65, your benefit can extend for 24 months before the age of 75.

You could be eligible for the Canada Pension Plan (CPP) disability benefit. The CPP disability benefit is available to those that have made a contribution to their CPP and who are not able to work regularly due to their disability.

I am part of a union, are the claims different for me?

Yes. Being a unionized worker means you have other factors to consider, compared to a group or individual insurance policy.

If you have a “self-insure” benefits package, you have entered into the Administrative Service Only (ASO) Agreement with the insurance company. This allows the insurance company to act as the administrator of your plan. The insurance company will process and cover all the significant steps in your claim.

When a claim is denied or terminated under “self-insure”, you are eligible under the Collective Bargaining Agreements (CBA) to dispute your termination or denial. This dispute will go through a hearing with the union.

Legal representation is required in these hearings. Speak with your Union Representative about this process to gain a full understanding.

My payable income has reduced significantly! Why?

Other sources of income during your claim can reduce the amount of payable income of your benefit. This may be due to direct and indirect offsets.

Below is a list of direct and indirect offsets:

Direct Offsets

  • Any income received by the government (Ex. Social Services such as Ontario Works)
  • Benefits programs including Canada Pension Plan (CPP), employee disability benefits (In Ontario, ODSP), Worker’s Compensation (WSIB)
  • Benefits paid under an auto insurance plan

Indirect Offsets

  • Retirement benefits linked to any employment
  • Canada Pension Plan (CPP) disability pension benefits payable to you by your dependants
  • Benefits payable from any association or other group benefit program
  • Income from any job or business for profit

If you have any questions, do not hesitate to call us for a free consultation at (905) 940-5554.


Paul Wilkins

Principal Partner

Paul is a member of the Ontario Trial Lawyer’s Association and the Advocates Society. Frequently involved in pursuing his clients’ claims, his areas of focus include statutory accident benefits, short term and long term disability benefits, disability claims and Canada Pension Plan disability benefits.

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