GENERAL INFO & BENEFITS

According to a survey conducted by the Royal Bank of Canada in July 2014 on disability insurance (moneysense.ca), one in three working Canadians during the course of their employment, will encounter a duration of disability which may last longer than 90 days. Apparently, 62% of employed Canadians have come across individuals who have had to take time off as a result of disability and approximately 25% Canadians have had to take time away from their place of employment due to their own disability.

According to another study conducted by the Canadian Payroll Association (CPA), more Canadians are now living their day to day lives from paycheque to paycheque, where savings are becoming less by the day and how Canadians are now lagging behind in reaching their retirement targets. According to this survey conducted in 2014, “51% would find it difficult to meet their financial obligations if their paycheque were delayed by a single week”.

Canadians, in general underestimate the importance of purchasing individual disability or having group disability insurance. Life is unpredictable and it is prudent to protect yourself from unforeseen events that can have devastating consequences on your life and such events can actually change your life forever. The Lawyers at our firm have seen clients who have been pushed to the brink of selling their homes and investment properties after being injured and only and only because, they did not have enough coverage or disability insurance to protect their income. Being involved in an accident or injuring yourself can have devastating and life altering consequences, if you do not have income protection or a disability policy in place and if you are not insured, your life style will completely change in the event of a disability.

Disability insurance, whether short-term, long-term, critical illness etc. can help secure and safeguard your family, your home, your investments from unanticipated illness, injury or an accident that may leave you in a position where you are incapable or returning to your place of employment and earn income. Disability insurance covers illness such as depression, anxiety, chronic pain etc. It is very common for an individual to become severely depressed after having gone through a traumatic event, such as losing a loved one and if you become disabled as a result of depression, anxiety or chronic pain, disability insurance can protect you in an unfortunate event as such.

Disability insurance, is part of your Employer’s Group Benefits Plan or it can be purchased individually depending on the type of policy being purchased. It is nowadays quite common for professionals such as doctors, lawyers, business executives to purchase ‘own occupation’ disability insurance in the event they are unable to return to their respective occupation.

The Canadian Life and Health Insurance Association (CLHIA) defines disability insurance as “A disability – whether it’s sudden or because of a degenerative condition – can rob you of your ability to earn a living. Disability insurance is a type of coverage that gives you protection against the chance of losing of income if you become disabled and you are not able to pay your expenses.”

As per a recent article published by the CLHIA (January 2018), group disability insurance plans offer 4.6 million Canadians with coverage for short-term disability and more than 10 million Canadians with long-term disability coverage.

Generally, disability insurance replaces between 60% and 85% of your regular income, up to a maximum amount, for a specified time if you:

  • temporarily can't work
  • are permanently disabled due to an injury or illness

Permanent refers to the nature of the disability. It does not mean that you'll get benefits for the rest of your life.

It is important for you to look into what kind of group benefits your employer has purchased for you. If you become injured or disabled, you cannot immediately apply for Long-Term Disability (LTD) benefits. There is usually a waiting period prior to being eligible for LTD benefits. Each employer plan is different. Some employers have no Short-Term Disability (STD) and in the alternative rely on the employee first applying for Employment Insurance (EI) benefits and upon exhausting their EI benefits, can they apply for LTD. Short-Term Disability plans can offer from 50% to 70% of your of your monthly pay and can extend for up to 15 or 26 weeks.

You can be eligible for Long-Term Disability benefits (LTD) once you have satisfied the waiting period or elimination period criteria. This can last for up to 60 days, 90 days or 180 days and coincides with EI and STD benefits. Every LTD policy is different and coverages for replacing income are different. Most LTD policies provide up to 60 to 85% of your regular income. If eligible, you can receive LTD benefits for up to 2 years for the percentage amount specified in your policy if you are unable to do the tasks of your employment, this test is known as the ‘own occupation’ test. You can continue to receive LTD benefits beyond the 2 year mark (date of disability), if you satisfy the ‘any occupation’ test. ‘Own Occupation’ test means you are incapable of performing the essential duties of your own employment. The ‘Any Occupation’ test means you must convince your LTD insurer that as the claimant you are prevented from performing any occupation for which you would be reasonably suited by means of your “training, education, and experience”, this is a subjective test and not an objective test.

Unfortunately, a significant number of plausible and genuine claims are denied by disability insurance companies. If your disability insurer has wrongfully denied your Long-Term Disability claim, then you can rely on the lawyers at our firm to passionately advocate for your rights and hold these insurance companies responsible for their wrongdoings, and if required, even sue them for aggravated and punitive damages and thereupon force them to abide by the terms of the policy.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


SHORT-TERM DISABILITY (STD)

Short-Term Disability (STD) benefits coverage is meant to compensate employees for lost revenue as a result of short-term absences from their place of employment due to illness, injury, sickness or disability. You may continue to receive disability payments as long as you meet the definition of total disability as per your policy. In general, what this means is that you are ‘totally disabled’ for your own occupation up to the maximum benefit period as defined in your policy. Short-Term Disability coverage typically provides benefits for up to a maximum of 6 months while you are disabled. The definition of total disability and the maximum benefit period definitions can be found in a benefits booklet provided by your employer.

Contingent upon the type of STD policy your employer has purchased for you, there are other requirements you may have to meet in order to continue receiving disability benefits. Insurers usually require the claimant to mitigate his or her damages. Insurance companies require you to continue seeking new employment opportunities, pursuing proper or attempt to return to work on modified duties. Some insurers have unreasonable and unrealistic requirements from disabled individuals and just because your insurance company says you have to do something, it doesn’t necessarily mean that they are right, always check with a lawyer to ensure that the insurance company is actually in compliance with the law.

Short-Term Disability benefits are based on a specific percentage of your weekly income from the date of disability. The benefit amount as per your plan can be found in the benefits booklet provided by your employer. STD benefits are usually paid to the claimant on a weekly basis. If your employer has a STD plan, the claim must be made through your disability plan. Note that the waiting period for STD benefits cannot be more than 7 consecutive days. Further, make sure that the STD benefits you receive must be at least equal to the amount of benefits an employee would receive from the Employment Insurance (EI) Program.

For example, the basic EI benefit rate is 55% of a claimant’s average insurable earnings, up to a yearly maximum insurable amount of $51,700 in 2018. This means that claimants can receive a maximum payment of $547 in EI benefits per week. Therefore, for 2018, the STD plan must provide at least 55% of an employee’s normal weekly insurable earnings, to a maximum of $547. When calculating insurable earnings, employers must include any additional employment income the employee has earned on a regular basis, such as overtime, bonuses and shift differentials.

If you are a victim of your disability insurer wrongfully denying your STD claim, then you can rely on the lawyers at our firm to assist you and advocate passionately for your rights. We can guide you right and lay out your proper options for you.

At UL Lawyers Professional Corporation, if your Short-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


LONG-TERM DISABILITY (LTD

According to a survey conducted by the Royal Bank of Canada in July 2014 on disability insurance (moneysense.ca), one in three working Canadians during the course of their employment, will encounter a duration of disability which may last longer than 90 days. Apparently, 62% of employed Canadians have come across individuals who have had to take time off as a result of disability and approximately 25% Canadians have had to take time away from their place of employment due to their own disability.

According to another study conducted by the Canadian Payroll Association (CPA), more Canadians are now living their day to day lives from paycheque to paycheque, where savings are becoming less by the day and how individuals are now lagging in reaching their retirement targets. According to this survey conducted in 2014, “51% would find it difficult to meet their financial obligations if their paycheque were delayed by a single week”.

The Canadian Life and Health Insurance Association (CLHIA) defines disability insurance as “A disability – whether it’s sudden or because of a degenerative condition – can rob you of your ability to earn a living. Disability insurance is a type of coverage that gives you protection against the chance of losing of income if you become disabled and you are not able to pay your expenses.”

As per a recent article published by the CLHIA (January 2018), group disability insurance plans offer 4.6 million Canadians with coverage for short-term disability and more than 10 million Canadians with long-term disability coverage.

You can be eligible for Long-Term Disability benefits (LTD) once you have satisfied the waiting period or elimination period criteria. This can last for up to 60 days, 90 days or 180 days and coincides with EI and STD benefits. During the elimination period and for the first 2 years, you are considered totally disabled if sickness or injury prevents you from performing the essential duties of your regular occupation, you are under the regular care of a physician and you are not gainfully employed elsewhere, this test is known as the ‘own occupation’ test.

You can continue to receive LTD benefits beyond the 2 year mark (date of disability), if you satisfy the ‘any occupation’ test. The ‘Any Occupation’ test means you must convince your LTD insurer that as the claimant you are prevented from performing any occupation for which you would be reasonably suited by means of your “training, education, and experience” and you are under the regular care of a physician and you are not gainfully employed elsewhere. This is a subjective test and not an objective test.

Unfortunately, a significant number of plausible and genuine claims are denied by disability insurance companies. If your disability insurer wrongfully denied your Long-Term Disability claim, then you can rely on the lawyers at our firm to passionately advocate for your rights and hold these insurance companies responsible for their wrongdoings, and if required, even sue them for aggravated and punitive damages and thereupon force them to abide by the terms of the policy.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation


EMPLOYMENT INSURANCE (EI) BENEFITS

The Employment Insurance (EI), commonly known as the EI program provides temporary financial assistance to workers who are unemployed. The program includes providing sickness benefits to individuals who are unable to return to their place of employment as a result of a sickness, injury or quarantine. If you cannot return to your place of employment as a consequence one of these three reasons, then you may be eligible to receive up to 15 weeks of EI sickness benefits.

You may be entitled to receive EI sickness benefits in the following scenarios:

(i) You have been employed in insurable employment;
(ii) You meet the specific criteria for receiving EI sickness benefits;
(iii) Your normal weekly earnings have been reduced by more than 40%; and
(iv) You have accumulated 600 hours of insurable employment during the qualifying period.

EI sickness benefits are available only to those individuals who are not able to return to their place of employment as a result of sickness, injury or quarantine but otherwise would be able to work if not for their incapacity due to their medical condition. To receive sickness benefits, you must obtain a medical certificate from your treating physician or your approved medical practitioner.

The basic rate for calculating EI benefits is 55% over your average insurable weekly earnings, up to a maximum amount. As of January 1, 2018, the maximum yearly insurable earnings amount is $51,700, which means you can receive a maximum of $547 per week. EI sickness benefits can be paid for a maximum of 15 weeks, contingent upon how long you are unable to return to your place of employment.

*The above information has been obtained from Service Canada and is updated on an annual basis. Our law firm does not assist individuals with EI sickness benefits claims. To verify the above information, we ask that you please visit www.canada.ca/en/services/benefits.ei.html

The above information has been provided on our website for the sole purpose of assisting our clients who do not have disability benefits during the elimination/waiting period for Long-Term Disability benefits.


APPEAL PROCESS

It is common practice for disability insurers to deny disability claims at the onset of a claim. You would be surprised as to how many claims go unchallenged and individuals end up forcing themselves back to work, either because they have not been informed of their legal rights or because they think that they have no other option and eventually in the due course of time, they end up causing greater harm to themselves by exacerbating their injuries due to lack of recovery..

When your claim is initially denied, your disability insurer will provide you with a package outlining the internal appeal process. Strictly speaking in our opinion, unless there are egregious circumstances, after filing the appeal and the insurer having reconsidered their position with respect to your entitlement, the disability insurer will give you the run around and continue to still deny you your claim. In fact, in this complex process of appeals, claimants at times end up missing out on limitation dates and lose the right to sue their insurer. This is something you need to be aware of and not let yourself become a victim of this vicious cycle.

Every disability insurance company has their own way of handling internal appeals and have different ways of determining whether to accept or deny the appeal. At times, they will first deny your initial claim, then deny the appeal and then give you the option to appeal again. We find that most of our clients are victims of this run around appeals process. In our opinion, attempting to appeal your denied long-term disability claim can be a sheer waste of time. It is always best to ask for legal guidance, so you can know what your rights are in general. In fact, individuals whose claims have been denied think that are required to first exhaust the appeals process before being able to sue the disability insurer and that is incorrect. The minute your claim is denied by your long-term disability insurer, you can commence a claim.

In situations where you failed to provide a proper Plan Sponsor Statement or a Physician Statement or inadequate information has been provided to the insurer by you or your treating physician, it would be logical to appeal your denied claim. However, in situations where the test change comes into play, from your ‘own occupation’ to ‘any occupation’, or a situation where your disability insurer referred you to a specialist of their choice and upon receiving the report, the insurer decides to terminate your benefits, or where the insurer has all of a sudden written to you advising you about some ‘exclusion clause’, there is no point in attempting to appeal the decision, you will just cause yourself unnecessary emotional harm, stress, frustration, anger and may even exacerbate your medical condition.

If your disability insurer has wrongfully denied your Long-Term Disability claim, then you can rely on the lawyers at our firm to passionately advocate for your rights and hold these insurance companies responsible for their wrongdoings, and if required, even sue them for aggravated and punitive damages and thereupon force them to abide by the terms of the policy.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


LONG TERM DISABILITY DENIED AFTER APPEAL

You have done everything that your disability insurer asked you to do, you were truthful in your Member’s Statement/Plan Sponsor Statement, your doctor or treating physician provided your insurer with a detailed explanation as to why you are incapable of doing your own employment or any kind of employment, your family doctor is completely supportive of you being off work and so is the specialist you are seeing, however despite this significant medical evidence you provided to your insurer, your claim has still been denied. Not to mention, you went through the cumbersome process of making two or three reconsideration appeals and you’re either not receiving a response or the answer is still the same.

Our advice is that you not let your long-term disability insurer take advantage of your vulnerability and take you on a ride. We recommend you stop giving the insurer the benefit of doubt and contact our office immediately for a free consultation. After having assessed your claim, we can give you direction on what the right course of action you should take.

If your disability insurer wrongfully denied your Long-Term Disability claim despite you going through the appeal process and providing everything the insurer asked for and your claim has still been denied, then you can rely on the lawyers at our firm to passionately advocate for your rights and hold these insurance companies responsible for their wrongdoings, and if required, sue them for aggravated and punitive damages and thereupon force them to abide by the terms of the policy.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


CPP DISABILITY SET OFF

So your long-term disability claim has been approved for over a year and you are now receiving mail or telephone calls from your disability case manager asking you to apply for Canada Pension Plan (CPP) benefits. You are probably asking yourself, why do I need to do this? They already know that I am disabled, why do they continue making my life difficult? What is the point of this? Is my disability insurer legally allowed to ask me to apply for CPP Disability benefits?

The answer to the above is, yes, your disability insurer is allowed to ask you to apply for CPP Disability benefits. Every Long-Term Disability policy has a clause that allows disability insurance companies to ask the insured to apply for CPP Disability benefits and your disability insurer is entitled to offsets or deductions from additional benefits you receive. LTD benefits are usually reduced by any benefits you may receive from CPP, QPP or WSIB.

The next question that comes to your mind is, well if my insurer is going to benefit from this offset and my LTD monthly benefit is going to be reduced, why should I have to apply? The reason why you have to apply is because is it a part of your policy and contract with your disability insurer and if you do not comply, your insurer can terminate your benefits. At times, insurers may avoid terminating benefits but at their own discretion, on an estimated basis, reduce your LTD benefits unilaterally, which is something they are not allowed to do. As you continue to read below, you will see how being approved for CPP Disability benefits can be advantageous to you.

It is our recommendation that you comply with your insurer when asked to apply for CPP Disability benefits. The process is quite simple and we highly recommend that you do it on your own to avoid paying any additional fees to us or for that matter to any other lawyer. Please visit https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit/apply.html for more information on how to apply for CPP Disability Benefits.

As mentioned above, it is imperative that you be advised of the advantage of being approved for CPP Disability Benefits. In order for you to be eligible for CPP Disability benefits, there is a disability test you have to meet, and the test is, “You must suffer from both ‘severe’ and ‘prolonged’ disability and it must prevent you from being able to work at any job on a regular basis. ‘Severe means’ that you have a mental or physical disability that regularly stops you from doing any type of substantially gainful work, while ‘Prolonged’ means that your disability is long-term and of indefinite duration or is likely to result in death”.

If approved for this benefit, it means that Service Canada views you as a disabled individual who cannot perform any type of work. It is common for disability insurance companies to discontinue LTD benefits close to the 24 month mark, when the definition changes and despite being cognizant that you have been approved for CPP disability benefits, they will still cut you off. The leverage you enjoy is that Service Canada agrees you are disabled, then who is your LTD insurer to say that you are not disabled? If this matter were go to go trial, how would a jury view the insurance company in light of Service Canada approving your CPP Disability benefits? Yes, your benefit will be reduced but at the same time, you can be given the security that you will continue receiving benefits from your LTD insurer.

Lastly, if successful, be advised that your LTD insurer is entitled to any retroactive payments that you receive from Service Canada, which means that you are eligible to receive CPP Disability benefits the fourth month after the month you are determined to be disabled by Service Canada. It usually takes four months or more for the adjudicator to determine that you are actually entitled to CPP Disability benefits. So when you are successful and your benefit has been approved, you can expect to receive a cheque for retroactive CPP Disability payments. We understand that you are already taking a hit in terms of your income and you do the need the money and it will hurt paying the disability insurer this cheque you just received, however we recommend you do the right thing and abide by the terms of the policy, so you can maintain your credibility and integrity. There is no need to give your disability insurer the opportunity to impugn your character.

At our firm, we do assist individuals in all of Ontario whose CPP Disability claim has been denied. However, we always recommend you attempt to apply for the benefit on your own and if denied, then we can assist you. If you are not comfortable applying on your own, then we would be more than happy to represent you and advocate for you. For more information, please visit the CPP Disability page under Practice Areas on our firm’s website.

At UL Lawyers Professional Corporation, if your CPP Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15. Or in the alternative, we may charge a flat fee or a percentage amount at the time of the decision in writing or judgment. If we are retained for your denied Long-Term Disability Claim and consequently retained for your CPP Disability claim and upon being successful in obtaining this benefit for you, retroactive payments are made to the LTD insurer, then our legal fees for your CPP Disability claim will be charged at the time of settlement or judgment of your LTD claim.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


WHEN SHOULD I RETURN TO WORK?

At UL Lawyers Professional Corporation, we always advise our clients to speak the truth. You do not want to misrepresent facts to your insurance company and neither is there a point in hiding information which you know they will catch on to and if you get caught lying or misrepresenting facts, you will harm your claim as you will erode your credibility and that is the last thing you want. If you are of the opinion that you can now finally return to work or at least return to work on a gradual basis, on modified duties or your full-time duties, you should speak to your treating physician or specialist, obtain his or her approval and advise your insurance company that you are going to make an attempt to return to work.

After returning to work for a few days, weeks or months, if you are of the opinion that your injury or disability has started to appear again, we recommend that you immediately get in touch with your treating physician or family doctor and advise him or her or health problems. If your physician is of the opinion that you should take time off work again, be sure to obtain this opinion in writing and provide it to your case manager that has been assigned to you by your disability insurer.

The next question that probably will come to your mind is, ‘what if I return to work and in a few months I become disabled again and cannot carry on working, do I then have to start the process of applying for LTD from the beginning?’ Well if that is the case you need not worry. Most Long-Term Disability Insurance policies have a clause that protects to you in such an event. In most policies, there is a 6 months period that you can reply upon in the event your disability or injury appears again. In simple words, if you return to work and within 6 months you become disabled again, then you rely on the initial application you filed for Long-Term Disability. If you are passed the 6 months period and you continue to work for longer than 6 months, it is most likely that you will have to start the process from the beginning.

It is imperative that you be cognizant of the fact that you are at all times under an obligation to mitigate your damages, which means that you should be making a constant effort to improve your health and circumstances. Think about it, if your insurer continues to deny your claim and eventually your dispute with the insurer goes to trial, who would a jury like? Would they like someone who has never made any attempt to return to work? Or would the jury like someone who has made a genuine attempt to return to work but eventually succumbed to his or her injuries and could not work? We shall let you decide, which category you would fall under.

The best advice that we can give to disabled victims is to continue to have your injuries and concerns documented with your treating physician, doctor, specialist, counsellor etc. Be vocal about your problems and how and why you are prevented from doing your own occupation or any occupation. Having a supportive treating physician is the key to holding the insurer accountable for failing to abide by the terms of the Long-Term Disability policy.

If you are in a situation described above and are looking to seek guidance, then we recommend you contact the lawyers at our firm immediately for a free consultation and case evaluation.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


WHAT IF I CAN’T RETURN TO MY JOB?

At UL Lawyers Professional Corporation, it is our advice to prospective clients and existing clients that you should always make a genuine attempt to return to work, however, before doing so, it is imperative to seek clarification and the approval of your treating physician. Only return, if your treating physician agrees.

We highly recommend that you not form an opinion of not being able to return to work without making an actual attempt on a gradual basis or modified basis. However, if you have sustained serious injuries in a car accident for example numerous fractures all around your body or in a work place accident had an extremity amputated, then the story is different as it will be obvious that you cannot return to work.

If you are unable to return to work, we recommend that you look for ways to mitigate your damages. If your doctor has asked you to attend therapy or made certain specific recommendations, then make sure you follow through with them.

If despite make genuine attempts to get your life back on track you have still succumbed to your injuries and your insurer continues to deny your long-term disability claim, we ask that you call the lawyers at our firm now for a free consultation and case evaluation.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


WHAT IS MY LONG-TERM DISABILITY (LTD) CLAIM WORTH?

There are numerous factors that come into play in determining what your long-term disability benefit is worth. Factors such as your annual income, monthly income, type of policy, who paid the premiums, did you ever receive LTD benefits, if you did receive LTD benefits then what stage they were terminated at, whether you have been approved for CPP Disability benefits etc. need to be taken into consideration.

The first step you need to take is, look at the benefits booklet provided to you by your employer and determine the percentage amount you would be entitled to if approved for long-term disability benefits. Benefits can range from 60% to 85% of your monthly income. Secondly, you need to determine who paid the premiums for Long-Term Disability premiums? Were these premiums deducted from your salary or did your employer pay for them? If you paid for the premiums then your benefits are not taxable, however, if your employer paid for premiums, then your benefits are most likely taxable. Then we need check for any deductions or offsets that your policy mentions. In all Long-Term Disability policies that we have come across, Canada Pension Plan (CPP) Disability benefits are a set-off if approved for the benefits. If approved for CPP disability benefits, then the amount that you are approved for, will be deducted from your monthly LTD entitlement.

After the proper value of your benefit is determined, we would need to look into at what stage your claim was denied. Were you ever approved? If approved then for how long? Were you benefits just approved to the 24 month mark or beyond change of definition? Depending on where your claim stands only then can the estimated value be determined.

If your insurer denied your long-term disability claim, there are two ways in which it can settle. After you have commenced a legal action in court, the insurer will review their file and reconsider and agree to pay you all the arrears, disbursements and costs of the legal action. The second way in which your insurer may settle the claim is on a lump sum basis where they settle your claim on a full and final basis.

It is imperative to have a lawyer who is well educated and experienced in this field. At times during settlement negotiations, insurance companies tend to secretly insert a clause the settlement documents, that in the event you are to ever return to work or are ever able to return to work with a new employer, and this new employer has benefits with the same insurance company you entered into litigation with, then this disability insurance company will never insure you again. The lawyers at our firm are well acquainted with such situations and will get out of their comfort zone to ensure that you are given a fair settlement and not barred from being insured again and if so, then only for the number of years you are expected to not return to any kind of employment. Moreover, the lawyers at our firm can advise you as to whether you should even accept a lump sum settlement or just have the insurer pay off the arrears or whether you should proceed with the matter to trial.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.


HOW LONG DOES IT TAKE TO SETTLE MY LONG-TERM DISABILITY CLAIM?

The answer to this question is, well it depends where your claim stands. Have you submitted the initial application and paperwork requested by your disability insurer? Have you applied for the internal appeal process? Did you receive disability benefits for a few months and then all of a sudden denied by your insurer? Have you already applied for CPP Disability benefits?

It is imperative that you be aware of the fact that your long-term disability insurer is under no obligation to settle your claim on a full and final basis. If your claim has merit and your injuries meet the definition of disability, your insurer can choose to settle in two ways, the first by simply paying the arrears, legal costs and disbursements of the action you commenced and then keeping your disability claim open and continue monitoring it and reassess at a later future date or by offering you a lump sum payment.

If you commence an action in court against your disability insurer for denying your long-term disability benefits, the litigation process can be long and lengthy. After your lawyer will issue a Statement of Claim (a legal document that outlines the allegations against the defendant, in this case your disability insurer) in the Ontario Superior Court of Justice on your behalf, a process server will be hired to serve the claim upon your insurer and upon being served, the insurer has 20 days to file their Statement of Defence. After the insurer files and serves the Statement of Defence, documents between both parties are exchanged. At times insurance companies do not provide all the documents in their possession (called Affidavit of Documents) and motions may have to be brought in court to compel the insurer to disclose all documents. Further preparing the claimant’s Affidavit of Documents can be a lengthy process as all relevant medical documentation has to be requested from doctors, hospitals etc. as these records speak to the evidence of your disability. Simultaneously discoveries (examinations) are scheduled and both parties have the opportunity to question each other. The case manager who denied your claim is examined by your lawyer and since you are the one making the claim, the insurer has the right to examine you and question you as to why you are unable to work. Not to worry, your lawyer sits beside you during this process of questioning. During examinations, the lawyers for the insurer will request additional documentation they may require to assess your claim further, which are called ‘undertakings’. Your lawyer during examining the adjuster or case manager for the insurer will request undertakings as well. It can take up to 60 to 120 days to satisfy all undertakings. Matters can further be delayed if motions need to be brought against the insurer or a third party that is refusing to provide requested documentation. Once the undertakings are satisfied, the next step is Mediation, however mediation is not necessary in all jurisdictions. If your insurer is genuinely interested in resolving your claim, then they will proceed to mediation.

At times, disability insurers prefer to go straight to mediation and not even proceed to discoveries. Each claim is different and has its own merits and shortcomings and therefore it is difficult to provide an exact time frame. If your claim does not settle at mediation, the next step would be filing for Pre-Trial and if that matter does not settle at the Pre-Trial Hearing, then you are headed to trial and that can take up to several years.

At UL Lawyers Professional Corporation, if your Long-Term Disability claim has been denied, we will work for you on a contingency fees basis, which means there are no upfront retainer fees that have to be deposited with us. We will initially pay for all your disbursements and any court costs. Upon settlement or judgment, fees will be calculated on the amount of recovery and not on disbursements or costs recovered in accordance with the Solicitors Act R.S.O. 1990, CHAPTER S.15.

Call us now at 18333-LTDLAW or email us at info@ullaw.ca for more information or a free consultation.