Having your long-term disability benefits either wrongfully denied or wrongfully terminated can be devastating. The lawyers at MacIsaac & Company have years of experience working with long-term disability providers. If your long term disability insurer has denied your claim, terminated your benefits, or has advised you that your benefits are ending on a certain date, we can assist in ensuring you receive the benefits you are entitled to.
Long-term disability benefits or “LTD” provides you with income should you become totally disabled due to an illness or injury and are thus unable to work. Typically long-term disability policies are available to individuals through their employment by way of a group plan. Or, individuals may purchase private insurance. Long-term and short-term disability policies are often grouped together. Short-term coverage typically provides you with income for the first six to 12 months of disability, and after that, if your disability continues, your long term coverage commences.
Long-term disability coverage contracts are not standardized. The requirements, wording and benefits vary from insurer to insurer and policy to policy. In order to receive benefits, policies often stipulate you need to be “totally disabled.” The insurer will require medical evidence to support your disability claim. Usually, this evidence will be provided by your family doctor on a periodic basis in a form provided by the insurer. Typically, at some point the insurer will require you to be assessed “independently” by a doctor of their own choosing, and often this will result in termination of benefits.
Long-term disability policies usually require the insurer to pay benefits for two years after you become disabled from your own occupation. It is at this two-year point that benefits are often terminated, because under most plans, the definition of “total disability” changes. In order to keep receiving benefits after two years, you must provide medical evidence proving that you are unable to work at any job for which you are reasonably suited on the basis of your education, training and experience, not just the job you held at the time you became disabled.
Insurance companies may investigate you and your claim under the guise of prevention of fraudulent claims. You must disclose all relevant information during this process. Though the insurance company cannot violate any laws, they are permitted to take pictures and interview your neighbours, former co-workers and friends. Insurance companies may use certain information to justify termination of your benefits, while disregarding information that supports your ongoing disability. For instance, if taken out of context, photographs or video evidence may suggest you are more physically capable than in fact you are.
Most people have no way of responding to an insurance company’s tactics. These claims are complex and a power imbalance often arises between you as the insured and your policy provider. Further, these claims are subject to strict time periods regarding when legal action can be taken. Your MacIsaac & Company lawyer has the skill and resources to address the complexities of your disability claim and to level the playing field between you and your insurer. If you are entitled to long-term disability benefits, we will ensure you get them.