Long Term Disability Lawyer Halifax

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Short-Term Disability (STD) and Long-Term Disability (LTD) insurance are programs that replace a portion of, or in some cases all of your, lost wages when you become disabled from work. Generally, employees and employers contribute to these plans jointly and are part of an employee’s benefits package. Short-term and Long-Term Disability plans are not straight forward and vary from plan to plan. This can become frustrating for the insured who is now injured, unable to work, and trying to navigate a complex insurance policy. Insurance companies often make it difficult to access or maintain these benefits that you’re owed. In many cases, valid claims are rejected leaving someone unable to return to work, and without any replacement income. Wagner’s can help you navigate your claim and  appeal your denial, and if required, start a lawsuit. A denial can leave you and your family emotionally and financially devastated. Wagners Law Firm works on a contingency fee model, meaning we pay all the up-front costs to fight your appeal and if we are unable to help, you don’t pay any fees. Our LTD lawyers have the skill and knowledge to present your LTD claim efficiently and effectively and we’ll work hard to get you the compensation you deserve.

What is Short-Term Disability Insurance and “Your Occupation”?

Short Term Disability Insurance is a type of disability benefits that provides income replacement in case a person is unable to work for a short period of time due to injury, illness, or hospitalization. In Canada average STD policy lasts from 3 to 6 months, some may last up to 2 years depending on a policy.

Disability is defined as the inability to do the substantial duties of your own occupation, as opposed to all occupations, and will entitle you to Short-Term Disability. However, some policies may require that you first exhaust any sick days you are entitled to and/or Employment Insurance Sickness Benefits (55% of your gross insurable earnings). If your employer has a short-term disability plan, your claim must be made through your disability plan. According to Financial Consumer Agency of Canada, employers aren’t required to provide paid sick leave and each employer is different.

What is Long-Term Disability Insurance and “Any Occupation”?

Most LTD benefits in Canada will cover up to 60%-70% of your official income, although each insurance policy is different. Usually LTD benefits last up to 2 years, after that you may continue receiving them only if you are disabled from all occupations, taking into account your age, education, and experience.

Generally, once the Short-Term Disability period ends you maybe entitled to Long-Term Disability. Depending on your policy, Long-Term Disability may provide more or less wage indemnification than Short-Term Disability, but generally the payments increase. Notably, the transition from Short-Term Disability to Long-Term Disability is when insurers will deny your claim. Even if you have documentation from your physician, stating you are disabled from all occupations, insurers may still dispute your disability and entitlement to Long-Term Disability.

Proof Of Disability

The Insurer will not just blindly approve your claim, they put pressure on the insured to provide all the documents necessary to prove the veracity of their disability. Even after disability is proven, the insurer will need additional information to understand the extent of the disability. The process of proving disability often includes your doctor or one or more medical specialists depending on your disability. It is important to submit all medical records illustrating your treatment and disability to the insurer within the correct time frames. Even after your benefits are approved, the insurance company will continue to monitor your medical condition to ensure there’s still ongoing proof of disability. This includes calling you for updates or requesting a medical review from time to time. This is most prevalent when you are younger or if the insurer expects your medical condition to improve over time.

It is possible to be employed while on long-term disability. As long as your employer doesn’t terminate the employment you can keep working. In most cases, an employer won’t risk terminating an employee on long-term disability (it is difficult to prove that termination is not based on disability).

Objective Evidence

Some conditions (ex. Post-Traumatic Stress Disorder (PTSD),  Multiple Sclerosis (MS), Chronic Pain, Depression, Anxiety, fibromyalgia, or migraines) often cannot be proven or be fully proven by “objective evidence”:

  • X-ray test results
  • MRI test results
  • CT scans
  • Blood panels
  • Nerve testing
  • Clinical notes from physician

These conditions are largely diagnosed on the subjective complaints and observations of the insured. Insurers will often deny claims on the basis they have not been provided “objective evidence” of your disability. This is an often used tactic by insurers to deny claims. Notably, there is no requirement that an insurer requires objective evidence to determine if an insured is disabled. In these scenarios, you should asked the insurer what type of “objective evidence” they are looking and then follow up with your medical providers to see if it is even possible to provide this evidence..  Often, in these types of scenarios credibility of the insured becomes more important. As these types of conditions are often based on self-reporting, insurers maybe be more likely to comb through your social media accounts or hire private investigators to surveil you.

Bear in mind, that setting your social media account privacy settings doesn’t guarantee you won’t produce them. The Court might ask you to do so if the insurance company will prove the document is relevant, and thus important.

Effect of Other Disability Benefits on Short-Term and Long-Term Disability

Typically, Short-Term and Long-Term Disability policies provide “set offs” regarding entitlement to other disability programs, such as Canadian Pension Plan Disability or a Workers’ Compensation scheme. If you fail to apply for these benefits, the insurance company may estimate and deduct the benefit amount from your payment.

Limitation Period for Suing your Insurer

The limitation period is the time limit in which you must sue your insurer. Generally, provincial limitation periods are either one-year or a two-years. However, some policies provide for a longer limitation period than that set by provincial legislation. Insurance policies can only extend limitation periods—not shorten them. The question around what limitation period applies to your claim is further complicated by when this period starts.  Generally, the limitation period will run when you first receive the first denial of benefits, even if the insurer gives you the opportunity to appeal their decision and/or submit further evidence.[1] However, there are some scenarios where the limitation may not run until by the insurer’s  actions and correspondence “clearly and unequivocally denie[s]” the claim.[2] Knowing which limitation period applies to your claim and when the limitation period starts to run is key to suing your insurer.

What to do if you are Denied Short-Term or Long-Term Disability?

  • If you have received a denial the first thing you should do is determine what limitation period applies to your claim, see the section on Limitations Periods above.
  • The second thing is to assess in what manner to appeal the decision. Generally, you can either appeal the decision by using the internal appeal system of the insurer or appealing via a lawsuit. Notably, in some instance you may not be able to sue an insurer at all, this is often part of policies negotiated in collective agreements. In place of being able to sue it may be that the last level of appeal is to a tribunal.
  • The third thing is to determine why the insurer denied your claim and what evidence is required to prove your disability. In some cases, you may need to hire a medical practitioner to review all your medical evidence and subjective complaints to provide an expert opinion. In other cases, your may need have a functional capacity evaluation conducted to objectively show your physical limitations.

Appealing a decision can be complicated, time consuming, and expensive. Appealing a decision is complicated by that fact you must determine which limitation period applies to your case and if you are able to sue your insurer.  An appeal can be time consuming in that you may need to collect all relevant medical evidence or other objective evidence. An appeal can be expensive as generally you will have to pay for medical charts and, if needed, medical opinions (ex. Independent Medical Evaluation (IME) or Functional Capacity Evaluation (FCE). Wagner’s can help you navigate this complicated, time consuming, and expensive process. As with all claims we take on, Wagner’s will pay the up-front costs of your medical records, IMEs and FCEs.

Reinstatement of Benefits vs. Lump-Sum Payment

If you are successful in appealing a denial, often an insurer will issue you a retroactive payment (usually from the date of denial to re-instatement) and will thereafter provide monthly payments. In some instances, an insurer may propose a lump-sum payment of future benefit payments. In the case of long-term disability, generally this is because the insurer views you as being disabled from all occupations. This is an advantage to the insurer as they do not have to have an insurance adjuster constantly reviewing your claim. A lump-sum payment can also be advantage to the insured, as they no longer are required to communicate with the insurance company. Further this often brings a sense of closure and decrease in stress. The insured is then free to pursue a job or some other form of income generation without fear of reprisal by the insurance company. Lump-Sum payments in regard to future benefits are traditionally assessed on the basis of “present day value”: an amount of money if invested at a set rate will result in the total amount of future monies. Future-amounts that are settled in lump-sum payments are tax-free.[3]

If you agreed to Lump-Sum payment, the insurance company won’t take the money back, if you pass way. Therefore, your family will receive most of the value of the policy of something fatal happens to you.

[1]Sun Life Assurance Company of Canada, 2020 ONCA 11

[2] Kassburg v. Sun Life Assurance Company of Canada, 2014 ONCA 922

[3] Tsiaprailis v. R., 2005 SCC 8

Disability lawyers are legal professionals who work on disability-related claims. Even though there’s no required certification to become a disability lawyer and any qualified lawyer can offer this service, it’s important to do your due diligence and hire a professional who is experienced in this field of law. Disability claims can be complex to resolve and require experienced hands from start to finish.

If you have a disability that has resulted in being unable to work, you need a lawyer to fight for your case and provide the financial security you deserve. A disability lawyer can come in if you’ve been denied benefits or you need your payments approved faster than when handling the claim on your own. If you need to appeal a denied disability claim but not sure where to start, hire a lawyer who is experienced in similar cases.

Disability lawyers help resolve the legal technicalities that may cause your claim to be denied. Many applicants are denied their benefits because of questions that arise regarding their work ethic and motives. A disability lawyer will focus on winning your claim by identifying the best strategy to align your entire story with the beliefs of the decision-makers. An experienced disability lawyer will communicate with the insurance company and identify any red flags that may result in your claim being denied. The lawyer will help prepare all the necessary paperwork, file the lawsuit, and head negotiations with the required parties to ensure a successful claim.

There are two major differences between group and individual disability insurance. First, when making premium payments for group disability insurance, there’s a high chance that the amount of premiums will increase during annual renewal. However, with individual disability insurance, the premium amount doesn’t change. Additionally, group disability insurance costs less because there’s a reduced level of risk involved compared to individual coverage.

Premiums for individual disability insurance are paid by the individual who is looking for protection in the event of an illness or injury that results in time off work and lost wages. If you take an individual plan, you have the flexibility to choose different policy options that may not be available in a group plan. Additionally, the benefits paid out in an individual disability cover are often tax-free if paid from personal income. This policy cannot be cancelled without your permission.

On the other hand, group disability insurance is purchased by an employer as a working benefit to employees. Businesses and companies that offer group disability insurance will pay premiums via paycheque deductions or through the employer’s contributions.

Both options provide coverage for long- and short-term disabilities, but the maximum number of benefits awarded will vary depending on the policy.

If you’ve sustained injuries or you have an illness that lasts for more than a year and prevents you from being able to work, you may qualify for long-term benefits. The condition can be physical, mental, or emotional. It may not be a single condition but multiple injuries or symptoms that affect your ability to work. At Wagners, we work with reliable medical professionals to ensure you get a proper prognosis of your condition and show how the disability has affected your future employment and income sources.

The main difference between short- and long-term disability insurance lies in the period for which the benefits are offered. Short term disability insurance is designed to replace your missing income for up to 6 months. Long term disability insurance, on the other hand, can last for many years. You can apply for LTD benefits to last for 2-, 5- or 10-year periods or until you reach retirement age.

Short term disability benefits are considered a short-term replacement to your wages since they are meant to supplement the temporary duration you’ve had out of work. However, long term disability benefits are designed to supplement your long-term income if the injury or illness completely prevents you or decreases your ability to return to employment over a longer period.

To begin with, you will need to provide some standard basic information on your disability claim form. This includes your full names, gender, date of birth, address, telephone number, and insurance policy number. Additionally, you will be required to provide your bank details, list of healthcare providers, and your medical history that’s related to the disability as well as your employment information such as source of income, employer name and how much you earn.

The disability claim forms vary from one insurance company to another. These forms must be completed by the insured as well as the treating physician. You will often be required to provide additional information about your injury or illness, such as how it occurred, the symptoms that are preventing you from returning to work as well as how it has impacted your day-to-day lifestyle.

When disability insurance is provided for up to 6 months, it is often regarded as short-term disability insurance. Long term disability insurance, on the other hand, often begins when the individual no longer qualifies for short term benefits and unemployment insurance. These benefits are paid in the event that you are disabled and can no longer work. There are other forms of disability insurance, such as a non-cancellable policy, which the policyholder retains control, and the insurance company cannot cancel.

There are different forms of long-term disability coverage. Some individuals have long term disability coverage paid by their employer as part of their paycheck contributions. Sometimes the employer purchases LTD coverage through a private insurance company. Some businesses pay LTD coverage for their employers as part of workers’ benefits.

The exact duration that your long-term disability benefits will be paid will depend on your insurance plan. Some policies even provide rehabilitation benefits that should help you go back to employment and off the LTD benefits after a couple of years. Long term disability insurance benefits may be paid for 5 years, up to 10 years, or until you are 65 years old, whichever is sooner.

If you’re planning on making a claim for LTD benefits, be aware that certain deadlines may give your insurer a reason to deny the claim. The deadline will depend on what’s stated in your coverage plan, so please review this contract to understand its specifications. A general rule of thumb is that you need to submit a disability benefit claim as soon as practically possible. Approach an experienced lawyer who can assist to complete the application process.

Most insurance companies will provide their “qualifying period” in the policy document. This is the period it takes for the policyholder to collect long term disability benefits. It can range from 90 to 180 days after the claim is approved. Some policies have a longer waiting period. In most cases, policies that have a shorter qualifying period attract higher premiums. They will pay out the long-term disability benefits immediately they are approved or when the short-term disability coverage period lapses. Your lawyer can review your insurance policy and clarify its waiting period.

Most long-term disability insurance policies do not cover extended medical or dental care. Review the terms in your policy to determine if this is covered.

You need to speak to an experienced long term disability lawyer immediately after your claim is denied. At Wagners, we take time to understand your case, explain your legal options and advise you on the best steps to proceed. Our goal is to ensure your rights are protected and that you receive the benefits you deserve. We know that disability claims can be complex and overwhelming for the claimant. That’s why we recommend contacting us early so that we can review your application and increase the chances of a successful claim.

At Wagners, we work on a contingency fee basis, which means you only pay when we win the case. When you come to us, we will provide a free one-on-one consultation to understand your case better and review your legal options. Keep in mind that the statute of limitations and specific requirements in your policy document may prevent you from bringing a claim against the insurer if you take too long to make your claim. Speak to a lawyer immediately to secure your rights to financial compensation.

There are cases where individuals are denied disability benefits unfairly. To determine if you have a case against your insurer for denying disability benefits unfairly, speak with an experienced lawyer. At Wagners, we come with years of experience dealing with insurance companies, and we are ready to negotiate a settlement that you deserve.

The amount of compensation that you receive will largely depend on your annual income. Typically, insurance companies offer 60% to 85% of the claimant’s annual income. However, there is usually a limit so that your claim will not exceed a certain amount. Check this limit so that your claim will not exceed a certain amount. Your insurance contract will clarify the amount you can receive from your insurer, which often cannot exceed 100% of your average income before the disability.

If you have reasons to believe that your long-term disability claim was unfairly denied, it is highly recommended that you hire a long-term disability lawyer. All insurance companies will put their best foot forward to fight these cases in order to avoid, minimize and delay payment of claims. As a victim, you may not have access to the resources necessary to successfully file for your LTD benefits. When you consider our services, expect years of experience in dealing with top insurance companies. We come with the resources required to provide all the information needed to support your claim. We are ready to explore all legal options, including commencing a lawsuit if your claim is denied.

If the claimant has received any other benefit, this may be reduced from the total amount of benefits to be paid out to the claimant. For instance, if the claimant has received severance pay or vacation pay, this amount will be removed from the total amount of LTD benefits. This is because LTD benefits are designed to work as income supplementation. Any additional benefits that you receive will likely be excluded from your total LTD benefits.

Some insurance companies will require you to apply for Canada Pension Plan disability benefits in order to qualify for their long-term disability coverage. To determine if this is a requirement, check the wording in your policy. If it is stated that the policy is a “last option,” it means that all the other sources of disability benefits must be exhausted before you can apply for long term disability benefits.

When signing up for disability insurance, one area that is overlooked by most clients is whether the benefits they will receive are taxable. In general, disability benefits will be taxed or not depending on who makes the premium payments. If an individual pays the premiums of their disability insurance, the benefits are generally not taxable. However, if the premiums are paid by the employer as part of an employment plan or group policy, the benefits may be taxable. If an employer contributes to an individual insurance plan, the benefits may not be considered taxable.

If your insurance company has denied you benefits or it’s taking too long to have your claim approved, you can consult a legal professional to advise on the next steps. Your disability lawyer will review the specifics of your case and advise on the legal options available to you. The lawyer may advise on suing the insurance company, which may involve attending a hearing or deposition where you get to answer certain questions under oath. During this process, you need an experienced legal professional who is well versed with negotiation strategies for disability claims.

Once the disability claim has been approved, your benefits can be paid according to what’s stipulated in your insurance contract. Most benefits are paid monthly. However, if there is any money owed together with interests and other costs, you may request a lump sum settlement.

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