Long-Term Disability Lawyers Calgary

What are long-term disability benefits?

In Alberta, long-term disability insurance policies are often available through your employer’s group insurance plans or by purchasing privately held insurance policies. Each policy is different. However, in most cases, long-term disability benefits are income replacement benefits that pay between 60% to 70% of your income in the event you have an injury or illness that prevents you from working in your chosen occupational field. Long-term disability benefits can provide essential financial assistance at a time when the road to recovery can be long, painful and debilitating. LTD policies provide income replacement coverage for people who meet the terms of the policy for “totally disabled,” which generally means they are unable to work or mostly unable to work.

Most LTD policies have two total disability tests: “own occupation” for the first two years of benefits, followed by “any occupation” until the age of 65 (or sometimes longer). To meet the “own occupation” portion of the test, you need to show that you are unable to work in your own job because of your disability. To meet the “any occupation” part of the disability test, you need to be unable to work in any occupation you are reasonably suited by education, training and experience.

Coping with chronic illnesses, serious mental health disorders, and physical disabilities often requires all an individual’s focus and efforts. Unfortunately, these types of disabling medical conditions can make it impossible for people to continue working in their chosen occupational field or, in many cases, in any area of employment, which is why LTD benefits exist: to make sure you can still pay your bills while you are unable to work.

Applying for long-term disability benefits in Calgary

To apply for long-term disability benefits in Calgary, Alberta – you should exhaust other benefits available to you first, like employment insurance (EI) and short-term disability. Even though long-term disability benefits may not provide you with the full amount of your salary, they can be extremely helpful paying bills or when you start to incur new expenses due to your injury or illness. Many people who need to access LTD benefits struggle to keep up with their regular household expenses, let alone the costs associated with their medical conditions.

Each insurance policy is subject to its own terms and conditions. It is important to understand the eligibility criteria of your own policy before submitting a claim for LTD benefits. The wording of these plans can be confusing and difficult to comprehend. If you are having difficulty interpreting the terms of your insurance policy, consider scheduling a free initial consultation with our Calgary disability lawyers and let us help you with applying for your long-term disability benefits.

Common medical illnesses and injuries that may qualify you for long-term disability benefits in Alberta

LTD policies do not only apply to physical injuries or illnesses. People with serious mental health disorders can qualify for LTD benefits. In fact, 30% of disability claims nationwide are attributed to mental health conditions. Make sure to review your policy’s specific terms to ensure you qualify for LTD benefits. Some medical conditions that often meet insurance plans’ eligibility requirements include:

• Heart disease or conditions
• Arthritis
• Musculoskeletal injuries
• Back problems
• Chronic pain or complex regional pain syndrome (CRPS)
• Lupus or Lyme disease
• Psoriatic arthritis or fibromyalgia
• Paralysis
• Depression
• Bipolar mood disorder
• Post-traumatic stress disorder (PTSD)
• Mental health ailments
• And more

You must include various forms of evidence to prove the severity of your medical condition to your insurer. You must also demonstrate how your ailments prevent you from completing tasks and functions associated with your job. Common examples of evidence are medical files from your treatment providers, like family doctors, specialist doctors, counsellors, and physiotherapists.

However, even after supplying insurance companies with ample proof, the insurance company might deny your claim. When this happens, claimants can feel frustrated, anxious, and unsure about their future financial security. Not having LTD benefits can mean you can’t pay rent or your mortgage.

Unfortunately, insurers do not always make it easy for qualifying applicants to receive the benefits they are owed. Even if a claimant’s conditions meet their policy’s eligibility requirements for LTD benefits, insurance providers may find reasons to deny their claims, withhold their payments, or drag the process out for as long as they can which can in turn discourage applicants from trying to access the funds they deserve. We recommend you consult with our Calgary LTD lawyers if your long-term disability benefits have been rejected. We may be able to help you get the compensation you deserve.

What happens if your LTD benefits have been terminated before or at the two-year mark?

Insurance companies can prematurely terminate your benefit payments. However, do not lose hope if your LTD benefits have been denied. You can appeal your insurer’s decision. In a situation like this, we recommend you contact our LTD lawyers for legal help.

By formally disputing your insurer’s decision, our Calgary long-term disability lawyers may be able to help you recover previously withheld benefits payments, the LTD coverage you are rightfully entitled to, as well as any other damages resulting from your claim’s initial denial, including punitive damages. Seeking full compensation is something our lawyers can help you with.

What happens if your LTD benefits have been terminated after receiving benefits for two years?

Benefits are often wrongfully terminated after being paid to the recipient for two years. After this time, many insurance plans update their definition of “disability” from the “own occupation” test to the “any occupation” test. This makes it harder to qualify for benefits.

The “own occupation” disability test means that someone will be entitled to LTD benefits if they cannot perform their own job. The “any occupation” disability test means that someone will be entitled to LTD benefits if they cannot perform any job to which they are reasonably suited by education, training, or experience. Each insurance policy may vary slightly in terms of the exact terms of the test, so it is important to read your policy carefully.

If you are facing this situation, we recommend you contact our disability lawyers today for legal help. Our disability lawyers can dispute the insurer’s decision and help you get the compensation you deserve. The best part is, you don’t pay our law firm anything unless we recover compensation for you on your behalf.

It is important to note that LTD policies generally do not require that you are unable to work at all in order to receive benefits. Most policies will allow you to work some hours while still receiving disability benefits. Most policies, for example, will reduce LTD payments by any income you earn while disabled. It is important to seek legal advice on the specific terms of your policy to know how disabled you must be to receive benefits and whether you can work while receiving benefits.

Common reasons LTD claims get denied

Employers pay monthly premiums to insurance companies so that their employees will be covered if they cannot work. Sadly, many insurance companies simply refuse to do the right thing by paying deserving people the benefits they need. Here are common reasons that insurance companies deny LTD claims (and if this has happened to you, contact us now for immediate legal help):

• You are not considered “totally disabled” by the insurance company
• Your insurer does not agree with your doctor(s)
• Your insurer believes there is a lack of supporting medical documents and/or objective medical documentation that demonstrate you are no longer able to work
• Your insurer believes there is no diagnosis for your disability
• Your insurer believes you can work in another occupation
• You have not followed instructions for reasonable treatments
• You applied for LTD too late
• Insurance surveillance proves you’re able to work and not disabled
• An Independent Medical Examination (IME) from the insurance company says you are not disabled
• You are refusing to go back to work when the insurance company wants you to
• You are in violation of your LTD policy or have breached it
• You have a pre-existing condition that excludes you from receiving LTD
• And more

Each of the above reasons for denial could be wrongful denials that should be overturned. Insurance companies unfortunately do not always apply the terms of your policy fairly or properly.

No one deserves to be given the runaround from their insurance company, especially people whose lives have been turned upside down by a serious injury or illness. Our lawyers have combined decades of experience helping unfairly treated benefits claimants stand up to their insurance providers. If your claim for LTD benefits was denied or if your payments were prematurely terminated even though you are still unable to return to work, contact us today for a free consultation.

Case Law On Long-Term Disability Claims and “Peace of Mind” Contracts

Long-term disability contracts are “peace of mind” contracts, meaning they exist to protect people when they need them most. Insurance companies have an utmost duty of good faith to treat people applying for LTD benefits fairly. If they do not treat people fairly, then they could be forced to pay aggravated or punitive damages.

In 702535 Ontario Inc. v. Non-Marine Underwriters Members of Lloyd’s London, 2000 CanLII 5684 (ON CA), the Court discussed insurers’ duty of utmost good faith:

[27] The relationship between an insurer and an insured is contractual in nature.   The contract is one of utmost good faith.  In addition to the express provisions in the policy and the statutorily mandated conditions, there is an implied obligation in every insurance contract that the insurer will deal with claims from its insured in good faith:  Whiten v. Pilot Insurance Co. (1999), 1999 CanLII 3051 (ON CA), 42 O.R. (3d) 641 (Ont. C.A.).  The duty of good faith requires an insurer to act both promptly and fairly when investigating, assessing and attempting to resolve claims made by its insureds.

[28] The first part of this duty speaks to the timeliness in which a claim is processed by the insurer.  Although an insurer may be responsible to pay interest on a claim paid after delay, delay in payment may nevertheless operate to the disadvantage of an insured.  The insured, having suffered a loss, will frequently be under financial pressure to settle the claim as soon as possible in order to redress the situation that underlies the claim.  The duty of good faith obliges the insurer to act with reasonable promptness during each step of the claims process. Included in this duty is the obligation to pay a claim in a timely manner when there is no reasonable basis to contest coverage or to withhold payment.  Bullock v. Trafalgar Insurance Co. of Canada, [1996] O.J. No. 2566 (Q.L.) (Gen. Div.);  Labelle v. Guardian Insurance Co. of Can. et al.(1989), 38 C.C.L.I. 274 (Ont. H.C.J.);  Jauvin v. L’Ami Michel Automobile Canada Ltd et al (1986), 1986 CanLII 2572 (ON SC), 57 O.R. (2d) 528 (H.C.J.).

[29] The duty of good faith also requires an insurer to deal with its insured’s claim fairly.  The duty to act fairly applies both to the manner in which the insurer investigates and assesses the claim and to the decision whether or not to pay the claim.  In making a decision whether to refuse payment of a claim from its insured, an insurer must assess the merits of the claim in a balanced and reasonable manner.  It must not deny coverage or delay payment in order to take advantage of the insured’s economic vulnerability or to gain bargaining leverage in negotiating a settlement.  A decision by an insurer to refuse payment should be based on a reasonable interpretation of its obligations under the policy.  This duty of fairness, however, does not require that an insurer necessarily be correct in making a decision to dispute its obligation to pay a claim.  Mere denial of a claim that ultimately succeeds is not, in itself, an act of bad faith:  Palmer v. Royal Insurance Co. of Canada (1995), 27 C.C.L.I. (2d) 249 (O.C.G.D.).

[30] What constitutes bad faith will depend on the circumstances in each case.  A court considering whether the duty has been breached will look at the conduct of the insurer throughout the claims process to determine whether in light of the circumstances, as they then existed, the insurer acted fairly and promptly in responding to the claim.

In Fidler v. Sunlife, the Supreme Court of Canada explained further:

People enter into disability insurance contracts to protect themselves from this very financial and emotional stress and insecurity.  An unwarranted delay in receiving this protection can be extremely stressful.  Ms. Fidler’s damages for mental distress flowed from Sun Life’s breach of contract.  To accept Sun Life’s argument that an independent actionable wrong is a precondition would be to sanction the conceptual incongruity of asking a plaintiff to show more than just that mental distress damages were a reasonably foreseeable consequence of breach.

Turning to the case before us, the first question is whether an object of this disability insurance contract was to secure a psychological benefit that brought the prospect of mental distress upon breach within the reasonable contemplation of the parties at the time the contract was made?  In our view it was.  The bargain was that in return for the payment of premiums, the insurer would pay the plaintiff benefits in the case of disability.  This is not a mere commercial contract.  It is rather a contract for benefits that are both tangible, such as payments, and intangible, such as knowledge of income security in the event of disability.  If disability occurs and the insurer does not pay when it ought to have done so in accordance with the terms of the policy, the insurer has breached this reasonable expectation of security.

Mental distress is an effect which parties to a disability insurance contract may reasonably contemplate may flow from a failure to pay the required benefits.  The intangible benefit provided by such a contract is the prospect of continued financial security when a person’s disability makes working, and therefore receiving an income, no longer possible.  If benefits are unfairly denied, it may not be possible to meet ordinary living expenses.  This financial pressure, on top of the loss of work and the existence of a disability, is likely to heighten an insured’s anxiety and stress.  Moreover, once disabled, an insured faces the difficulty of finding an economic substitute for the loss of income caused by the denial of benefits.

Fidler para 54 and 57

When an insurance company unfairly denies benefits, they may be ordered to pay punitive damages to punish the bad conduct and deter them from hurting someone else in the future.

When a wrongful denial harms someone who cannot work, then the insurance company may be ordered to pay aggravated damages for how the denial caused mental distress or made their health condition worse.

The only way that insurance companies will stop wrongfully denying LTD claims is for people to stand up and fight back for fairness and justice and seeking aggravated and punitive damages is a part of that solution.

Our Calgary disability lawyers are here to help. Contact us for a free consultation.

After receiving a denial for LTD benefits, people suffering from severe medical conditions may feel overwhelmed, frightened, and without hope. For many Albertans who need LTD benefits, this may be the only source of income keeping them and their families from financial disaster. Without access to these potentially life-changing benefits, seriously injured or ill insurance policyholders may be unable to continue supporting themselves and their loved ones. The idea of taking on a large insurance provider in a legal battle may feel daunting. But we are here to help.

If you are eligible to dispute your claim’s denial, our legal team may be able to help you recover the compensation you are rightfully owed. This might include:

• Previously denied benefits payments
• Legal fees
• Damages you have incurred as a result of your claim’s initial denial, like interest on loans
• Punitive damages
• Aggravated damages
• And possibly more

We are familiar with the unfair tactics often used by insurance providers to try withholding money from deserving policyholders.

At Preszler Injury Lawyers, we fight on behalf of our clients’ best interests so that they can finally get the fair treatment they should be owed. To learn more about how Preszler Injury Lawyers may be able to assist you, schedule a free initial consultation with our legal team today. And remember, you don’t pay anything unless we win.

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