We recently posted a blog with information about CPP Disability benefits. That blog can be found here.
CPP Disability benefits are part of a federal government regime and designed and available for those who, as a result of severe and prolonged disability, are unable to work. They are often the only source of income for those who are disabled and do not have access to disability benefits through an employment or private benefits plan.
Long Term Disability (LTD) benefits are similar to CPP disability benefits. They also provide a stream of income to those who are unable to work as a result of a disability. They are usually part of a Disability and Health Benefits package provided by your employer but can also be purchased through a private insurer.
Who is eligible for these benefits?
Long Term Disability benefits are available for those who, as a result of disability, are unable to work.
For the first two years following the disability, you are entitled to LTD benefits if you are unable to complete the essential tasks of your own employment.
After the initial two-year period, the test changes. You continue to be entitled to LTD benefits if you are unable to fulfill a job for which you are suited by reason of education, experience, or training. To put it simply, if a disability prevents you from doing a job that you are qualified to do due, you remain entitled to LTD benefits.
What happens if my application is denied?
If your application for LTD benefits is denied, not all is lost.
In the initial denial letter following an application, the LTD insurer will provide reasons for their denial. They also usually offer an opportunity to reconsider your matter. They will be seeking additional medical reports or evidence that may not have existed at the time of the initial application. If this new evidence convinces the LTD insurer that you suffer a qualifying disability, they may approve your application upon reconsideration.
The LTD insurer may also contact you to clarify some issues or ask additional questions that arise from review of the new evidence.
After a reconsideration is completed, you will receive a second letter from the insurer which outlines their decision.
What happens if my reconsideration request is denied?
If your reconsideration request is denied but you remain disabled from work and have support from your medical team, it is time to contact a lawyer.
You should find a lawyer who is experienced in LTD claims as they will be best suited to pursue your claim in an efficient and effective manner.
The lawyer will review the LTD file including all medical records. They will also speak to you to find out the pertinent details about your job and how the disability prevents you from working.
If the lawyer is of the view that the medical records and supporting evidence confirm the disability and resulting inability to work, they will write to the LTD insurer to advise that they have been retained to pursue a claim. Following that and unless the LTD insurer changes their decision, litigation will commence.
How do LTD lawsuits work?
An LTD claim ruins similar to most other personal injury claims.
The action begins with filing of court documents by both parties.
Following that, the matter often proceeds to Examinations for Discovery. Examinations for Discovery are the opportunity for the lawyers for each party (injured person and LTD insurer) to ask questions of the other party. The lawyer for the LTD insurer will ask questions about your injuries, your job, and your activities of daily life. The purpose is to obtain as much information as they can to assess whether or not you are unable to work as a result of the disability.
Your lawyer will also examine a representative of the LTD insurer – usually the adjuster assigned to the file. The purpose of that discovery is to find flaws in how the LTD insurer handled the claim.
Following Examinations for Discovery, the parties often engage in settlement discussions or proceed to Mediation in an attempt to resolve the case on a full and final basis.
If the matter is not able to be settled, it proceeds to Trial where the question of whether or not you are entitled to LTD benefits is left to the discretion of a Judge. If the Judge finds that you have been and continue to be entitled to LTD benefits, they will award you a lump sum amount to cover your past lost LTD benefits and also force the insurer to put you on benefits moving forward. If this happens, the LTD insurer will not be able to cut you off unless they can prove that there is a material change in your condition which proves that you can work.
If your application for LTD benefits has been denied or you are considering an application for LTD benefits, do not hesitate to contact Bergeron Clifford.
ABOUT THE AUTHOR
Casey Dorey is an associate lawyer at Bergeron Clifford LLP. He works primarily in Kingston but travels across Eastern Ontario.
Casey obtained his LL.B from the University of Leicester, United Kingdom, with First Class Honours. While in law school, Casey was a Moot Court champion and represented the school externally in London, England. He was also awarded the Canadian Spring Scholarship.
He has appeared before the Ontario Superior Court of Justice, Small Claims Court, Criminal Injuries Compensation Board, and the Social Security Tribunal.