Disability Law Specialists

Long-Term Disability Claims & Denied Benefits

Professional legal representation for individuals whose disability claims have been wrongfully denied. We fight for your rights on a contingency fee basis - no upfront costs to you.

1 in 3 Canadians face disability lasting 90+ days

60-85% Income replacement available

No Win No Fee Guarantee

General Info & Benefits

The Reality of Disability in Canada

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".

Why Disability Insurance Matters

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.

What Disability Insurance Covers

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.

Depression and anxiety disorders
Chronic pain conditions
Physical injuries and illnesses
Degenerative conditions
Mental health conditions

Official Definition

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."

Coverage Statistics

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.

Income Replacement

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

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

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.

Coverage Duration

Typically provides benefits for up to a maximum of 6 months while you are disabled.

Benefit Amount

Usually 50% to 70% of your monthly pay, paid on a weekly basis.

Waiting Period

Cannot be more than 7 consecutive days before benefits begin.

Requirements and Obligations

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:

Continue seeking new employment opportunities
Pursue proper medical treatment
Attempt to return to work on modified duties when possible

Important Note

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.

Long-Term Disability (LTD)

Eligibility Requirements

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.

"Own Occupation" Test (First 2 Years)

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.

"Any Occupation" Test (After 2 Years)

You can continue to receive LTD benefits beyond the 2 year mark (date of disability), if you satisfy the 'any occupation' test. This 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".

Claims Often Denied

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.

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.

You may be entitled to receive EI sickness benefits if:

You have been employed in insurable employment
You meet the specific criteria for receiving EI sickness benefits
Your normal weekly earnings have been reduced by more than 40%
You have accumulated 600 hours of insurable employment during the qualifying period

Benefit Calculation (2018 Rates)

Basic rate: 55% of average insurable weekly earnings
Maximum yearly insurable earnings: $51,700
Maximum weekly payment: $547
Maximum duration: 15 weeks

Note: 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, please visit www.canada.ca/en/services/benefits.ei.html

Appeal Process

The Reality of Appeals

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.

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.

Initial Denial

Insurer denies your initial claim

First Appeal

You submit internal appeal - often denied

Second Appeal

Another appeal opportunity - more delays

Legal Action

You can sue immediately after first denial

Critical Information

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.

When Appeals Make Sense

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.

When to Skip Appeals

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.