A long-term disability lawyer helps people whose illness, injury, or medical condition prevents them from working and whose long-term disability benefits have been denied, delayed, terminated, or disputed. Disability insurance disputes can affect your monthly income at a time when you are already dealing with medical treatment and financial stress. An experienced disability lawyer can help you understand your long-term disability coverage and deal with the insurance company on your behalf.
Every disability insurance policy is different. Some policies initially assess whether you can perform your own occupation. The definition of disability may later change and require proof that you cannot perform another suitable occupation. The exact test depends on the wording of your long-term disability insurance policy. Our disability lawyers review the policy, medical records, correspondence, denial letters, employment information, and other evidence. We then identify what must be proven and what steps may be available in the disability claim process.
If you need help with a long-term disability claim, Auger Hollingsworth’s personal injury lawyers in Thornhill can assist with new claims, denied disability claims, benefit terminations, appeals, negotiations, and disability insurance litigation.
What Qualifies for Long-Term Disability in Ontario
Eligibility for long-term disability (LTD) benefits generally depends on the definition of disability contained in your policy. A diagnosis alone may not be enough. The insurer normally considers how your symptoms affect your ability to perform your occupational duties.
Conditions that may support a claim can include physical or psychological impairments such as:
- Brain injury
- Spinal cord injuries
- Chronic pain
- Cancer and other forms of critical illness
- Neurological disorders
- Musculoskeletal conditions
- Autoimmune diseases
- Depression, anxiety, PTSD, and other forms of mental illness
- Other physical or mental injuries
- A serious or catastrophic injury
A pre-existing condition does not automatically mean that LTD coverage is unavailable. However, some disability insurance policies contain pre-existing-condition exclusions. Their application depends on the wording of the policy and the circumstances surrounding the claim.
The insurer may also assess whether the claimant meets the policy’s definition of total disability. Total disability does not necessarily mean that an insured person must be completely incapable of every activity. The applicable definition must be determined from the policy itself.
Strong medical evidence is often important. It may include treatment records, specialist reports, diagnostic results, medication history, functional restrictions, and other medical documentation showing how the condition affects your ability to work.
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The Process of Filing a Disability Claim
A disability claim begins by reviewing the available coverage and determining the insurer’s requirements.
A typical disability claim process may involve:
- Reviewing the insurance policy. The policy identifies the definition of disability, waiting period, benefit calculation, exclusions, and procedural requirements.
- Notifying the insurer. Claims should be submitted according to the timelines and procedures specified by the insurer.
- Completing claim forms. The claimant, employer, and treating medical professionals may each be required to provide information.
- Submitting medical evidence. Records should explain the diagnosis, treatment, symptoms, limitations, restrictions, prognosis, and effect on work capacity.
- Providing occupational information. The insurer may examine your actual job duties and the physical, cognitive, or psychological demands of your occupation.
- Responding to insurer requests. Disability insurers may request additional records, interviews, medical assessments, functional evaluations, or other information.
- Receiving a decision. The insurer may approve the claim, request further evidence, or issue a denial.
- Challenging a denial when appropriate. Depending on the circumstances, this may involve further evidence, negotiations, an insurer appeal, or a disability lawsuit.
Keeping copies of forms, medical records, correspondence, and denial letters can help preserve a clear record of the claim.
Benefits of Working with LTD Lawyers
LTD disputes involve detailed policy language, medical records, occupational evidence, and communications with insurance providers. Legal representation can help organize these issues and reduce the burden of dealing directly with the insurer.
Our LTD legal services can include:
- Reviewing the disability insurance policy
- Evaluating the reasons for denial or termination
- Gathering relevant medical documentation
- Communicating with the insurer
- Reviewing occupational duties and employment records
- Examining income and benefit calculations
- Assessing CPPD or other benefit offsets
- Responding to requests from the insurer
- Negotiating disputed claims
- Commencing litigation where appropriate
- Advising clients about settlement proposals and ongoing benefits
A disability case differs from a typical personal injury claim. LTD disputes focus heavily on contractual rights under an insurance policy and whether the medical and occupational evidence meets the policy’s requirements. Our personal injury law firm can assess the appropriate legal approach based on the type of claim involved.
