Toronto Long Term Disability Denial Lawyers

Disability Insurance Plans Available in Toronto

Disability insurance is a type of insurance coverage that supplements your income in the event that you become injured, chronically ill, or otherwise unable to work. As benefits are determined based on salary or wages, only employed persons in Toronto can purchase a disability insurance policy. 

Depending on the nature of your work and eligibility, you might obtain benefits through government insurance programs or through private plans. Government disability insurance coverage is available through the province of Ontario’s Workplace Safety and Insurance Board (WSIB), through federal Employment Insurance (EI), and, for those who qualify, through Canada’s Pension Plan (CPP). Both the WSIB and CPP programs also provide certain benefits for the family and other dependents of the policyholder.

Private disability insurance policies may be available through a group plan provided by your employer or purchasable through your union or professional organization or individually purchased directly from an agent or insurer itself. In the case of some employer-provided group disability insurance plans, you may see deductions on your paycheck to help contribute to your premiums. But only the portion of the benefits your employer pays for are taxable; you will not owe taxes on any premiums you pay. 

Individual disability insurance policies are also available for anyone to purchase privately. There are many reasons you may choose to purchase an individual plan, such as if your employer-provided coverage is inadequate, if your employer does not provide disability coverage at all if the group plans are available to you via other sources (unions, professional organizations, etc.) are unaffordable, or if you don’t have a direct employer. Individual disability plans allow policyholders to have the utmost control over the coverage they carry, and they offer portability—in other words, the plans are not tied to a specific employer. For this reason, many Canadians enjoy the peace of mind and flexibility of private individual plans.  

Most Common Reasons for Long Term Disability Denials

With long-term disability denials, you can be informed that you do not qualify for benefits from the beginning or that you no longer qualify for benefits after a certain period. Some of the most common reasons for denying claims include:

• Injury or condition not considered restrictive enough – You may be informed that your medical condition or injury is not considered serious enough to prevent you from going to work or is excluded from coverage as per the terms of the insurance policy.

• Lack of medical evidence – Some conditions such as psychological conditions, brain injuries or chronic medical conditions like fibromyalgia or chronic fatigue syndrome, have few visible symptoms.

• Material misrepresentation or non-disclosure – Insurance companies frequently attempt to void policies for material misrepresentation or non-disclosure, thereby invalidating a policy.

• Failure to pay premiums – If your policy has lapsed due to non-payment of premiums, you may be ineligible for long-term disability coverage.

• A review of your case after surveillance – Some insurance companies hire private investigators to conduct surveillance without the claimant’s knowledge. Within limits, this is legal and is done to try to catch claimants doing things that they say they can’t do (and therefore undermine their credibility and their claim).

• Breach of a rehabilitation clause –  Most long-term disability policies pay benefits as long as you get appropriate treatment for your condition from a qualified physician. Failure to do so may be deemed a breach of the clause.

Types of Disability Insurance

Disability insurance is not all geared around long-term disabilities. It is important to know what type of policy you have and what you are covered for.

The main four types of disability insurance in Ontario are the following:

Long-term disability insurance (LTD)

This is like income protection insurance. If illness or disability renders you unable to return to work, you will be paid a portion of your income. This can help with living expenses, medical treatment, rehabilitation, and so on.

Coverage is normally provided for two years, after which time you are expected to take up any occupation for which you are reasonably qualified (or could become qualified for). Failure to do so can see the withdrawal of long-term disability benefits.

Short-term disability insurance

This is also a form of income insurance protection, providing income replacement if you are unable to work due to a medical condition or injury.

It is usually purchased by employers on behalf of employees but applies regardless of where an injury occurs – it does not have to be in the workplace. Payments are generally made only for the first 120 days of a medical issue.

Critical illness insurance

Critical illness insurance covers you if you are diagnosed with a serious illness such as cancer, stroke, heart disease, heart attack and generally around 10-15 other serious medical conditions.

This cover is paid in one lump sum and is not dependent on whether you return to work or not.

Disability mortgage insurance

If you become disabled and unable to earn an income, disability mortgage insurance ensures that you have the financial support to pay your mortgage.

It generally includes up to a certain amount every two weeks or month and limits on the duration of payments may apply.