There are three steps required to resolve Long Term Disability claims: denial, appeal or lawsuit, and settlement. Each step is outlined below. Michael has helped many clients get through this process quickly and efficiently.
Claims are denied either after the initial application, or following a period of benefit payments. The insurance company will provide written reasons explaining its refusal to pay. Common explanations include lack of objective medical evidence, lack of evidence of impairment, a pre-existing medical condition, failure to participate in treatment, longer than expected recovery times, or a general statement that you do not meet the test of disability, either for your “own occupation” or “any occupation”.
You have the right to appeal and the right to commence a lawsuit. It may be tempting to appeal, but very few appeals are successful. Unless there is new compelling evidence not available at the time of denial, most appeals are doomed to fail. Some companies will allow up to three appeals. Each appeal can take months.
Unlike appeals, lawsuit success rates are very high: more than 95% for a skilled Long Term Disability lawyer. Once you retain a lawyer, there will be no more direct contact with the insurance company. Your lawyer will handle everything. This will include obtaining the insurer’s file and analyzing it to discover errors, mistakes, and weaknesses; preparing a statement of claim and issuing it with the court; obtaining and paying for updated medical and other records that support your claim; securing and paying for expert opinions; attending to all legal issues as they arise; and, negotiating the settlement of your claim. You are involved as much or as little as you want to be while the litigation is ongoing.
There are two types of LTD settlements. The first is reinstatement, where past benefits owing are paid and the insurer resumes payment of monthly benefits. In this scenario, you are back “on claim”, meaning the insurer can request more medical records, send you to assessments, conduct surveillance and other investigations, and require your participation in specific treatment or rehabilitation efforts. There is nothing preventing the insurance company from denying the claim again at some unknown point in the future.
The second and more common type of settlement is “full and final”. You receive a single lump sum amount for both past and future benefits. The amount of the lump sum settlement is determined by many factors, including the value of past benefits owing and the value of future benefits for the remainder of the policy, typically to age 65. This sum is then reduced for the relative strengths and weaknesses of the case, the present value of money, and other factors.
The settlement will either be entirely tax free, or mostly tax free, depending on your policy. You will done with the insurance company, although you can usually maintain your medical and other benefits.
Our “No Fee Guarantee” means: (1) you pay no fees or other expense unless successful; (2), the legal fees you do pay are a fixed percentage of your recovery; and (3), the legal fees are reduced by the fees paid by the Long Term Disability insurer as part of the settlement. This is all contained in a document both your lawyer and the client sign, called a Contingency Fee Agreement. Typically, our clients recover more than 80% of their damages. Other firms charge more.
There are several advantages of Contingency Fee Retainer Agreements:
Call or complete the contact form to arrange a free consultation.
All calls and form submissions go directly to Michael, not a receptionist or legal assistant. Michael will provide immediate free legal advice, and answer all of your Long Term Disability questions. If you would like to meet with Michael in person, he has offices in Toronto, London, and Ottawa, plus he will come to your location almost anywhere in Ontario.
Don’t let the insurance company get away with an unfair denial of your claim. Call now to speak directly with Michael, or complete our confidential form for a quick response, usually within 15 minutes. Michael will guide you through the claims and appeals process, and answer any LTD questions you may have, free of charge.