At Kotak Law, we know the terrible toll caused by denial of your long term disability benefits. The immediate reaction of most Caledon residents in this situation is to turn to their insurer’s internal appeals process. Unfortunately, the deck is stacked against the claimant in this process, and it can be difficult – and take years – to win the benefits that you are owed.
That’s why you need an experienced Caledon disability lawyer to force your insurance company to give you the disability benefits that you deserve. Take charge of your case, and contact Kotak today.
Caledon Disability Cases in the News
ASK THE RIGHT QUESTIONS WHEN YOU APPLY FOR LONG-TERM DISABILITY INSURANCE
About one out of three Canadians become disabled for at least 90 days before the age of 65. For many individuals and families, long-term disability (LTD) coverage provides an essential form of financial security and protection in the event that an income earner becomes ill or injured and is unable to work for an extended period. In such circumstances, LTD coverage pays a percentage of the disabled person’s income up to a maximum amount specified in the policy. LTD benefits can be used at the claimant’s discretion to pay day-to-day expenses, medical bills or any other expenses incurred while the person is unable to work due to their disability.
When applying for long-term disability coverage in Caledon, you should consider several key questions that may determine whether your LTD coverage is adequate and right for your unique situation (as suggested by the Canadian Life and Health Insurance Ass.). Remember that a group plan, such as an employer-provided plan, does not offer as much flexibility as an individual LTD plan.
- What percentage of your current income is paid by the plan, and what is the dollar limit, if any? Also consider how the plan co-ordinates with other benefits to which you, your spouse or another family member is eligible. It’s a good idea to calculate your essential annual expenses to ensure that your LTD plan provides adequate coverage, or at least, that you are fully aware of your financial situation if you were to become disabled.
- When does the plan begin to pay benefits? Every LTD plan has a waiting period or ‘elimination period’ before a claimant may receive payments. Many plans have a waiting period of 17 weeks, but the wait may vary between 3 months and even up to 1 year. If the claimant does not have access to short-term disability coverage, such as may be provided by an employer-provided group plan, a person may be eligible for employment insurance (EI) benefits for the first 17 weeks after they become disabled, after which they may be eligible for LTD benefits through their LTD policy.
- Does the plan have exclusions or limitations? Some plans have a clause precluding claimants from receiving benefits for a pre-existing condition that precedes the date of application and/or the plan may not provide coverage if the claimant applies for benefits within the first year of their application.
- Does the plan provide a partial disability benefit if you are able to return to work in a limited capacity under the supervision of a physician?
- How does the plan define ‘disability’? You must meet the definition of ‘disability’ under the plan in order to be eligible for payments.
- Are the benefitis taxable and/or indexed for inflation?
- Can you later increase the amount of coverage without having to provide medical evidence of good health?
- Does the plan provide a waiter of premium to cover insurance premiums, such as medical, dental, and life insurance, during the disability period? Also to be considered is the date when the waiver of premium begins, and whether the plan refunds premiums paid after you were injured or became ill?
In Van Maele, the wording of the exclusion clause applied to any disability caused by an injury or sickness for which the claimant received any form of medical consultation or treatment, which includes ‘diagnostic measures’, during the 3-month period prior to the effective date of the insurance. The claimant had received a diagnosis and treatment for several symptoms before and during the waiting period, and his claim for LTD benefits was based on many of the same symptoms and illnesses. His conditions was later diagnosed as Cushing’s Syndrome, and his symptoms included hypertension, asthma, stress fractures, back pain, bruising, diabetes mellitus, depression and poor healing of wounds. The judge decided that, but for the exclusionary clause in the policy which clearly applies to the diagnosis of his symptoms during the exclusionary period, the claimant would have been entitled to received long-term disability payments.
If you or a member of your family were denied long-term disability benefits, talk to an LTD benefits lawyer at Kotak Personal Injury Law to learn about your legal rights in the matter. At Kotak Law, we specialize in representing clients in LTD benefits disputes and other insurance disputes, and you can be assured that we will explore every legal means of getting you the benefits you deserve.
Source:
the Canadian Life and Health Insurance Association Inc. (CLHIA): CLHIA article on disability
Disclaimer: This article is intended to supply general information to the public. We make every effort to ensure the accuracy of this information. However, as laws change quickly, the reader should always ensure the accuracy and applicability of such information with respect to their particular case. The information contained in this article cannot replace a thorough and complete review of the reader’s situation by competent legal counsel who has had an opportunity to review all of the facts.
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