Questioning your medical condition is not the only way insurers could challenge a claim for long-term disability benefits.
In many cases, disability insurance companies will attempt to sidestep any assessment of a person’s ability to work, seizing instead on “technicalities” to deny an injured worker’s claim based on deficiencies in their application.
Being forced off work because of a disability is typically one of the most stressful times in a person’s life — especially for those with a psychological element to their injuries. And while lay observers may be inclined to excuse an injured worker for missing deadlines or omitting crucial information in this context, LTD applicants sadly can not expect the same kind of compassion from their insurer.
Still, it is important to know that these kinds of technical mistakes do not necessarily have to tank your claim, and a denial on that basis may not be the final word on the matter.
Recently, our firm represented a former professional athlete in his 40s whose LTD denial had nothing to do with his insurer’s view of his ability, but was based purely on the late filing of his application for benefits. Read on to find out how we helped him fight back and successfully resolve his claim.
How it started
Jeremy (not his real name) overcame a difficult childhood touched by tragedy to make a name for himself in the competitive world of professional sports. After his retirement, he quickly established himself again in a new realm, working as an account representative for a business.
Over time, Jeremy struggled with anxiety and depression, compounded by an alcohol use disorder as he carried out his work duties, which required a great deal of concentration and communication with various parties. By 2020, he stopped working as a result.
LTD benefits denied and lawsuit launched
Overwhelmed by his mental health issues, Jeremy missed the deadline set out in his LTD group policy to apply for benefits by one year. Rather than insisting on a medical assessment, the insurer simply denied Jeremy’s claim based on the lateness of his application.
Thankfully, Jeremy’s next step was contacting Kotak Law instead of accepting the insurance company’s invitation to engage in its internal appeal process. These procedures tend to be a waste of time since the result is often a foregone conclusion. Like students grading their own tests, LTD providers rarely find fault with their original decisions and stick with their denials, leaving claimants in the same place they started, except weeks or even months down the line.
After seeing Jeremy’s file, we moved quickly to sue his insurer, and they agreed to our request for an early mediation. In the meantime, we also obtained our client’s existing medical records and scheduled an appointment with a renowned psychologist who ultimately concluded that Jeremy’s diagnosed conditions made it impossible for him to perform the essential tasks of his occupation.
Relief from forfeiture
At the heart of Jeremy’s case was an application for “relief from forfeiture,” a special type of court-ordered remedy that essentially excuses a person from losses incurred as a result of a contractual breach, so long as certain conditions are met.
Provincial legislation gives a judge the discretion to grant a person relief, taking into account various factors, including the gravity of the breach, the conduct of the applicant and the disparity between the forfeiture and the damages caused by the breach.
We felt Jeremy had a strong case for relief, given that the medical evidence supported his need for benefits, as well as the minimal prejudice that the one-year delay caused to his LTD insurer. However, we didn’t get a chance to make the argument in court since the case was settled before we got that far.
How we resolved Jeremy’s case
After reading the case for relief laid out in our mediation brief, the insurance company agreed to drop its argument that the denial was justified based on Jeremy’s delay in filing, freeing both sides up to concentrate on the merits of his case for LTD benefits.
When the mediation day arrived earlier this year, Jeremy gave a powerful account of his struggle over the course of his life and in the years since he was forced off work. By the end of the session, we reached an agreement with his insurer for a six-figure sum to resolve the matter that will allow Jeremy to concentrate on his health and recovery without worrying about dealing with his insurer any longer.
It’s always satisfying to help clients like Jeremy, who have been so clearly wronged by an uncaring corporation. His case is a harsh reminder — in case anyone needed it — of the coldness of many insurers. If they can’t argue with the medical necessity of your claim for LTD benefits, they will not hesitate to issue a denial based on technicalities, regardless of how deserving you are.
Remember, the insurer’s denial does not have to be the final word on your LTD application. With the help of an experienced disability lawyer to guide you, you can begin fighting back.
If your disability insurance claim has been denied or cut off and you’re considering hiring a lawyer, our blog post has helpful tips and questions you should ask a lawyer before hiring one.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies, including Manulife, Sunlife, Desjardins, Cigna, Great-West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.
Call your trusted long-term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). Our consultation is free, and we don’t get paid until you do. We represent disabled people throughout Ontario, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St. Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Fort Erie, Keswick, Kingston, Ottawa, Barrie, Timmins and other locations. We also serve clients throughout Alberta, including Calgary, Edmonton, Red Deer, Lethbridge, Medicine Hat, Fort McMurray, Grande Prairie, Airdrie, Spruce Grove, Lloydminster, St. Albert, Wetaskiwin, Camrose, Banff, Canmore, Jasper, Cochrane, Okotoks, High River, Sylvan Lake and others.
