By Nainesh Kotak
The wheels of justice do not always grind slowly for injured workers denied benefits by their disability insurers.
Our court system has a well-earned reputation for sluggishness and inefficiency; you don’t have to search for long to find litigation horror stories from disabled people who fought it out for years in court with their insurers before finally getting their say before a judge.
But it’s important to know that in other cases, a legal claim can generate results quickly — without having to go all the way to trial.
With so many variables in play, including the nature of your injuries, the strength of your case and the aggressiveness of your insurer’s approach, there can be no guarantees regarding a timeline for settlement.
Still, there are certain steps that disabled workers can take to put themselves in position for an early settlement and maximize their chances of a speedy resolution.
Recently, our firm represented a 57-year-old worker in a lawsuit filed against her disability insurance provider. Follow the journey she made below and the steps we took with her to successfully resolve her claim, all within six months of her last day of work.
How it started
Tina (not her real name) had spent more than 15 years working in a physically demanding job at a grocery store when multiple long-term impairments finally caught up with her.
Like many disabled workers, she could not point to any specific event or trigger that prevented her from performing her job properly. Instead, the gradual corrosion of her physical and mental health escalated to the point where work became unbearable.
Over the years, Tina had dealt with hip problems and received diagnoses for several conditions, including chronic pain, lupus, arthritis, fibromyalgia, and chronic fatigue. In addition, Tina found that the onset of her physical symptoms was compounded by depression and anxiety, and submitted applications for both short-term and long-term disability payments.
STD and LTD benefits denied
When her insurer engaged a medical expert as part of its evaluation of her claim, Tina could have been forgiven for thinking that she would have an in-person exam with a health professional to discuss her medical issues.
However, the assessment was what’s known as a “paper review,” a common process used by insurers that sees them appoint someone to read all the medical documents in the injured person’s file, before coming to their own conclusion about their treatment options, rehabilitation progress or ability to work — all without ever actually examining the claimant in person.
Despite the wealth of medical evidence in Tina’s health records, the expert conducting the paper review in her case concluded that she was able to work, and her claims for both STD and LTD benefits were denied.
Suing the disability insurer
The single most important contribution Tina made to the extraordinarily swift settlement of her claim was her decision to consult Kotak Law so soon after receiving her insurer’s denial of her claim for benefits.
Claimants often choose to challenge a termination or denial appeal through their insurer’s internal appeal, but these procedures are little more than a waste of time. In many cases, the result is a foregone conclusion — just like students grading their own tests, STD and 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.
When we saw Tina’s file, we had significant concerns about how her disability insurer had treated her, and we moved quickly to file a lawsuit on her behalf, seeking damages against the company.
In the meantime, based on the nature of Tina’s significant physical complaints, we decided to engage an orthopedic surgeon who could examine her and provide an opinion on her condition and prognosis going forward, including her ability to do her job.
Ultimately, our expert concluded that Tina’s difficulty with standing — as well as with reaching and pulling movements — made it impossible for her to complete the essential tasks of her own occupation. Not only that, but the seriousness of her medical conditions would prevent her from obtaining employment in any occupation for which she was currently qualified or could be trained for, the doctor found.
How we resolved Tina’s case
When Tina’s insurer agreed to our request for an early mediation, we got to work on a mediation brief outlining the unfairness of Tina’s STD and LTD denials, while preparing her on how to communicate the impact of her conditions on her day-to-day functionality.
Armed with the compelling report of our expert, the presentation of evidence on the mediation day itself was very favourable to Tina, and by the end of the session — much to our and Tina’s delight — the insurer agreed to pay a six-figure sum to resolve the matter in its entirety.
The satisfaction I feel in helping Tina conclude her case so quickly will always be tinged with disappointment that she had to bring a lawsuit to receive the benefits to which she was entitled.
Not everyone who is wronged by their insurer will be able to get the compensation they deserve so quickly, but with the help of an experienced disability lawyer to guide you, you can begin the process of 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 or (416) 816-1500. 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.