Insurance Disability denials and lawsuits present unique legal tests and engage different legal principles than other injury cases. If you have been denied disability benefits by an insurance company despite the fact that you are unable to work, it is important to understand the principles that apply and how they affect you. It is important to speak with a lawyer who understands disability benefits law. To begin with, the relationship between the parties (you and the insurance company) is not founded on a common law duty to reasonably protect the safety of others (as is the case with certain car accident or slip and fall cases).
Instead, the relationship between you is founded upon a contract – the insurance contract that you agreed to (or the group insurance contract that your employer or union agreed to) and the insurance policy that insures you. For the first two years of disability, most claimants are governed by the “own occupation” test: a test that requires you to prove that you are, essentially, unable to return to the job that you were working at the time of the accident. Beyond two-years, most claimants are governed by the “any occupation” test – a test that requires you to prove that you are, essentially, unable to return to any job for which you are reasonably suited by education training or experience.
The tests are subject to legal interpretation and case-law. It is important to speak with a lawyer if your disability benefits have been denied by the insurance company. It is advisable to speak with a lawyer even before you go through the appeals process.
While the wording in the disability policies are important, it is also important not to simply throw up your hands and give up if the wording seems unfair. Keep in mind that the wording for the any occupation test is subject to legal interpretation and just because you can stand for 15 minutes and lift a box of cereal 3 times without pain that does not really qualify you to work in a grocery store and it does not necessarily disqualify you from benefits.
Do not just give up because an insurance assessor says that there are some jobs that you are able to do. I have had cases where, after I have questioned the insurance representative, they have point blank admitted (on the record) that the jobs were not suitable for the claimant, even though they had previously cut the claimant off because of their suitability for those jobs. You have to seriously and vigorously vet those opinions.
Like it or not, disability insurance companies have a vested interest in not paying you – every dollar that they pay out reduces their bottom line. Many disability insurers say that they don’t think that way and maybe they don’t, maybe they are all honorable and upstanding corporate citizens, but I sure would want to check out every decision and obstacle that they threw up before I gave up my rights.
Disability insurance contracts will typically give rise to a duty of “good faith”. The insurance company and yourself are governed by this duty and there are serious ramifications for a failure to live up to the duty. Not that long ago, an insurance company was required to pay $1,000,000 in damages for failing to live up to the duty when it, allegedly, denied a person’s fire loss claim without good reason and persisted in alleging that it was intentional arson by the insured.
Insurance companies may also require you to apply for CPP disability benefits or ODSP benefits. Speaking with disability benefits lawyers can help to explain your rights and obligations.
Disputes with companies such as Manulife Insurance Company, Desjardins, SunLife, Great West Life and others do happen. After paying into your insurance plan for years, you may feel offended, victimized and left alone when you are denied long term or short term benefits. Sometimes these companies may change their minds when you launch an appeal, but that is certainly not guaranteed. It is important to have early legal advice – remember that what you submit on your appeal becomes part of the record.
You should treat the date of your first denial as the start of the running of the limitation period (and you likely have two years from that point). Do not just accept an unfair denial of further benefits, find out what we can do for you. Remember that the choice of your lawyer can say a lot to your insurer about who you are. If you choose a lawyer who advertises about maximum compensation you may be perceived in a certain way by the company and the courts.
I have had a few cases where insurance companies have reversed a denial once they received our initial letter. My belief is that receiving a lawyers letter triggers some kind of internal review for some insurance companies. In those case we did not bill our client.
We are here to seek fairness and justice for people who have been wrongfully denied and that is what we have been doing since 1929. We choose our clients carefully because we know that our reputation matters. We like what we do and we get true satisfaction from helping victims.
Call us today for a free, no obligation, consultation. Steven Polak is a lawyer who restricts his practice to injury and disability claims. He is a partner with Lerners LLP (since 1929 and over 100 lawyers strong) and a member of the Ontario Trial Lawyers Association Long Term Disability Litigation section.
We provide services to clients out of our office at 105 Consumers in Whitby/Oshawa Ontario and out of offices in Toronto and London Ontario. Cases commenced in the Durham area are handled through the Oshawa central courthouse at 150 Bond street east. A case typically starts with our firm requesting the records from the disability insurance company and filing a lawsuit with the Oshawa Courthouse. The next step is typically discoveries, which normally takes place at Durham Court Reporting at 12 Stanley Court in Whitby Ontario. There is then often a mediation and then a pre-trial before a trial to see if the matter can be settled.
This article is not legal advice. It is simply general information and you are encouraged to immediately seek legal advice to consider how long you have to start a lawsuit and whether your case is viable.
Whitby Disability Insurance Lawyer and insurance denial lawyers specializing in long term disability insurance denials and insurance claims lawsuits, claims, pay outs and disputes. Serving Whitby, Oshawa, Ajax, Toronto, Southern Ontario.
Clearly Mr. Polak is ahead of the game and has been throughout this litigation in relation to the efforts made to service his client.
Thanks a lot for your excellent work on my case
G.G. Toronto, Ontario
You really did a great job on the case. The other Injury Lawyers that I spoke with in Toronto and Oshawa wouldn’t even talk to me. I am glad that I called.
RP, Oshawa, Ontario
I want to express my thanks for everything that you have done for me.”
AF, Whitby, Ontario