If you are applying for a long term disability claim, you must know the definitions, qualifications, timelines, limitation periods and what to do if you get denied. All are integral parts of understanding the application process. It can be a daunting and confusing process, and denials can occur for a myriad of reasons. For this reason, knowing your rights can bring you closer to being approved for long term disability. Here are some things to consider if you have a long term disability claim.
Documentation
Before applying for a long term disability claim, you must ensure you have all the necessary documents. This includes the long term disability application, a copy of the policy, and any rejection or denial letter. If you received a phone call relaying the denial of your benefits, you should get the decision in writing. If you do not have a copy of the policy or are missing some parts of the application, a lawyer can assist in requesting your full and complete file from the insurer.
Appeal
If you submitted a claim and it has been denied, long term disability policies generally provide the right to appeal internally within a prescribed time, which is usually 60-90 days. It is recommended, however, that you speak to a long term disability claim lawyer before appealing internally. The appeal process can be long, and if you are not careful, you could miss the two-year limitation period in which you must bring your claim. In any event, most appeals are denied. It is better to speak with a lawyer and commence litigation rather than waste any time with an internal appeal.
Limitation Period for Submitting the Claim
Your ability to bring a claim for denied long term disability is subject to a limitation period. Typically, a claim must be brought within two years from the date the benefits were denied. Cases like the Ontario Court of Appeal decision in Pepper v. Sanmina-Sci Systems (Canada) Inc. have established that the insured has a claim for breach of contract when the insurer stops paying the benefits. The principle of discoverability (i.e., the point at which the insured ‘discovers’ they have a claim) is an added concern in these types of claims. An experienced LTD Lawyer can help you keep track of limitation periods, and ensure you never miss one.
Further, long term disability policies may attempt to introduce even shorter limitation periods than what is required by law. The Limitations Act states that to successfully contract out of a statutory limitation period, the policy must:
- Be clear in its description of the limitation period;
- Pinpoint the scope of the application of the limitation period; and,
- Exclude other limitation periods.
Deductions
Depending on the policy, there are certain deductions that can be applied to long term disability benefits. While not an exhaustive list, the following are sources that could reduce the amount you receive in LTD benefits:
- Severance Packages;
- Canada Pension Plan (CPP);
- EI sickness benefits; and,
- Worker’s Compensation (WSIB).
Damages
In exceptional cases, the court may award punitive or aggravated damages if it finds the insurer acted in bad faith. For example in Kardaras v. Sun Life Assurance Company of Canada, 2020 ONSC 3925, the court awarded $10,000.00 to the plaintiff for mental distress. The Court found that Sun Life’s approach to the plaintiff’s claim was not balanced or reasonable. This approach caused the plaintiff significant distress, leaving them feeling unacknowledged and unheard.
Take Away
If you have been denied a long term disability claim, it is important to seek legal advice from a long term disability claim lawyer regarding your options. Having a lawyer who specializes in long term disability can make a claim less difficult. The long term disability claim lawyers at Monkhouse Law can fight against the insurance company on your behalf.
This was written by Shane Burton-Stoner. Shane is licensed by the Law Society of Ontario and is an Employment Lawyer at Monkhouse Law.
Monkhouse Law is an employment law firm located in Toronto focusing on employees’ issues. Call us today for a 30 minute free consultation regarding your long-term disability claim. Please call us at 416-907-9249 or fill out this quick form.
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