Disability Insurance Coverage and Policies

If you have sustained a disability due to an illness, car accident, medical negligence, slip/trip and fall, or assault, you may be eligible to receive benefits under one or more types of disability insurance. These include short-term disability insurance, long-term disability insurance, mortgage disability insurance and critical illness insurance. If you have access to any of these policies, applying for benefits can be difficult and, unfortunately, many valid claims are unfairly denied or terminated by insurance companies. An experienced disability insurance lawyer can help you challenge the insurance company in the event of an unfair denial or termination of benefits.

Short-term disability (“œSTD”) may be available at the onset of an illness or injury. Most STD plans are provided by an employer as part of their benefits package – payable by either the employer itself, or, another insurance carrier. A STD period is one where the employee uses up his or her allotted sick leave, and must then go on STD leave before they can qualify for long-term disability benefits. STD may consists of anywhere from full salary to a percentage of salary. Alternatively, an LTD policy may require that the person apply for and receive Employment Insurance Disability benefits before applying for LTD – in this scenario, the period of Employment Insurance Disability benefits is in fact the STD period.

Long-term Disability (“œLTD”) insurance is a form of income replacement. The policyholder may be the employer, or, if you have purchased the LTD policy yourself privately, then you are the policyholder.

LTD benefits are available once the insured person has exhausted their EI disability, sick leave or STD benefits, as the case may be, and they meet the definition of “œtotal disability” as contained in the LTD policy. Most LTD policies define “œtotal disability” as an inability (due to illness, injury or disability) to perform the duties of one’s own occupation for the first 24 months of disability, and an inability to perform any occupation thereafter. An LTD benefit is usually equivalent to 50% to 70% of a person’s pre-disability income, although the precise percentage varies from policy to policy. It may or may not be taxable, depending on who pays the premium. More information about LTD insurance can be found here.

Critical Illness Insurance provides coverage for individuals who are diagnosed with a critical illness as defined in the policy. Most critical illnesses include terminal and life-altering medical conditions, such as cancer. The critical illness insurance will usually pay a lump sum, one-time payment in the event of diagnosis, which the insured person can then use towards living expenses while they are off work, private nursing, medical expenses, or specialized out-of-country medical treatments.

Mortgage Disability Insurance, also known as mortgage payment protection insurance, is a type of LTD insurance. This insurance policy is taken out when you enter into a mortgage contract. The mortgage holder is also the beneficiary of the insurance. The purpose of Mortgage Disability Insurance is to pay your mortgage payments in the event that you become “œtotally disabled”, as that term is defined in the insurance policy. The length of time that the payments continue will depend on the wording of the insurance policy. It is possible to have both LTD insurance as well as Mortgage Disability insurance.

Long-Term Disability FAQ: Money Matters

How much money is paid by my Long-term Disability (“œLTD”) insurance policy?

The money that is paid is called a benefit. The benefit amount varies from policy to policy, but typically it is paid monthly in arrears, and is equivalent to a percentage of your pre-disability income. The percentage also varies from policy to policy, but can range from 50% to 70% of your gross earnings. Some policies also factor in bonuses and overtime when calculating the benefit amount. Additionally, some policies may have a monthly maximum, particularly in the case of high-income earners.
If your LTD policy has a “œcost of living” adjustment clauses, then the monthly benefit will increase each year.
Some LTD insurance policies provide a set monthly amount, rather than percentage of income, as the LTD benefit.

Most LTD policies will pay benefits if the person is “œtotally disabled.” Total Disability is generally defined as the inability to perform your own occupation for the first 24 months of disability; after 24 months, the definition of Total Disability changes so that benefits are only payable if the person suffers a complete inability to perform any occupation. The “œany occupation” can continue until age 65, provided that the person continues to meet the definition of Total Disability during that time.

The maximum duration of LTD benefits is to age 65.

The general rule is that if an insured person pays part or all of the monthly insurance premium, then the LTD benefit is a non-taxable benefit. If the employer (in the case of a group disability plan) or other policyholder pays the premium, then the LTD benefit is taxable.

Other than taxes, the LTD insurance policy will usually contain a clause than lists all offsets or deductions from the monthly benefit. These offsets usually include other forms of income replacement, such as under auto insurance legislation, Canada Pension Plan Disability benefits, Workplace Safety and Insurance benefits, and pension income. However, it is important to note that not all LTD policies are identical. Group insurance plans are typically more stringent in terms of the listed offsets than insurance policies purchased by the individual policyholder.

To speak with an experienced long-term disability lawyer, call Howard Yegendorf & Associates today or book a consultation online.

Why has my Long-term Disability Claim Been Denied?

Many long-term disability (“œLTD”) insurers carefully abide by the terms of their policies and adjust claims in an honest and prompt manner. Theoretically, as long as an insured person complies with policy requirements for filing a claim and meets the definition of Total Disability, they will be eligible for receipt of LTD benefits.

However, as many LTD lawyers know, many claims are denied by insurers – claims that may very well otherwise be valid. If your claim for LTD benefits is denied, you need the advice of a lawyer experienced in long-term disability insurance who can help protect your rights and interests – and get your benefits back.

Sometimes, claims are denied or delayed for simple procedural errors, such as:

  • Failing to complete all of the application documents
  • Failing to send all requested medical documentation to the insurance company
  • Sending the documentation to the wrong address or fax #
  • Applying for LTD benefits before you are Totally Disabled
  • Your physician has not completed the Physician’s Statement
  • In some instances, failing to make timely premium payments

Most of these errors can be avoided with careful attention to detail, and/or otherwise quickly remedied.

An insurance company will consider applications for benefits that have been filed in a timely manner. Most LTD insurance policies contain timelines for applying – for example, an application has to be filed within 90 days of the end of the short-term disability or elimination period. Applying for LTD benefits months or years after a disability has commenced may compromise your entitlement. There are certain circumstances where a late application may be approved, however. To find out if you fall in this category, you should consult with a lawyer with experience and skills in litigating long-term disability claims, such as Najma Rashid at Howard Yegendorf & Associates.

Limitation periods for starting a lawsuit against an insurance company for wrongful denial of a valid LTD claim, or termination of LTD benefits, are set out in Ontario’s Limitations Act, and the insurance policy itself. Most LTD insurance policies are governed by the Limitations Act unless the policy says otherwise. The Limitations Act provides for a 2-year limitation period. This 2-year period begins to run from the date that there is a clear denial of your LTD claim. You should consult a lawyer within this 2-year period, and preferably as soon as your claim has been denied or terminated.

Once the limitation period expires, you will be forever barred from starting a legal action against your LTD insurance company for wrongful denial or termination of benefits.

Many claims are denied or terminated because the insurance company does not feel that the medical information submitted meets the requirements of the policy. To qualify for LTD benefits, you must be “œtotally disabled”. That phrase is defined in your insurance policy. Generally speaking, most policies define “œtotal disability” or “œtotally disabled” as the inability to perform the tasks of your own occupation for the first 24 months, and, after 24 months, the inability to perform the tasks of any occupation for which you are or may become reasonably suited by education, training or experience. The said inability must be due to a medical condition such as accident, injury or disease.

To prove “œtotal disability”, the insured person must submit medical information including a written Physician’s Statement, which is a questionnaire or medical certificate completed by the treating doctor. The Statement will set out the diagnosis, current treatment, medications, and opinion about whether the medical condition prevents the person from working.

Additionally, particularly if the claim has been approved but the insurance company is re-evaluating your entitlement to continued LTD payments, the insured person will be required to provide the records of his/her family physician, specialist, lab results, surgical and hospital records, physiotherapy records, and all other medical records.

If these records are not provided in a timely fashion to the insurance company, or they suggest to the insurance company that you are getting better or that you are not following regular treatment recommendations, then your LTD benefits may be in jeopardy.

Even if your illness, medical condition or disease causes “œtotal disability”, many policies have certain exclusions that may negate your eligibility for benefits. Review your policy carefully to determine if these exclusions apply to you. Some claims may be excluded from eligibility if:

  • The medical condition was the result of engaging in an activity prohibited by the policy
  • The individual was not employed full-time when the disability arose, or, they has not been employed for a sufficient period of time to trigger coverage under the policy (where the policyholder is the employer, and employee is the insured beneficiary)
  • The medical condition may be a pre-existing condition that is excluded under the policy

Please call 1-866-303-5118 to schedule a one-on-one appointment with one of our long-term disability insurance lawyers at Howard Yegendorf & Associates to discuss your legal options.

Howard Yegendorf & Associates

Howard Yegendorf has spent his entire career as a personal injury lawyer protecting the rights of clients who have been seriously injured.

Howard Yegendorf & Associates

Howard Yegendorf has spent his entire career as a personal injury lawyer protecting the rights of clients who have been seriously injured.

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How do I Qualify for Long-Term Disability Insurance Benefits in Ontario?

While many of us will be lucky enough to avoid suffering a serious illness or injury that makes it impossible for us to continue working on a full-time basis, a long-term disability insurance policy will provide income continuity in the event of a serious injury or illness.

Unfortunately, even when a person is covered by a long-term disability insurance policy, it can be difficult to actually obtain benefits under that policy, as the application and insurance and approval process can be complex. If you recently sustained an illness or injury that prevents you from working, and your claim for LTD was denied, you should consider speaking with an experienced long-term disability insurance lawyer who can assist you.

Long Term Disability, LTD, Suing for Long Term Disability

How do I Prove that I am Disabled?

Before an insured person can begin collecting benefits through their long-term disability insurance policy, they will need to demonstrate that their injury or illness meets the definition of “œtotal disability” that is contained in the policy. Although not every insurer’s definition is the same, in most cases, a person is considered totally disabled when he or she is unable, due to an injury or illness, to substantially perform the duties of his or her occupation for the first 24 months of disability. After 24 months of disability, the definition of “œtotally disabled” changes, and the person must be unable to perform any occupation for which they may be suited by education, training or experience.

To prove that an injury qualifies as a disability, a claimant will need to submit a written statement provided by a physician that describes the extent and cause of the policyholder’s injury. Objective proof of a disability is also often required, which includes medical records, such as clinic notes, lab results, MRIs, x-rays, exam findings, and surgical reports.

Requirements for Receiving LTD Benefits

Aside from being able to prove that an injury or illness results in “œtotal disability”, the insured person may need to take the following steps to ensure that they will be able to receive benefits:

  • Pay the monthly premiums, if necessary, which will keep their policy from lapsing
  • Prove that they were full-time employees at the time that the disability occurred
  • Wait for the termination of the elimination period, or the time between when a disability actually begins and when a person begins receiving benefits
  • Demonstrate that an illness or injury is not excluded under their policy
  • In some cases, prove that their medical condition was not pre-existing, which means that it was not diagnosed or treated within a certain period of time before coverage began

It is important to keep in mind that this is not an exclusive list, as each long-term disability insurance provider has its own unique requirements.

Will My Insurance Company Require Me to Apply for Canadas Pension Plan Disability Benefits?

Most long-term disability insurance policies also require claimants to apply for Canada Pension Plan Disability Benefits (“œCPP-D”), Disability benefits, as they are permitted to offset the amount that is received from CPP-D against the monthly long-term disability payments that they are required to make.

How Retaining a Long-Term Disability Insurance Lawyer Can Help

At Howard Yegendorf & Associates, our long-term disability lawyers have been helping individuals with serious injuries or illnesses obtain compensation for decades. Please call us at 1-866-303-5118 today to learn more about how we can help you challenge the insurance company’s decision to deny or terminate your benefits.

Long-Term Disability Insurance Claims Lawyer in Ottawa

Professional Lawyer Serving Ottawa, Kingston and the rest of Ontario

Long-term disability (LTD) insurance is available primarily through private purchase or by purchasing a policy through a benefits plan offered by an employer. Many people pay the premiums for years only to find they are denied when they attempt to make a claim.

This is disheartening as people are left unsure of their rights and in need of assistance as they deal with the reality of a long-term injury or disability that is preventing them from working.

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    Choose Yegendorf

    Reason 1

    Our personal injury law firm has decades of experience in helping victims of traffic accidents.

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    Our lawyers understand not just personal injury law but also the health care system.

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    Our team of personal injury lawyers is committed to protecting the rights of victims of serious accidents.

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    Our injury law firm focuses on cases involving brain injuries, spinal cord injuries and wrongful death.

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    Reason 5

    Our injury lawyers have vast experience in dealing with accident insurance claims and disputes.

Howard Yegendorf of Our Ottawa Injury Law Firm

“Our results in catastrophic injury cases are measured in financial terms. But I have always felt that the true success in legal cases where lives have been shattered in an accident comes from a compassionate and thorough understanding of the deep human costs involved.”

– Howard Yegendorf, Founding Partner.

Ottawa ‘s LTD Disability Benefits Lawyers

At Howard Yegendorf & Associates, we understand that insurers sometimes fail to uphold the policy contract by erroneously denying legitimate claims. We seek to level the playing field on behalf of our clients, holding the insurance company accountable for the benefits our clients are entitled to as a result of their long-term disability policy.

Common Reasons for Denial of LTD Insurance Claims

Insurance companies often present the following reasons for denying claims:

  • The claimant does not meet his or her criteria for “totally disabled.”
  • Misrepresentations were made on the insurance application.
  • The claimant is deemed to be able to return to work.
  • The disability is a pre-existing condition that was not disclosed.

Claimants are at a disadvantage as they often lack sufficient knowledge of insurance law and are unsure of how to challenge the misrepresentations of the insurance companies.

We’re Here to Help | Call 613-237-5000 or 1-866-303-5118 for a Consultation

If you believe your claim has been wrongfully denied, you can rely on our lawyers to pursue the full benefits you are entitled to under your policy. Contact us for a consultation with our Ottawa long-term disability lawyers. We have consultation offices in Ottawa, Toronto and the GTA, and throughout Eastern Ontario.

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“Howard and Najma protected and helped us during a terrible time in our lives.”

At Howard Yegendorf & Associates, we have nearly 50 years of combined experience with personal injury claims. Our primary focus is on catastrophic injuries such as brain and spinal cord injuries and wrongful deaths, but we will guide and represent you during any personal injury case.

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rath khan
rath khan
20:04 28 Jul 19
Receptionist She is always in bad mood. I did observe her a lot. If you are happen to be other ethnicity than caucasian , she will racially profile you. She doesn't have simple courtesy . Also one of the lawyer I dealt with not professional at all and rest of the lawyers I don't know much about them. At this place, you don't feel like they care about your situation much.
rath khan
rath khan
20:04 28 Jul 19
Receptionist She is always in bad mood. I did observe her a lot. If you are happen to be other ethnicity than caucasian , she will racially profile you. She doesn't have simple courtesy . Also one of the lawyer I dealt with not professional at all and rest of the lawyers I don't know much about them. At this place, you don't feel like they care about your situation much.
Jonny Hare
Jonny Hare
09:00 05 Mar 19
In 2014 I was involved in a car accident on HWY 417 near Ottawa. It involved myself and two other vehicles being rear ended. I was the middle vehicle and ended up being transported by ambulance to Queensway hospital. My injuries were misdiagnosed at the time of the accident and I was referred to Howard Yegendorf. I met with Mr. Yegendorf and he showed me overwhelming concern and care for my situation, injuries and surgery. He explained how he could file liens for surgery and physical therapy to resolve my health issues sooner rather then later. He then fought 100% with the auto insurance company completely looking out for my best interest.I cannot put into words how tremendously grateful l am for everything that Howard Yegendorf has done for me and my family!
Jonny Hare
Jonny Hare
09:00 05 Mar 19
In 2014 I was involved in a car accident on HWY 417 near Ottawa. It involved myself and two other vehicles being rear ended. I was the middle vehicle and ended up being transported by ambulance to Queensway hospital. My injuries were misdiagnosed at the time of the accident and I was referred to Howard Yegendorf. I met with Mr. Yegendorf and he showed me overwhelming concern and care for my situation, injuries and surgery. He explained how he could file liens for surgery and physical therapy to resolve my health issues sooner rather then later. He then fought 100% with the auto insurance company completely looking out for my best interest.I cannot put into words how tremendously grateful l am for everything that Howard Yegendorf has done for me and my family!
Carol Dunlop
Carol Dunlop
02:09 04 Mar 19
2 years ago I was hit by a car on Hunt Club and Riverside intersection in Ottawa, the lady behind the wheel was not looking at me at all even though I had white sign for crossing. She stopped before the traffic light, I stepped on the crosswalk and she just turned right while looking to the left. She bumped me with her car and my foot got stuck under rear passenger wheel. Then she apparently panicked and went backwards rolling over my foot one more time. Later at emergency they diagnosed me with multiple bone fractures, I had to go through 2 complicated surgeries and over a year of rehab before I could use my foot again. And it still hurts when I run, jump, stand for too long or stress it somehow else.Engaging Howard Yegendorf and his team shortly thereafter was one of my best decisions ever. His knowledge, and confidence told me I was working with the best professionals I could have found. Howard guidance was invaluable. He listened and helped me throughout the case. We were both patient and that patience produced positive results.He helped me to deal with insurance company, guided me through LTD insurance and closed my case for really good amount of compensation.
Rony Podolsky
Rony Podolsky
13:34 19 Jan 18
Mr. Yegendorf is very different than the stereotypical lawyer. He is sympathetic to his clients and eager to help. Probably one of the most ethical, professional and experienced lawyers out there. Highly recommended!
Natalia Bradu
Natalia Bradu
15:46 17 May 17
I can not express my warmest wishes to Howard Yagendorf and his amazing team. I had a great experience working with them and I'm so thankful to his expertise and help in my difficult situation. He guided me and my family through the process and helped us to get the outcome we've never hope about. Great people, great team and overall experience was easy and worry free. Thank you so much.
Brian Mandelker
Brian Mandelker
15:41 21 Apr 17
Howard is an excellent, meticulous lawyer. Perhaps even more important though, is that he is a compassionate human being. A very good listener and an even better questioner!
Michael Dagenais
Michael Dagenais
16:42 14 Mar 17
I have known Howard for nearly 20 years. During that time he not only helped me with sound, expert advice pertaining to a "Ponzi scheme" that devastated my family, he has helped countless others. He is dedicated to the law and a true expert in his field. I know first hand that he has changed the destiny of many of his clients , allowing them to move forward with dignity after suffering catastrophic events. He cares deeply , has dogged determination, vast experience and his team of lawyers and support staff are second to none. I would highly recommend Howard and his team.
Stephen McGill
Stephen McGill
14:22 16 Feb 17
I've known Howard Yegendorf for well over a decade and consider him to be one of the most capable, professional, knowledgeable and trustworthy people I've met in my business career. His attention, compassion and skills were reinforced to me when he helped a very close family member with a potentially serious legal situation. Without hesitation I will continue to recommend Howard and his firm to anyone who wants exceptional legal representation.
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