If you are unable to work and have been denied short term disability (STD) or long term disability (LTD) benefits from your insurance company, we can help.
Long-term disability (LTD) insurance is meant to provide policyholders with peace of mind in the event an illness or injury prevents them from working.
But for too many employees, that feeling of security dissolves into thin air when they are forced off work due to a medical condition, only for their insurer to deny them the LTD benefits they need to get their lives back on track.
Every year, thousands of Canadians are left unable to perform their normal duties at work due to medical issues caused by serious accidents, chronic illnesses, mental health conditions and more.
However you were knocked out of the workforce, the LTD lawyers at Edwards Pollard can help you hold your insurer accountable following a denial or termination of your claim, ensuring that you get the benefits that you are entitled to.
What to do after an LTD denial or termination
Whether your LTD claim is denied outright or terminated after a period of receiving benefit payments, your top priority should be to seek legal help.
Insurance companies count on the fact that many policyholders aren’t aware of their legal rights, and as a result, will accept a denial or termination without challenge. With the assistance of an experienced Edwards Pollard LTD lawyer, you will be empowered to start fighting back.
It’s important to note that there are strict deadlines associated with filing a lawsuit against a disability insurance company, and the clock starts ticking the moment you receive your denial or termination letter. The faster you can act, the better.
Although the insurance company’s correspondence will lay out your right to an internal appeal, that process rarely results in a change of decision, and typically succeeds only in delaying your file for months and running out the clock on your opportunity to sue.
At all times throughout this process, it’s important that you continue to seek help from your doctor and follow their advice regarding treatment or further assessment by specialist medical professionals.
What to expect if you file a legal claim
When a thorough review of a client’s LTD policy and claim file suggests that the denial or termination of benefits was unjustified, an Edwards Pollard LTD lawyer will file a lawsuit on their behalf.
Our team tailors their approach to a client’s individual needs, guiding them through every stage of the litigation process, which could include assessments by medical experts, mediation, examinations for discovery and, in some cases, a trial.
We prepare for every case as if it will go the distance before a judge, but we are always alive to opportunities to reach a fair and reasonable settlement, which could arise at any point between the launch of a claim and the first day of trial.
How we can help
LTD disputes can feel like a mismatched contest for individual claimants who have been denied benefits: in addition to dealing with their own financial troubles and debilitating medical conditions, the insurers they are going up against are some of the largest and most well-resourced companies in the country.
An Edwards Pollard LTD lawyer levels the playing field, putting clients in the best position to get the benefits and compensation they deserve.
With several decades of experience going up against many of the leading insurance providers, our LTD lawyers know the strategies insurance companies leverage as well as the hidden pitfalls that plague unfortunate claimants.
Over the years, we have used that knowledge to obtain outstanding results for individuals with a wide variety of physical and psychological disabilities.
If your claim for long-term disability insurance has been unfairly denied or terminated, call Oakville’s disability lawyers at Edwards Pollard for a free consultation on your case at (289) 529-0404.
FAQs: Returning to work while on long-term disability benefits
Returning to work after a period on long-term disability (LTD) can feel like a huge milestone, but for many, it’s also one of the most stressful parts of their recovery journey.
Benefit recipients typically find the idea daunting for different reasons: those who feel ready to go back often worry that it could put their benefits at risk should the attempt fail. Meanwhile, a common concern for those who don’t feel up to a return to the workplace is that their employer will pressure them to come back prematurely.
To help clear up some of the uncertainty, and to help you understand when to seek support from a long-term disability lawyer, here are answers to some of the questions I’m most often asked about returning to work while on LTD.
The short answer is no.
Although every situation is different, any return-to-work plan will require a joint effort between the employer, the employee and the medical professionals in charge of their treatment, so your employer can’t take matters into their own hands.
As with most LTD matters, the first place claimants should look is their policy, the contract that sets out the terms of their relationship with the insurer. While every policy is different, many contain a rehabilitation provision that allows the insurer to explore a return-to-work program in certain circumstances.
Often, the clause will be triggered by medical reports indicating signs of recovery or where a doctor has given an estimated date of return. If you’re unsure how these provisions apply to your situation, a long-term disability lawyer can review your policy and explain your rights.
Nobody wants a returning employee to be overwhelmed by their duties and immediately go back on claim, which is why a return-to-work program generally starts slowly. Duties and hours can be gradually increased over time to maximize the chances of success.
The plan generally has to be approved by the worker’s medical team before it’s implemented, so ensure that it’s documented in writing. This way, your treatment providers can give you a detailed assessment of your ability to meet your employer’s expectations and suggest any changes that will improve the chances of a successful reintegration into the workplace.
Check your policy for details on the payment of benefits during a return-to-work program; many will allow benefits to keep flowing. For workers who can only work part-time, there tends to be a mechanism for the employer to pay for the hours you work, with the insurer making up the difference between your earnings and the previous level of benefits.
Again, the text of your policy will be critical here. In cases where the rehabilitation provisions have been activated and your medical providers have approved a proposed return-to-work plan, the LTD policy typically states that failure to participate could be grounds for terminating benefits.
If you’re uncertain about your obligations or concerned about potential consequences, consulting with a long-term disability lawyer can help you understand your rights and options.
Many LTD benefit recipients are understandably concerned that a failed return to work will jeopardize their benefits, even if they are feeling up to some level of their old job. However, it’s important to know that most LTD policies account for the unpredictability of a person’s recovery through a provision known as the “recurrent disability” clause.
This allows LTD recipients to skip the waiting period that usually accompanies a new claim if they’re forced back off work due to the same medical issue within a certain period — generally between three months and a year.
In these cases, LTD claimants can treat their return to work as a practical experiment testing whether they continue to meet the policy’s test for disability, taking some comfort that they can likely return to their benefits if the attempt must be abandoned because their disability recurs.
In these situations, a return to work can be seen as a practical trial run, a way to test whether you still meet your policy’s definition of disability. The recurrent disability clause offers peace of mind by reducing the risk. If your condition forces you to stop working within the set timeframe, you can usually resume benefits without restarting the waiting period.
That’s why I tell clients there are two key benefits to attempting a voluntary return:
- If you’re successful, you can go back to your job and likely make more than when on disability, as benefits paid under most policies only cover a proportion of your previous earnings.
- If you’re unsuccessful because your disability recurs, it can strengthen your claim because it shows you are motivated to return but were unable due to your disability. Insurers tend to look more favourably on claimants who are doing everything possible to return to work.
If you’re considering going back to work — or feeling pressured by your employer to return before you’re ready — reach out to the Edwards Pollard team of long-term disability lawyers in Oakville to discuss your options.