long term disability claim

Overview

Because of the particularity of each Long-Term Disability (LTD) claim, it is important to have a lawyer review your policy before giving you a legal opinion about your options.

Long Term Disability claims are contractual in nature. Your particular policy will define:

  • what disabilities are entitled to benefits
  • how much the benefits will be
  • if they are taxable
  • what other income may be deducted from them
  • what if any rehabilitation expenses are covered
  • any exclusions (for example, that impairments arising from work accidents are not covered)
  • what your obligations as a claimant are

Many LTD policies have more than one standard of disability, which apply at different times. For example, a policy may state that for the first two years of your claim, you are entitled to benefits if you are disabled from returning to your own occupation, but after the two years you must be disabled from any and all employment in order to qualify.

If you dispute the insurance company’s decision about your entitlement to benefits, most LTD policies require a lawsuit to be filed within one year of a clear denial of benefits. If the policy is silent on the issue, the Limitations Act allows you two years. If you do not file a lawsuit by that time, you may still be able to sue the insurer, but the amount of your claim will be limited.

The evidence required to prove an LTD claim is similar to that required for other personal injury cases, and consists mostly of medical reports and documents establishing your impairments, and information about the requirements of your occupation and your education, training, and vocational aptitudes.

Once a lawsuit is filed, the procedure for LTD claims is similar to other personal injury claims. There may be a mediation to try to resolve the dispute, and there will be an examination for discovery and a pre-trial conference before any trial.

long term disability claim

Cultural Perspective

Not only can the personal injury lawyers and staff members at Carranza help overcome the language barrier, we can also assist with any cultural issues that may arise, including:

  • Traditional versus modern medicine and conflicts about medications
  • Informing loved ones of medical issues and facilitating discussions between rehab teams and key decision makers in the family
  • Explaining body language and how its interpretation might affect your care
  • The impact of religion on care, treatment and recovery
  • Cultural stigmas surrounding shame, depression and isolation
  • The importance of nutrition, diet and the use of herbal remedies
  • How brain injuries affect the family, their social status and future possibilities
  • Bridging the gap between a family’s beliefs and the Canadian healthcare system

real examples of cultural issues in a case

At Carranza, we understand how difficult it can be when English is not your first language. Cultural differences can often affect your case. Having the right representation can make a big difference.

views of authority

One of our clients grew up in a country where the police were corrupt and violent. He learned early in life to fear and obey the police without question.

In Canada, he was involved in a car accident. He was issued a traffic ticket at the scene for making an improper turn, even though the other vehicle had run a red light. The officer told him to pay the ticket, and the client obeyed even though he did not believe the accident was his fault.

In the resulting civil action for damages, the insurance lawyer argued that our client’s payment of the ticket meant that our client admitted responsibility for making an improper turn and causing the accident. Since we were aware of our client’s previous experience with police in his home country, we were able to demonstrate his deference to police and were able to settle the claim on the basis that the other driver was 100% at fault.

long term disability claim

How we can help

Families are often surprised and overwhelmed by how much an injury can impact their lives and their financial situation. An experienced personal injury lawyer can help you understand your current situation better and explain your legal entitlements.

At Carranza, our involvement begins the moment we meet you. Through every interaction, we strive to make you feel comfortable, safe and supported to the best of our abilities.

We are so committed to ensuring we consistently meet you and your family’s needs, Carranza has become the only ISO certified personal injury law firm in Canada.

This ISO certification ensures that our firm is held to the highest standard of client service, that we continually improve our communication, our training and our procedures. We did this, because you are the focus of all we do. We did this, because you are important.

At Carranza, our job is more than helping you through litigation; it is also our responsibility to ensure you have the right resources for your rehabilitation. Your medical and rehab teams work hard to help you recover. They will address your physical, emotional, mental and social needs. We will work closely with them, so you and your family do not have to worry about the additional costs of rehab treatments and assistive devices.

Take care of you.

We'll take care of the rest.

long term disability claim

Your options for compensation

If you are involved in a vehicle accident there is help available.

You are entitled to:

accident benefits

Whether or not you were at fault for the accident, all Ontario auto insurance policies provide compulsory benefits outlined in the Statutory Accident Benefits Schedule (SABS).

Your family members and dependents may also be entitled to some benefits even though they were not involved in the accident. Accident Benefits can be claimed no matter what your legal residence status is in this country.

disability insurance

Short-Term or Long-Term disability benefits available from your job or a private policy must be applied for immediately. These benefits are always primary. Your car insurance will only cover what your private disability policy will not cover.

fault-based lawsuits

In addition to the Accident Benefits claim, you may also sue the person or people responsible for the accident.

This type of claim, called a tort claim, seeks compensation for:

  • Pain and suffering
  • Economic losses (e.g. present and future income losses)
  • Loss of earning capacity
  • The cost of future medical treatment and care
  • The cost of future attendant care
  • The cost of housekeeping and care giving needs
  • Out of pocket expenses
  • Loss of shared family income
  • Loss of care, guidance and companionship suffered by your immediate family
  • Economic losses of family members incurred due to the accident

Once we have a firm understanding of the particulars of your case, we can provide you with an estimate of what you can expect to recover. We look at every means of compensation available to you. We know how important every dollar recovered is to you and your family.

With significant changes made to the Statutory Accident Benefits Schedule as of September 1st, 2010, it is imperative that you consult a lawyer to find out what you may be entitled to. For a printable overview of what you may be entitled to, click here.

long term disability claim

Time Limits

Insurance companies will generally only pay for any treatment or expense after you apply for the corresponding benefit, so it is important that you apply for all the benefits you will need as soon as possible. Strict time limits apply. We will meet these deadlines for you, so you can focus on your recovery.

Some of the key limits to keep in mind:

7 Days – you must inform the Accident Benefits insurance company of the accident and that you were hurt.

30 Days – you must complete and send the Accident Benefits application within 30 days of it being provided to you by the insurance company. If you take longer, the insurance company can delay your benefits 45 days and may be able to deny you benefits altogether.

120 Days – you need to give written notice of your intention to sue the at-fault parties.

2 Years – to commence a lawsuit against an at-fault driver or your own insurance company if your benefits are denied.

You must provide the insurance company all the information it needs to determine your entitlement. You have 10 business days after it requests such information to provide it, or it can suspend or deny your benefits.

long term disability claim

Disclaimer

This website is meant as a general reference for injured persons and their families. The medical and legal information contained in this manual is not intended to offer legal or medical advice. The content of this website is for informational and educational purposes only and is not intended as a substitute for the professional judgment of a legal and/or healthcare professional, and you should not rely upon any material or statements made on this website for legal or medical advice. It is not intended to create a solicitor-client relationship.

It is recommended that you review any medical information carefully with your doctor or healthcare professional before making any decisions regarding your health or recommended medical treatment. While reasonable attempts have been made to ensure the accuracy of the information on this website, our firm cannot make express or implied representations or warranties about the accuracy or completeness of the information. Each person's legal needs are unique, and these materials may not be applicable to your legal situation. Please contact an Ontario Personal Injury lawyer for a consultation on your particular personal injury matter.