Policies of disability insurance exist to provide income security for individuals who become disabled and are unable to work.
We have strong expertise in:
- advising and representing individual policy holders whose claims have been denied
- working with medical professionals such as doctors, nurses, physiotherapists, occupational therapists, psychologists and pain specialists to get the medical evidence needed to confirm that an individual qualifies for benefits under the policy
- successfully suing major Canadian insurance companies for breach of contract when disability insurance claims are wrongfully denied.
Disability insurance fills an important gap when other income security arrangements, including government benefits, are not available. For instance, the benefits available through the Workplace Safety and Insurance Board (WSIB) only cover disabilities that arise from workplace accidents. The disability benefits available under the Canada Pension Plan (CPP) and from Employment Insurance (EI) are capped, and for most people will cover only a small percentage of their pre-injury income. In this regard, disability insurance policies can be a useful part of a working person’s overall financial planning.
When someone becomes chronically ill and their claim for disability benefits is denied, the impact upon an injured or chronically sick person can be enormous and the ripple effects on their family devastating. Many of our clients experience shock, anger, and despair when the benefits that they were counting on and paid premiums for are denied. The policies themselves are often legally complex, as are the procedures to hold insurers accountable for breach of contract.
There are many different types of disability coverage available. Some Short Term Disability (STD) and Long Term Disability (LTD) plans will replace an injured person’s entire income whereas most plans replace only a portion of the person’s income. Some plans will cover mortgage payments, car loan payments, or student debt payments. Some are time-limited, while others can potentially provide income security until retirement age. Certain plans provide benefits if you cannot perform your own job, while other plans provide benefits if you cannot perform any job. Many plans are hybrids in which the definition of disability changes after a specified period of time.
Some of the legal issues which may arise in litigating a disability insurance claim include:
- subrogation, which refers to an insurer’s right to reduce benefits when other sources of income are available
- job re-training, which arises when insurers allege that a person may be re-trained for a different type of work that is compatible with his or her injury or illness
- limitations periods, these can be different under particular policies of insurance and under the laws of Ontario
- independent medical assessments (IMEs) – sometimes insurers will dispute a claimant’s diagnosis or capacity to do remunerative work, and will request that a claimant see a doctor who the insurer considers to be independent
- lapses of policies – sometimes an insurer will justify the denial of a claim by stating that the policy had lapsed or that it was issued based on incorrect information provided by the policy holder
- pre-existing conditions – insurers will sometimes deny a claim if they believe the illness or injury was a condition which pre-dated the policy of insurance.
If you have a disability claim that has been denied, contact us for sound advice and strong representation.
