Hamilton Long-Term Disability Lawyer

If an injury or disability has made you unable to work, you may be entitled to disability benefits under your disability insurance. To get these benefits, it’s in your best interest to consult an experienced disability lawyer in Hamilton. Derek Wilson has helped numerous Canadians to successfully pursue disability claims and get fair compensation or the benefits that they are legally entitled to. The ability to work and provide for your loved ones is a valuable asset.

Unfortunately, this asset can disappear if an injury or illness causes a long-term disability. Ideally, your long-term disability insurance coverage will ensure you’re financially secure. However, there are times when insurers deny long-term disability claims or try to reduce the amount of compensation. You need an experienced lawyer to fight for your rights and protect your interests in such cases.

For Canadians with no long-term disability insurance coverage or who have a limited policy, the government offers coverage through the CPPD (Canada Pension Plan Disability Benefits). If your insurer or the CPP has denied your disability claim, speak to an experienced long-term disability lawyer. It’s a smart move that will protect your interests and obtain disability benefits you deserve.

Denied Disability Claim

Long-term disability insurance providers have strict guidelines that determine eligibility and specific conditions regarding what they cover. These are the regulations you must follow throughout the coverage period and claim process to ensure your claim remains valid. Failing to follow these terms and conditions may result in unnecessary delays or claim denial.

It’s a scary and often frustrating position to be in, and most people — if they have long-term disability insurance — look to their disability insurance policies for hope and help moving forward. Making an insurance claim may seem straightforward, but unfortunately, it is not always so. That’s why you need the help of a professional and reliable disability lawyer.

An Experienced Long-Term Disability Lawyer Can Help

It is unfair that in a time of pressing need, many Canadians discover their long-term disability benefits are hard to get. This is because most insurance providers try to stall or deny these benefits. Derek Wilson is a reputable and experienced long-term disability lawyer who assists disability claimants across southern Ontario. Do any of the following questions relate to your case?

• Have you been treated unprofessionally or unfairly by your long-term disability insurance provider?
• Does your relationship with the disability adjuster seem like it’s becoming adversarial?
• Do you feel you are not being listened to? Are your doctor’s orders being overridden or ignored?
• Is your disability insurer forcing you to get back to work or telling you there’s something else you can do?
• Is your adjuster not responding to your emails or returning your calls?
• Has your disability claim been denied, and now it feels like you are drowning financially?

These are some of the issues or stories our long-term disability lawyers have been hearing since our law firm’s inception. Sure, you have paid premiums on every pay cheque, and now you need access to your disability benefits. Unfortunately, your disability insurance company has denied your claim and left you on your own – no answers and no financial support. It’s a frustrating situation that most disability insurance claimants have found themselves in.

A disability, whether sudden or degenerative, can leave you with lost income and unable to pay for your living expenses. However, don’t give up yet. Regardless of what your insurance provider has told you or their grounds for claim denial, you have rights, and we can help. We will fight for your right to fair compensation and access to the disability benefits you legally deserve.

Can Disability Insurance Be Denied?

Well, you should be able to rely on your disability insurance benefits when an injury or illness makes you unable to work. Unfortunately,  we see both long-term disability (LTD) claims and even short-term disability claims unfairly denied often by insurance companies on simple technicalities.

In fact, about 60% of the claimants for the Canada Pension Plan disability benefits are initially denied. The most common reason for claim rejection is insufficient documentation and proof of employability. Lack of sufficient medical information on the claim applicant may also lead to claim denial. Our disability lawyers will fight for you and ensure you get the disability benefits you are entitled to.

Why Was My Disability Claim Denied?

There are several common reasons why your claim may have been denied. It could be that the claim did not include proper medical documentation that was required by the insurance provider for the policy, or the injury/illness didn’t meet certain policy requirements. There are even times when claims are denied because the claimant may have missed a deadline. Let’s face it — the application process for disability benefits can be extremely complex and time-consuming. Here are the reasons disability claims get denied.

Lack of Objective Evidence For Disability Insurance Claim

Claims reviewers may sometimes deny disability claims, stating that there are no objective findings to support them. What this means is that the reviewer doesn’t have hard data, such as x-rays, lab results, MRIs, or other medical tests to support a physical or mental health diagnosis. In some cases, a claims reviewer will use a lack of objective evidence to justify denying your claim, even though this is not a requirement in your insurance policy. In that case, you may need to get help from a lawyer who is experienced with denied disability claims. Some insurance companies have even been known to demand “objective evidence” where the policy does not call for it. Knowledge is power, and so is proper documentation. A simple note from your physician stating that you’re disabled isn’t enough to support your long-term disability claim.

There are two categories of medical evidence – objective evidence (x-rays, blood tests, etc) and subjective evidence (the patient’s complaints like fatigue and pain). Insurance companies often deem subjective complaints more credible when supported by carefully documented diagnosis and treatment (objective evidence). In support of your medical records, a statement about your injury or health condition from your doctor is also a vital piece of evidence. Similarly, an independent medical exam (IME) may be performed by medical professionals that insurance companies often use. Be sure to get insights from your disability lawyer during this process to ensure your interests are protected.

Pre-Existing Conditions

Some insurance companies will try to deny a claim based on a condition or symptoms that existed when your policy was not effective. For example, they may justify the denial with evidence that you have received treatment during a period of exclusion listed in your policy.

They may also deny claims if the reviewer indicates that you should have already sought reasonable treatment for a non-treated condition. However, just because this is a valid reason for denial in many policies does not mean that your claim is accurately lumped into this category, and this kind of denial should always be reviewed further. Your disability lawyer can help get the same insurance company to review your claim again. Most insurance companies limit or exclude long-term disability coverage for pre-existing health conditions. This often occurs if you didn’t disclose a health condition when you applied for disability benefits or if the condition started within the “pre-existing period.” While each long-term disability insurance policy has a different pre-existing period, this period often ranges from six months to two years. If you didn’t receive treatment within this period, then your insurance company cannot justify claim denial based on a pre-existing period.

 For instance, suppose your LTD insurance policy has a pre-existing period of a year after the effective date of your coverage, and you have not had treatment for your health condition in five years. In that case, the insurance company won’t deny your long-term disability benefits based on your pre-existing medical condition. Pre-existing limitation clauses are hard to interpret. Therefore, contact our experienced long-term disability claim lawyers to help you understand your LTD insurance coverage better. Your disability lawyer can also help if your LTD insurance claim was denied based on a pre-existing health condition.

Change in Plan’s Definition of Disability Claims

In many long-term disability policies, a predetermined change in the definition of disability as time goes on is used by insurers to give themselves an easy way out to discontinue disability benefit payments to otherwise eligible people. For example, most LTD insurance policies have a limited amount of time that a claimant can be paid when they can no longer perform their regular employment tasks. Once this predetermined period — usually two years — is complete, the insurance company will only continue to provide coverage when you cannot work in any occupation. The ‘change of definition’ in a long-term disability claim refers to the variation in the definition of disability after 24 months or a specified applicable period. That means disability definition transitions from ‘own occupation’ to “any occupation.” During the initial period, disability benefits are payable as long as you’re unable to work within your “own occupation.”

After the change in definition, disability benefits are payable if you can’t work at “any occupation.” That means you are unable to perform duties under any occupation for which you may be qualified in terms of skill, experience, or education. So, the change in definition wasn’t created to benefit Canadians who pursue long-term disability claims. After all, it gives the insurance companies a reason to reassess your claim to find reasons to stop your disability benefits. A transition to “any occupation” definition allows insurance companies to tell you that you can find another job! That’s why you need an experienced Hamilton disability lawyer to ensure the change in disability definition doesn’t result in an unfair treatment of your claim.

Lack of Appropriate Medical Treatment

Generally, all disability insurance policies require that people receiving disability benefits receive ongoing medical treatment, but there is a catch. If the policy does not define “ongoing care” but requires it, then the insurance company can always say you have not been receiving appropriate ongoing care. In some cases, insurers may not accept certain kinds of doctors as appropriate, or they may make recommendations for the care they will later use to deny a claim. Therefore, you can’t expect to ignore a qualified medical professional’s guidance or fail to adhere to the recommended treatment plan and get disability benefits. You must cooperate or participate in the prescribed medical treatment plan appropriate for your injury or health condition. If you don’t follow the treatment guidelines, your insurer may see this as a reason to justify claim denial and terminate your disability benefits.

Surveillance

Insurance companies often hire private investigators to watch, follow, photograph, and film someone who has filed a big claim. They may also interview your neighbours, former co-workers, and other people you regularly interact with to see if your claim is fraudulent. When you are being honest with the insurance company and your doctors, you have nothing to worry about from their surveillance. Our experienced long-term disability lawyers will likely tell you that digital investigation is a less costly avenue to gather information about claimants and what they’re up to. Your insurer may hire private investigators to assess content from your social media profiles and other online platforms.

This allows them to get firsthand insights into your social interactions, routine, and your physical capabilities. If this information contradicts the limitations stated in your healthcare records, there’s a chance your claim will be denied and your disability benefits terminated. Remember that having a disability does not mean life stops — in fact, almost 40% of the Canadian population aged 15 years and over with a disability is considered to have a “mild” disability. Our Ontario disability lawyers will provide professional counsel and help you avoid mistakes that could derail your disability case or lead to the termination of your monthly benefits.

Am I Eligible for Disability Benefits?

Suppose you have an LTD policy, either through your work or a private policy that you have purchased because you are self-employed. In that case, there are a few things you should review in your insurance contract to check your eligibility for disability coverage under your policy and current circumstances. Your policy will have one of several ‘tests’ to determine when you might be eligible for disability insurance coverage:

‘Own Occupation’ Test

This definition states that you are eligible for benefits if you are not able to return to the exact job you had before your accident or the onset of your disability. A policy with this test and no time limit for how long it applies is probably the costliest, but it also might be a good policy for those with specialized jobs. In these cases, many people who become unable to perform in their specialized occupations end up taking a major pay cut if they have to work in another field. Therefore, you must consult your long-term disability lawyer to understand the difference between short-term disability and long-term disability as well as the change of definition.

Percentage Test

This definition outlines a specific percentage of your duties that you are unable to do that qualify you as being disabled. For example, if you cannot do 65% of your prior duties, you would be considered as being disabled.

‘Any Occupation’ Test

This definition is the strictest of the eligibility tests. It means that your injuries are severe enough that you are unable to work in any occupation for which you are reasonably suited, taking into account your work experience, education, training, and previous salary. You must have suffered a permanent or serious disability that prevents you from getting and keeping a job in any profession you are qualified for.

Our Long-Term Disability Lawyers Can Help

Most disability claimants ask our long-term disability lawyers whether it’s possible to change an insurance company’s decision regarding a change in disability definition. This is challenging unless there’s a piece of dramatic medical details or change in your injury that makes it clear that you’re unable to work in any occupation or any capacity.

Fortunately, we have a proven track record of winning claims denial based on a change in disability definition. Keep in mind that the initial long-term disability benefits denied or claim rejection were based on the insurer’s interpretation of your disability case. Similarly, the insurer may have used their doctors to review your medical history. None of these entities had your best interests in mind. Their concern would have been the cost savings if they did not pay your short-term disability or long-term disability benefits.

Luckily, our Hamilton disability lawyers and the justice system don’t interpret the disability insurance law or assess disability insurance claims the same way as insurers. Your long-term disability lawyer will only focus on getting you long-term disability benefits from your disability insurance company. Therefore, our long-term disability lawyers will review the reason behind your claim denial and use their years of experience to work for you and ensure you get the benefits you deserve.

Types of Claims

In Ontario, medical conditions that prevent you from working and that meet the requirements of your group or employer’s long-term disability policy are eligible for benefits. These may include:

Mental Health Claims

Mental health conditions include clinically recognized and disruptive changes to a person’s mood, cognition, thinking patterns, or behaviors. As we learn more about mental health, we have come to recognize that these conditions can be caused by physical changes to the brain, genetics, and other factors, just like physical health conditions.

Mental health conditions vary widely, and even two people with a similar diagnosis can have very different experiences. One person, for example, may have more severe symptoms that don’t react well to medication, while for another person with the same condition, the illness may not affect the ability to work.

Some mental health conditions that may be covered by long-term disability claims include:

• Bipolar disorder. This group of mood disorders can cause an individual to fluctuate unexpectedly between intense mood highs and lows. Individuals with this condition may have racing thoughts, sleep disorders, and other challenges that can impact their ability to work. While there is no cure, some patients respond well to treatment. There are three types of bipolar disorder recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Bipolar I, Bipolar II, and Cyclothymia.
• Post-traumatic stress disorder (PTSD) is a condition that can occur after someone has been exposed to severe trauma, including war, violence, and assault. Police officers, army personnel, and other professionals can also be exposed to situations that put them at risk of PTSD. This condition can cause flashbacks, concentration difficulties, sleep disturbances, and other debilitating symptoms that can make work very difficult.
• This mental disorder can lead to low energy levels, isolation, severe sadness, withdrawal, forgetfulness, and a range of physical and cognitive symptoms. This condition can make it very difficult for individuals to focus on work and to find motivation for work tasks. While antidepressant medication and therapy options can work for some, depression can be difficult to manage.
• This mental illness can cause hallucinations, communication problems, cognitive challenges, and unpredictable behaviors, among other symptoms. Individuals with this condition may have a hard time working or taking care of themselves and may need medication to manage psychotic episodes.
• This condition can take many forms and can involve panic attacks, difficulty concentrating, restlessness, and a debilitating level of worry. The extreme levels of tension and catastrophizing can make it difficult for patients with this condition to take part in work activities. For those with extreme anxiety, it can even be difficult to leave the house to come to work.

These are only some of the mental health conditions that may qualify you for a long-term disability claim in Ontario. If your mental health condition prevents you from working for at least a year, you may be eligible for benefits.

One challenge is that mental health disorders are sometimes called “invisible disabilities” because there is no blood test or imaging scan you can do to determine whether you have this type of condition. In fact, you may go through multiple diagnoses and treatment options before medical professionals determine the right diagnosis. This can make it challenging to prove your disability so you can get your rightful benefits.

Disability Claims for Chronic Conditions

Chronic conditions are serious medical conditions that have symptoms, require treatment, or affect your ability to function for at least one year. By their very definition, these conditions should make you qualified for long-term disability benefits if your illness prevents you from working.

Chronic conditions can include diabetes, endometriosis, heart disease, respiratory disease, chronic back pain, and other illnesses. One challenge with these conditions is that some are difficult to quantify. For example, women with endometriosis (a condition where tissue similar to the uterine lining grows outside the uterus) can experience very severe or mild levels of pain.

While ultrasounds can show the presence of atypical tissue growth, these tests cannot definitively prove the level of pain, which can make it easier for insurance companies to dismiss legitimate claims.

Another challenge with chronic conditions is that symptoms may fluctuate widely. Someone with chronic back pain, for example, may get a reprieve for a few days only to be devastated with pain again immediately after. The unpredictable nature of these conditions can lead insurers to minimize or deny valid claims.

Injury Disability Claims

Injuries from sports falls, car accidents, and other incidents can leave someone with severe injuries that can make it hard to return to regular work duties. An employee may not be able to return to work due to a range of injuries, including:

• Head injuries that result in memory loss, cognitive problems, and other symptoms.
• Back and spinal cord injuries that impact mobility.
• Amputations that affect mobility.
• Vision loss.

Any other injury that prevents you from working for at least 12 months may make you eligible. 

Cancer Disability Claims

According to the Canadian Cancer Society, 2 in 5 Canadians are expected to be diagnosed with cancer at some point in their lives, and the latest research finds that cancer is being diagnosed in younger individuals—including individuals who are still in their prime working years.

Cancer can require multiple rounds of chemotherapy, surgery, and other treatment. Patients fighting cancer can experience extreme weakness, nausea, and other symptoms that prevent them from working. In addition, the process of getting treatment can be time-intensive and requires its own recovery time, so that someone who is affected by cancer may not be able to return to work while undergoing these treatments.

With one in 14 Canadians succumbing to cancer, cancer means a fight for your life. The last thing you should have to worry about is how you will pay the bills. If your group insurance or employer’s benefits offer long-term disability insurance and your cancer keeps you from working for over a year, you will want to pursue the fairest amount so you can focus on your health.

How Do I Fight an Insurance Claim Denial?

Denied disability insurance benefits are very common in the insurance industry. If you were wrongfully denied disability benefits, here is what you can do.

Put your Denial Letter in a Safe Place

This is an important document because it will include the date of the letter, and in Ontario, this is the date from which the 2-year limitation period to sue starts to run. Your denial also includes the definition of “disability” as per your policy, the provisions of your policy, the insurer’s reasons for denying your long-term disability benefits, and in some cases the last day of your long-term disability payments.

Skip the Internal Appeal Process

Internal appeals rarely work. Essentially, someone from the same company that unfairly denied long-term disability benefits is reviewing a co-worker’s previous decision. Unless you have brand-new information or medical reports to present containing information the insurer did not already have, it can be very difficult to win the appeal. It does happen, but it’s challenging, which is why many people choose to retain a disability lawyer.

Read your Policy or the Policy Booklet provided by your Employer

Much of the information about denied long-term disability benefits may be difficult to understand, but being informed can only help you. Look for any information that stands out to you, and make note of any questions you have that you can ask when you contact our team of experienced disability lawyers.

Be Aware of Deadlines

These might be deadlines imposed by the insurance company concerning providing more information for your claim or taking legal action. If in doubt about these deadlines, ask. In any situation in which your LTD benefits have been denied or terminated, you should speak with a lawyer who has experience in handling LTD claims as quickly as possible before making any decisions about your claim.

Call a Disability Lawyer

The moment you receive your denial letter, it is time to call our Hamilton disability lawyers with experience in long-term disability insurance claims in Ontario. Even if you are fairly confident you understand the reason for your denial, disability law can get complicated. For example, your policy may have rehabilitation care requirements written in complicated legal language that you thought you were meeting but have fallen short of because of understandable confusion. Having professional disability lawyers on your side who are looking out for insurance company tricks can be helpful.

Keep Seeing your Doctor

Have them update your medical information. You will need your ongoing medical records (medical evidence) to support your disability claim, and your doctor will also refer you to specialists. These specialists can help diagnose your condition, provide treatment options, and serve as expert witnesses in your case if needed.

Document Conversations in Writing

Even if you just send a quick email to yourself with a recap of a doctor’s appointment, or a phone call from the insurance company — which will hopefully be handled by your lawyer from this point — make sure to document dates, times, people, and important information.

How Do I Write an Appeal Letter for Long-Term Disability Denial?

You can always appeal your denial directly with the disability insurance company, but an own hamilton disability lawyer can help you save crucial time getting back on track. Skip the internal appeal process; it’s very difficult to win because, essentially, someone from the same company is reviewing a coworker’s previous decision. The process of writing a formal appeal letter can be complex. Work with a lawyer to draft a persuasive long-term disability appeal letter and attach all your supporting documents.

Our lawyers have been handling claim appeals for many years, and you can rely on their experience to create a personalized, detailed, and persuasive letter of appeal. You do not even have to wait until you are fighting a denied LTD claim to seek legal help. Even if you have not yet been denied, you may be getting a sense that receiving benefits under your long-term disability plan is becoming more complicated than seems reasonable. Hiring a lawyer can help you make sure that you are staying on top of your deadlines, paperwork, and any other eligibility requirements to build the strongest claim possible.

How Can a Long-Term Disability Insurance Lawyer Near Me Help?

Derek Wilson Injury and Disability Law can help you navigate your long-term disability benefits case. Disability insurance companies and long-term disability policies in Canada can be complex to navigate on your own. That’s why our team of Hamilton disability lawyers is prepared to take all reasonable steps to proceed with your claim and get you fair LTD benefits. Indeed, we are passionate legal professionals in disability law and have assisted many individuals across Ontario in pursuing long-term disability claims and recovering fair settlements. We are happy to discuss with you the strategies we have used in our appeals process for cases that insurance companies approve. Therefore, legitimate claims are not hopeless under the disability law.

Affordable Disability Lawyer Fee

Personal injury law firms are different from other types of law because we only get paid if we get compensated for your injury damages. This structure is called a contingency fee, and many personal injury lawyers work on a contingency fee arrangement. This is generally a good thing.

For one, it means you can expect that any lawyer who takes your case is confident they can build a strong claim. It also means we don’t charge legal fees for your long-term disability lawyers unless we get your disability benefits reinstated or reach a lump sum settlement of your current and future benefits. However, you do need to account for the legal fees when considering the final settlement amount you can expect to receive. Understanding the contingency fee process is important, and you should be prepared to ask any lawyer you speak to about their fee arrangements during your free consultation.

Let Me Help You

My firm focuses only on personal injuries and represents clients with long-term disability claims. We provide fair and honest legal representation and advice with a focus on helping clients in the disability claim process recover fair compensation with no up-front fees. Are consultations with a Hamilton disability lawyer free? Yes. Call us at 855-769-0418 or get in touch online to schedule a free consultation with an experienced long-term disability lawyer, Hamilton.