Do you remember the scene in Jerry Maguire when Jerry, played by Tom Cruise says to Rod Tidwell (played by Cuba Gooding Jr.): “Help me, help you…!”
Now, while I don’t claim to be Tom Cruise, I have found myself saying this line many times, when helping a client with their long term disability claim.
Help me, help you. It’s the bottom line when it comes to personal injury claims, lawsuits and settlements.
Let me tell you why:
What Is Long Term Disability?
Long term disability, or LTD, is coverage that many of us have through work, or through an additional insurance policy. It’s there to pay out disability benefits that replace part of your income and let you continue to cover your bills in the event that you can’t work, due to an injury.
Unlike the coverage you get with your car insurance, which is regulated by the province, every LTD policy is different. The definition of disability, and whether or not you qualify for the benefits, can range from:
- Own occupation — where you are defined as disabled if you cannot return to the job you did prior to your accident.
- Percentage test — where you are defined as disabled if you cannot return to a certain percentage of the duties of the job you had prior to your accident.
- Any occupation test — where you are defined as disabled only if you cannot do any job for which you are reasonably suited.
- Some combination of these. For example, some policies may start out as ‘own occupation’ for the first two years, and then switch to one of the other tests.
If you qualify, you will likely have a 90 to 180 day waiting period before you begin these benefits. That’s because in many cases, there are other benefits that need to be exhausted first, such as EI benefits or accident benefits coverage, in the event of a car accident.
How Can You Help Your Lawyer
- First off, if you have an accident and sustain injuries, whether in an MVA (motor vehicle accident) or a slip and fall, call a personal injury lawyer. Not a real estate lawyer, not a family lawyer, but a personal injury lawyer. Dealing with the insurance companies in these cases requires experience. The lawyer will want to document your case from the beginning, accurately and with all details. That’s best accomplished if they’re on the case from the start.
- Secondly, do everything your lawyer tells you to do and be 100% honest with your lawyer throughout all your communication. This is important: we can’t help you if you set us up to fail. Submit paperwork on time, as requested, and beware of posting on social media. Social media is the new surveillance and you don’t want the insurer to investigate, see a picture of you strolling at the beach, and decide that you don’t meet the eligibility standards for disability benefits.01
- Thirdly, seek medical treatment for your injuries, and follow your medical practitioners orders to the letter. If they say you need to go to physio three times a week, do it. If they say you need to do other therapies, do them. If you don’t follow their advice, it will be a flag to the LTD insurer that you aren’t in fact seriously injured. Make sure that you and your lawyer have an accurate paper trail of notes relating to your case, treatments being undertaken and so on.
What Happens If Your LTD Benefits Claim Was Denied?
There is an appeal process with every insurer, in the event that a claim is denied.
Don’t follow it. Hire a personal injury lawyer instead.
The appeal process offered by insurers is an internal process: it doesn’t involve independent third parties. In other words, it works for their benefit, not yours. And if no new information has come to light, it’s unlikely they would change their decision. In the meantime, we must remember that timing is important. You only have two years after a denial to appeal. It’s not unheard of for companies to run the appeals clock. That’s two years from the initial denial date, not from an appeal denial.
The bottom line with LTD claims is that the maximum amount your entitled to is set out in your policy. So the crux of the claim is whether or not you are disabled enough to be off work.
Providing evidence that you can’t work in the face of the insurer looking for reasons why you can work is where it gets murky.
While the insurance company is starting from a point of zero dollar value, your lawyer is starting from the maximum amount you could receive if you were disabled until age 65.
The final number will be somewhere in the middle, taking into account your relative level of disability and other issues.
What Happens If Your LTD Benefits Are Cut Off?
Once again, hire a lawyer if you haven’t done so already.
Your lawyer will not work to get you back on to benefits; rather, they’ll work to get you a settlement. Unlike MVA claims, which can take up to two years to settle, most LTD claims are settled in a year or less.
There are a couple of benefits to settling over getting payments to resume:
- Peace of mind — once the payout happens, you are free from worrying about whether or not you might be cut off or denied again in the future. You wouldn’t have to deal with the terms of your policy, including providing documentation on a regular basis from your doctor.
- To come full circle back to Jerry Maguire, the second reason is all about ‘showing you the money’. LTD payments are taxable. At the end of each year that you are on benefits, you get a T4 and must pay tax on the money. In contrast, settlement funds for future LTD payments are not taxable. That’s a major incentive to settle, for many people.
There are usually warning signs that your insurance company might be looking to cut off your benefits:
- You are nearing the two year mark of your claim, as mentioned above.
- They ask for a lot of medical documentation: more than usual or asking after being silent for a while.
- The insurer wants to meet with you at your place of employment.
- The adjuster assigned to your claim makes reference to it in a conversation.
All of this is manageable for your personal injury lawyer if they are involved from the beginning and you do everything you can to make it possible for them to do their jobs:
Follow all instructions from them and your doctors; don’t do things that could harm your settlement, like posting pictures of surfing in Bali on your Facebook page; and be truthful with your lawyer every step of the way.
Help them help you… It’s the best way to go!
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