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Short-Term & Long-Term Disability Lawyer Toronto
STD benefits will compensate individuals while they are off work because of injury or illness. If an individual is off work for a long time, STD benefits will typically convert into LTD benefits.
Entitlement to benefits is outlined in each individual policy and policies can vary from company to company. Duration and amount of STD and LTD benefits is also determined by the policy. In all policies, your inability to work must be supported by your treating physicians.
If your application for STD or LTD benefits is denied, you may have the right to sue. If you have been receiving STD or LTD benefits and your insured has terminated your benefits, you may also have the right to sue.
At Grillo Barristers, we have over 30 years of experience litigating STD and LTD benefits claims. We can help you better understand the law and assist you in recovering the compensation that you deserve. If you or a loved one have sustained injuries and have your benefits denied, call Grillo Barristers at 416 – 614 – 6000 for a FREE consultation.
Remember, you will not pay any fees until your case is won or settled.
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Individual disability insurance is purchased by individuals in order to insure against illness or injury that may result in time off work and lost wages. Individual disability insurance can act as a stop gap or addendum to an employer-provided group disability insurance plan. Some benefits to an individual plan include the flexibility in policy options that may not be available under a group plan, portability of the policy, tax free benefits if paid from personal income, and the fact that the policy cannot be cancelled without your permission.
Group disability insurance are comprehensive, group plans that are purchased by businesses and companies and provided as working benefits to their employees.
Premium payments for the insurance pan are either paid through pay cheque deductions or by employer contributions. Coverage for both short and long term disabilities exist although there are caps to the total benefits amount receivable under the policy.
Each disability insurer has their own disability claims forms that must be completed by the insured and often by their treating physician.
A claimant’s statement of disability includes standard personal information such as your name, gender, date of birth, address, health card number, telephone number and importantly, your insurance policy number.
More specifically, you will also be asked to provide information such as whether your medical condition is the result of injury or illness, and details regarding the injury or illness such as how the injury occurred, the symptoms it may cause, how the illness or injury prevents you from returning to work, and how it may affect your daily living conditions. For further detail on these requirements, it is best to speak to a medical professional.
In the case of a group insurance plan, your employer will be required to corroborate this information.
The test for the type of disability that qualifies you for long term disability is an illness or injury that prevents you from being able to work, whether this be a physical, mental, or emotional health issue. The courts have determined that this is a subjective test, but generally any long term condition lasting a year or longer may qualify.
Importantly, it may not be one isolated injury or illness that allows you to qualify for LTD benefits but a whole bevy of injuries and symptoms over time. Here at Grillo Barristers we work closely with the best medical professionals to come up with accurate prognoses of your situation and a plan on how your disability may affect your future employment or income stream.
Disability insurance is categorized into “short- term” and “long- term” categories. There are also many features associated with these types of policies.
Short term disability insurance can provide benefits for up to 6 months for an illness or injury. Long term disability insurance will generally begin when the short term insurance benefits and unemployment insurance (EI) end. Other forms of disability insurance exist for more specific uses, such as insurance that covers critical illnesses or those that guarantee mortgage payments (disability mortgage insurance) in the event that you are disabled and can no longer make your periodic payments.
Also, there are a number of features attached to the types of disability insurance available. For example, non-cancelable disability insurance is the most comprehensive, and thus often most costly, form of coverage. The primary benefits to a non- cancelable policy is that the policy-holder retains control and the insurer cannot cancel the policy. Guaranteed renewable insurance policies allows an insured person to guarantee their policy, on similar terms and premiums, when it comes time to renew their policy.
Short term disability insurance provides the injured claimant with “short term” replacement wages in order to supplement a temporary time off work. Long term disability insurance is designed to supplement your long term income in the case that your injury completely prevents or decreases your ability to work over a period of time.
Therefore, the difference between short term and long term disability insurance is generally the period of time for which these benefits are offered and designed to help replace your missing income and the nature and severity of impairment.
Depending on the type of long term disability coverage, funding can occur from differing sources. Long term disability coverage can be paid for by individuals, either purchased separately or as part of their paycheque contributions. It can also be paid for by employers and businesses, as a form of workers’ benefits.
It is important to meet the notice deadlines for making a claim for LTD insurance benefits, as failing to meet these deadlines will give insurers a reason to deny the benefits. These deadlines will often depend on the insurer and the coverage plan, so please review your insurance policy contract specifically. As a general rule, we recommend that you submit your claim and proof of disability or injury as soon as practically possible. If you need assistance completing your LTD application package, the experts at Grillo Barristers would be more than happy to assist you.
There is some interesting case law on the matter. In Ortiz v Great- West Life Insurance, the court held that insurers have a duty to assess the disability status of the insured within 24 months from the injury or event, and for a further 24 months afterwards. In the case of Ortiz, the claimant had submitted his lawsuit against the insurer well after this period of time, up to 3 years after the disabling incident. As a result the court established that the statute of limitations, as it pertained to the specifics of the case, had elapsed.
Generally the waiting period for long term disability benefits is known as a “qualifying period” and can range from 90 to 180 days after the claim is approved, or even longer, depending on your policy. Shorter qualifying periods are associated with higher insurance premiums, generally. Long term disability benefits will kick in if approved, after the short term disability coverage period expires, so it is best to consult the language in your insurance policy for specific details. For assistance in doing so, feel free to contact Grillo Barristers.
The amount you receive from long term disability insurance benefits will again depend on the language of your insurance contract. As a general rule, LTD benefits will never exceed 100% of your pre-disability average income. In fact, most LTD policy plans will often compensate you for around 50 to 80% of your gross monthly salary amounts.
Some clients often think that they do not need a lawyer’s help in claiming their disability policy, but they are often mistaken. Insurance companies have bureaucratic tools at their disposal to avoid, minimize, and delay the payment of claims. Furthermore, victims who have been disabled are often unable to amass the resources necessary to complete a comprehensive and complete application for their LTD benefits. For these reasons, we advocate that you consider our services at Grillo Barristers. We have over 30 years of experience in dealing with insurance companies, and as a large firm with over 60 professionals and support staff, we have the resources on hand to help you get the necessary medical and corroborating information, as well as proceed with further legal options including commencement of a law suit, should your claim get denied.
The duration of your long term disability insurance benefits also depends on the insurance policy contract. Generally, LTD benefits will persist for two to five to even 10 years, or until you are 65 years old, whichever is sooner. Policies may also have certain rehabilitation clauses that will help assist you off of LTD benefits and back into employment.
Depending on the wording of your policy, the total amount of disability benefits that are paid may be reduced by any other amount of benefits that the claimant has received. This may include benefits such as severance pay or vacation pay. Other forms of disability benefits, such as CPP or EI (Employment Insurance), may also be reduced from the total amount. The reason for this is because LTD benefits are meant as a form of income supplementation, and insurance companies will argue that it is only fair that your total compensation be inclusive of existing benefits you are already entitled to receive.
Extended medical or dental care by is generally not covered under most LTD benefit policies. It is imperative to review the specific wording and terms of the policy.
Can my long term disability insurance company force me to apply for Canadian Pension Plan (CPP) Disability or other benefits?
This depends on the wording of your policy. Some policies are a “last option”, meaning that only after all other sources of disability benefit are exhausted will the long term disability policy apply. However, most policies do require the applicant to file for CPP disability benefits.
If your claim has been denied, it is imperative that you consult with an experienced lawyer such as Grillo Barristers in order to figure out your legal options and how best to proceed, to ensure your rights are protected and receive the insurance compensation you deserve. The process for establishing a claim against your insurance company can be complex and difficult, and we recommend consulting a legal professional at the onset of your disability, before the application is processed, or as soon as possible thereafter.
One of the most common questions our clients ask is whether insurance benefits are taxable, or considered as employment income or taxable benefits. In general, the distinction between taxable and non-taxable depends on whether the insurance premiums
are paid for by the individual or by the employer. Individual disability insurance policies are generally not taxable.
On the other hand, where the employer pays for the insurance premiums as part of an employment insurance plan or group disability insurance policy, the benefits may be considered taxable benefits and thus included in your income at the end of the year.
More specifically as well, where an employer contributes to an individual insurance plan, these may also be considered a taxable benefit.
Grillo Barristers offers free first time consultations and we work on a contingency fee basis, which means you do not pay until we win the case for you! It is vital that you speak with a lawyer as soon as possible in order to review your legal options. Due to the statute of limitations and requirements under your policy terms, you do not want to have missed the period for which you can still bring a claim against your insurance company. A case such as Ortiz v Great- West Life Insurance Co. shows the dangers of waiting too long to make your claim.
If you feel that you have been unfairly treated by your insurance company, or they have breached their contractual obligations, the first step you should take is to consult with an experienced legal professional such as the lawyers at Grillo Barristers. Your lawyer will access your case and advise you on the scope of your legal options. If it is decided that it is in your best interest to proceed with a claim against your insurer, your lawyer will commence a Statement of Claim against the company. Disclosures of information will be exchanged and you may have to attend a hearing or deposition, where lawyers will ask you questions under oath. Rest assured that we at Grillo Barristers are well versed in negotiation strategies and will help you with the legal process.
If you have been denied disability benefits, you may have a case against your insurer if you feel that they have unfairly denied your claim or if they have breached their insurance contract with you. For further advice, it is best to speak with a lawyer from Grillo Barristers. At Grillo Barristers we have over 30 years of experience dealing with insurance companies and we are well prepared to prevent a costly trial and help you mediate or negotiate a settlement.
If the insurance company agrees that I am still entitled to benefits, what are the different ways that my settlement can be paid to me?
Insurance benefits, once approved, or mandated by a court, can be paid on a monthly basis as stipulated in most standard form insurance contracts. You may also opt for a lump sum settlement amount that accounts for moneys owed and future benefits, plus interest and costs owing.
Additional Articles – Short-Term & Long-Term Disability
Understanding the Long-Term Disability Process how does it work?
First, every LTD policy will state how many days an employee must be off work with an illness or injury before LTD benefits can start. This can be referred to as the “elimination period.” Some employees must exhaust their sick days, short-term disability benefits, employment insurance sick benefits, or possibly all of these. It is after the elimination period that LTD benefits could begin.
Next, an LTD policy will have what is called the “previous occupation” or “any occupation” period. What this means is, when a person starts LTD benefits, they are being assessed for their ability or inability to perform their previous occupation. Over time, usually around the two-year mark, the definition of disability changes and then the employees are evaluated for their ability to perform any occupation that they are reasonably qualified to perform. During this period, the employee’s medical health is often closely assessed.
Next, is the payment amount or the amount your LTD will pay as a percentage of your pre-disability income. This amount is negotiated in the contract, but sometimes employees are offered the opportunity to pay a higher premium prior to their disability in order to get a higher payment. Some LTD policies pay as low as 30% of your previous income and as high as 70- 100%.
It is important to note that your LTD contract will have a provision that any money you receive from any other source, such as Workers’ Compensation benefits or Canada Pension Plan disability benefits will be deducted dollar-for-dollar from your LTD benefits. In this situation, you will get the same total amount, just from two sources. The policy may often also require that you apply for CPP Disability.
Your LTD payment could be taxable income or could be tax-free. Your benefits information should state this, but the way it is determined is that if an employee pays either a tax or the full premium amount for the benefits, then the income will be tax-free, otherwise it is taxable.
Another element of LTD contracts is the Recurrence Clause. This clause applies to employees that return to work after being on LTD benefits, but become ill or injured again. Typically, a Recurrence Clause states that if the employee becomes sick within six months from returning to work from LTD, they will go back directly onto LTD benefits. If the employee returns to work beyond the six month mark or whatever timeframe is stated in the contract, then the employee would need to start back at the beginning and access short-term disability benefits or employment insurance sick benefits.
There are typically four reasons why a LTD benefit stops: an employee turns 65 years-old, they pass away, they return to work, or the insurance company suspends their payment.
If you are located in the Toronto area and your LTD claim has been suspended or denied, you should immediately contact an injury lawyer at Grillo Barristers P.C. to assess your application and advise you on the best way for you to move forward with your claim.