By Matt Lalande in Long-Term Disability on November 05, 2021
Canada Life markets long-term disability insurance policies to consumers throughout Canada, citing that 40 percent have disabilities that last at least 90 days or longer before they reach age 65. The company claims its disability insurance will “protect your most valuable asset” your ability to bring in income for the length of your career. When that income cuts off abruptly due to a disability, Canada Life and its disability coverage will be there to help. Or will it?
Disability insurance is an investment we make to protect ourselves and our loved ones should we lose our abilities to work. When disability strikes, we expect our disability coverage to kick in and provide the financial support we need to cover our bills and expenses. However, Canada Life policyholders regularly learn that obtaining disability benefits under their coverage is more challenging than it should be.
Disability insurance offers safety and security, but when claims end in a wrongful denial, we can experience just the opposite. Claimants can experience stress and concern about how they will cover all their expenses without the insurance benefits they expected.
Have your Canada Life long-term disability benefits been wrongfully denied? Reach out to a Canada Life insurance disability lawyer at Lalande Personal Injury Lawyers for information on how we can help. In addition to our personal injury practice, we zealously defend the rights of disability benefit claimants throughout the Hamilton area and Ontario.
The purpose of disability insurance is not much different from other forms of insurance in that it aims to protect the economic value of what the policy insures. If your car has insurance and sustains damage in an accident, the purpose of your insurance is to cover repair costs to minimize out-of-pocket expenses.
With disability insurance, you insure the economic value of your earning ability and contribution to the support of your household. Like car insurance, you and your family rely on your disability insurance to promptly payout when it matters.
Disability insurance policies require policyholders to pay premiums, and in return, the insurance company should pay out benefits upon the physical or mental disability of the policyholder. Unfortunately, it is never that simple, as there are caveats, policy exclusions, and other disqualifying factors that can result in a claim denial.
Canada Life is a for-profit organization, and the company may improperly deny claims to increase profit margins. Improper denials are also sometimes an attempt on behalf of the insurance company to get you to negotiate and accept a lesser benefit amount or settlement to avoid having to go to court.
A Canada Life insurance denial lawyer can fight to ensure that the insurance company pays your claim completely, and if any penalties are available for the insurance company’s unjust denial, you get them as additional compensation.
When you are in an unexpected situation, and it comes time to collect on any type of insurance benefits, you might think that this is the time that the insurance companies will get to work for you, putting the premiums you or your employer paid into play.
This is not always the case, as insurance companies do not work for you they work to produce a profit. When profit is the goal of an organization, it seeks to cut down on costs while increasing revenue.
For insurance companies, this means processing claims as quickly as possible to minimize the resources invested in the claim, which can often lead to errors in the process. Insurers also try to save costs by denying as many claims as possible and paying as little as possible on those claims that they approve.
By moving through claims faster and denying as many as possible, insurance companies can maximize their profits for their shareholders, and this is at the expense of policyholders and benefit beneficiaries.
Knowing that the insurance company does not work for you is important and can help to inform the way you proceed through the claim process. The goal of the insurance company is not to approve all claims but to identify only those claims that qualify for coverage and to deny the rest.
Specifics and details of particular claims can be lacking, leading to initial denials that require time-consuming appeals. Instead of requesting more information, some companies will simply issue a denial right out of the gate. Having an experienced insurance claims lawyer on your side with experience processing disability claims will support the outcome of your application and help to line up your coverage as soon as possible.
Your disability insurance coverage can let you down when you need it the most. This coverage states it will provide benefits when you suffer an illness or injury that has disabling effects. Disabilities such as multiple sclerosis or even mental illnesses can prevent you from working and disrupt your source of income, and long-term disability benefits should provide financial support in this time of need.
However, insurance companies can deny valid long-term disability claims for various reasons. If your long-term disability claim results in a denial, this does not mean that you do not deserve long-term disability benefits. Instead, it means that you need the help of a Canada Life insurance claims denial lawyer who can assess your options for an appeal.
The insurance companies require extensive evidence of disability to grant benefits, and you will need to jump through these hoops even if you pay your premiums and comply with all insurance requirements. While your condition might qualify for benefits, you might not have all the information necessary right away to support your claim. Further, insurance companies can cause delays by requesting unnecessary documentation, which can frustrate claimants and even cause them to give up.
It can be even more difficult to keep up with claim requirements because you are also dealing with your disability. In the face of chronic pain, medical treatment, anxiety, and other limitations, the last thing you need on your plate is constant communication and negotiations with the insurance company.
This is why you should never hesitate to contact a Canada Life insurance claims lawyer who can help with every step of the process. If your claim already resulted in a denial, we can help you get back on track and appeal the decision. Do not wait to seek out the help you need to get the benefits you deserve.
Like many disability insurance companies, Canada Life tends to re-evaluate disability claims as they approached the two-year mark. They do this because the definition of a “total disability” changes. Your adjuster might have mentioned the words “change of definition” to you. The change of definition means that the definition of total disability in your disability insurance policy changes after being on disability for two years or 104 weeks.
Normally, most disability policies provide that for the first two years that a claimant collects monthly disability benefits, that claimant must only prove that he or she is unable to perform the substantial duties of his or her own occupation. This definition of total disability is commonly referred to as the “own occupation” definition. After two years, the definition changes to that of “any occupation”. This means that a claimant must prove that he or she is unable to perform the duties of any occupation for which he or she is reasonably suited by way of education and training or experience.
If a claimant satisfies the definition of total disability in relation to “any occupation” then that claimant is entitled to collect disability benefits to the age of 65, or when the policy ends. Disability insurance companies like Canada Life become concerned as a claimant approaches the change of definition. Many disability carriers start instituting return to work (RTW) plans which are ineffective and often contrary to the advice of the claimant’s own medical providers. Oftentimes, disability insurance companies will do whatever they can to terminate a person’s benefits if they think that a claimant can get back to work.
This is important to remember that if you’ve been cut off disability benefits at the two-year mark, it is very important to contact a disability lawyer sooner rather than later. Oftentimes, disability insurance companies will convince claimants to go through the “internal appeal process” which hardly ever works out in the claimant’s favor. The process simply involves another employee from Canada Life reviewing your denied claim. The process simply delays benefits that a person is entitled to.
In addition to disability coverage, Canada Life also promises families that it will provide life insurance benefits upon the loss of a loved one. People purchase these policies expecting to protect their surviving families once they pass away. However, when it is time for Canada Life to payout, they often deny the valid claims of people who are already dealing with a tragedy.
One of the most common reasons for a benefits denial is material misrepresentation. Material misrepresentation stems from the duty you have when applying to honestly disclose all information that is material to the risk the insurer takes.
Should Canada Life allege that the policyholder concealed or misrepresented any information that might weigh in the decision to issue the policy, the insurance company will challenge the payout. The information the insurance company claims was lacking must be “material,” which means it must be something that a reasonable insurer would use to deny a policy or increase premiums to provide coverage.
Should an individual pass within two years of beginning a life insurance policy, any failure to disclose a material fact that an insurance company discovers can provide a basis for the insurer to deny the claim. A family expecting benefits will instead receive communications that they are receiving nothing often due to an alleged misrepresentation by their deceased loved one.
Forgetfulness is unfortunately not an excuse for an omission or mistake on a life insurance application, and so insurance companies will often use this defense to avoid paying out on your claim. Should an individual pass after two years of starting the policy, it becomes more difficult for the insurance company to deny the claim, as there is a high burden to prove that a misrepresentation occurred after time passes.
Beyond the common claim of misrepresentation, life insurance companies may deny your benefits for a variety of other reasons. If a person passes while engaging in a high-risk activity, life insurance companies may seek to avoid payment because the claimant put themselves in the danger that killed them.
This same logic applies to situations when the death happens due to drug or alcohol use, as well as by suicide. Passing away during travel in a restricted country can prevent payout, as can the failure to pay a premium, which can cause the entire policy to lapse. Many of these denials are challengeable, however, so do not automatically give up if you receive a claim denial for one of these reasons.
Improper life insurance denials can put the cost of the funeral and other related passing expenses on you and can remove a financial safety net that you planned for upon the passing of your loved one. Many people intend for life insurance to cover their children’s education, the funeral costs, and the lost financial contribution of your loved one, and when a claim is denied, delayed, or reduced, it can completely throw off this plan.
A Canada Life insurance claim denial lawyer can negotiate the best possible settlement with the life insurance company before heading to court, and if the insurance company refuses to be reasonable, your lawyer can represent your interests in court to generate the best possible outcome.
There are many reasons why long-term disability insurance, life insurance, and other similar insurance claims receive denials. The most important thing is to act quickly, as your policy likely has strict time limits during which you have to file your claim. Never delay in contacting our law firm for help with your disability insurance claim appeal.
These insurance policies state they will help you or your family when you need it most, and a denial can only make a bad situation much, much worse. Do not freeze up and forget to seek legal help, as we can begin working on your claim appeal right away.
There are different ways our lawyers can help you:
Sometimes, all it takes is a conversation with an experienced lawyer for the insurance adjuster to come around. They know they can take advantage of unrepresented claimants especially those in vulnerable positions like dealing with a disabling medical condition and not having many other financial options. However, our lawyers know the tricks and tactics of insurers, and these companies know they cannot use these same tactics once we are on the case.
If you have been wrongfully denied or cut off your long-term disability insurance benefits, you need the right legal team fighting for your rightful outcome. It is best to hire a law firm that regularly works with Canada Life adjusters and knows how this process works. Whether you need to file a disability claim with this company or appeal a denial, we know how to fight for the long-term disability benefits that our clients deserve.
Contact Lalande Personal Injury Lawyers local in the Burlington/ Hamilton / Niagara Areas at (905) 333-8888 or anywhere in Ontario by calling 1-844-LALANDE for more information about how we can assist you in your time of need. Alternatively, you can contact us confidentially by sending an email through our website. You might not know who to turn to when you receive your Canada Life disability denial, but we are ready to fight for you.
1 King Street East, Suite 1705
Hamilton, On L8P 1A4