Have you been treated unfairly by your disability insurance company? Does your relationship with your disability adjuster seem like it’s become adversarial? Are you not listened to? Are you doctor’s orders ignored and over-ridden? Is your disability insurance company forcing you back to work or even worse, telling you that you can “do something’? Is your adjuster not returning your calls or emails? Have you not been paid your disability benefits – and now you are drowning financially?
This is the story our Hamilton Long-Term Disability Lawyers have heard time and time again for the last 20 years – you’ve paid you premiums on every single pay-cheque and now your left on you own with no answers….and no income. But please, don’t give up, no matter what your disability insurance company tells you – you have rights. You have the right to hire you own Hamilton disability lawyer for free to help fight get your monthly disability payments back on track.
Matt Lalande is sought after Hamilton disability lawyer who has recovered millions of dollars in wrongfully denied disability benefits for claimants in Hamilton and throughout the surrounding area since 2003. Our Hamilton disability law firm represents claimants through all stages of denied disability benefits, including denied short term disability benefits, long-term disability benefits, or disability benefits that are cut-off at the two-year mark or at the “change of definition”. We understand the devastating stress and financial implications that individuals and families are often face, as well as the deep emotional toll that a disabled person can experience when their disability carrier leaves them suddenly without income.
The process of appealing your long-term disability denial could be complex and confusing – our Hamilton disability lawyers have recovered millions in wrongfully denied insurance benefits, and we can help you start your case today.
If you’ve been denied long-term disability contact our Hamilton Disability Lawyers to learn what options you may have. We have over two decades of experience with litigating against every major disability insurance company in Canada, and can provide professional representation to ensure that you receive the long-term disability benefits you are entitled to. Contact us today for more information or to schedule an appointment with our firm. Call us today, toll-free, no matter where you are in Ontario at 1-844-LALANDE or local in Southern Ontario at 905-333-8888 or fill in a contact form on our website and we will be happy to get right back to you.
Our Hamilton Disability Lawyers understand that the last thing that you need after having your benefits denied or cut-off is another bill – which is why consultations with us are always 100% free. We are more than happy to discuss your case with you and advise you of your legal rights and options.
Remember, the disability claims process is often discouraging and time-consuming. The complex language of the insurance contract adds to the frustration. If you’ve been denied disability benefits, you need an experienced disability lawyer to help protect your rights and get you the benefits your deserve. We welcome your live chat, email or telephone call in order to set up a video, phone or in-person consultation to answer any questions you may have about your case without charge, no matter how long it takes.
Not only are consultations with our Hamilton Disability Lawyers free – but if we decide to work together, the fee is free. You only pay IF we win your case – meaning we only charge legal fees if we are successful in either reinstating your benefits or arriving at a lump sum settlement of your future benefit entitlement. With our firm, we only get paid when you get paid – this type fee is called a contingency fee.
A contingency fee is a type of fee arrangement commonly used by lawyers and law firms in which the lawyer’s payment is dependent on the outcome of a case. Under a contingency fee agreement, our disability lawyers will represent you without charging any upfront fees or costs. Instead, we are paid a percentage of any money recovered, typically ranging from 20 to 30 percent of the total amount recovered.
Contingency fee arrangements are commonly used in disability cases, where the client has been denied long-term disability and is seeking compensation from the disability carrier in terms of past and future claims, bad faith and/or punitive damages.
One of the advantages of a contingency fee arrangement is that it allows a disabled person who might not otherwise be able to afford a disability lawyer to pursue their claims. Additionally, because the lawyer’s payment is dependent on the outcome of the case, there is an incentive for your disability lawyer to work hard to achieve a successful outcome.
Hiring a disability lawyer can be a crucial step in navigating the complexities of disability law and securing benefits. Here are some steps to help you find and hire the right Hamilton Lawyer, as well as some important questions to ask:
Research disability lawyers: Start by searching online for disability lawyers in your area or asking for referrals from friends, family, or local disability organizations. Look for Hamilton lawyer, such as Matt Lalande, who specializes in disability law and have experience handling cases similar to yours.
Check credentials and experience: Review the disability lawyer’s websites or professional profiles to check their credentials, education, and years of experience.
Schedule consultations: Although we believe clients always return to us, we do recommend that you meet one or two disability lawyers before making your decisions. Contact a few lawyers to schedule initial consultations, which are often provided free of charge. This will give you an opportunity to discuss your case, ask questions, and determine if the lawyer is the right fit for you. To contact and schedule your free consultation with Matt Lalande, click here.
Prepare for the consultation: Before the consultation, gather all relevant documents, such as your denial letter, work history, and any previous correspondence that you may have on hand between you and your disability insurance company. Then, make a list of questions you want to ask the disability lawyer.
Questions to ask a disability lawyer during the consultation could be such as:
After the consultations, compare the responses from different lawyers and choose the one who best fits your needs, has a proven track record, and with whom you feel most comfortable working. We always say that comfort is the best indicator of a good relationship. We would suggest the last thing you need in a time of crisis not feeling comfortable with the lawyer you decide to hire.
Remember, it’s important to find a Hamilton Disability lawyer who not only has the necessary experience and expertise but also one who is responsive and easy to communicate with, as the disability claim process can be lengthy and complex.
When Disability Insurance Companies deny benefits to their own claimants the benefits they need, they often advise to submit new or fresh medical documents to their “Appeals Team” or to their “Appeals Specialists” for review.
Often times, claimant are so despondent and desperate for money so they listen to their disability insurance company, hoping that the insurer will change their mind, reverse their decision and restore their monthly benefits.
Unfortunately, this never really happens. Not only do claimants end up exhausting their own resources by paying doctors for new records, they end up caught in long wait times associated with the appeals process with no income and bills piling up. In our experience, the so-called “independent appeals process” never works in favor of the appellant and insurance companies typically do not change their mind – which is not surprising. How can the same insurance company who denied your benefits be “impartial” when reviewing new documentation? The appeals committee are employees paid by the same insurance company that denied your benefits in the first place.
If an “internal appear” is something you’re considering it might be best to call our Hamilton long-term disability lawyers for long-term disability support right away – because unfortunately, internal appeals rarely work.
Unfortunately, many disability claims are initially denied. Disability applications can be denied at the application stage for a variety of different reasons and if this occurs, it’s important that you retain experienced Hamilton disability lawyer to ensure that your case is handled efficiently so that you can receive the disability benefits you deserve.
Most disability claimants obtain disability insurance through their work group disability policies. Disability insurance in Ontario covers all types of medical conditions, such as severe bi-polar disorder, anxiety, depression, schizophrenia, severe chronic pain, MS and other related health conditions.
Remember, in order to qualify for long-term disability benefits in Ontario, you must suffer a total disability, meaning you are deemed by medical professionals to be unable to perform the substantial duties of your own occupation. Individuals that suffer severe injury or illness often rely on monthly income benefits to pay their bills and contribute to family finances – however some insurance companies unreasonably deny disability benefits to properly qualified claimants. The system is complicated – it’s important that you talk to a Hamilton disability lawyer today to learn your rights.
If your insurance company has wrongly cut-off your disability benefits, it’s important that you speak to an experienced Hamilton long-term disability lawyer. Do not wait. Disability polices in Canada provide that claimants are entitled to disability payment of benefits if they satisfy their policy definition of total disability. The definition “total disability” within the first two years, is established when you are unable to perform the important duties of your “own occupation”, even though you may be capable of performing another job. After two years, most disability policies change their definition to “any occupation”, meaning that you must be unable to perform the activities of any occupation for which you are reasonable suited by your education, training and experience.
It’s normally at the two-year mark that disability companies cut-off disability benefits. Insurance companies will often use the argument that you are able to work at “some type of job” – when this may not entirely legally proper. While it’s true that insurance companies can terminate your benefits at any time if they find that you are no longer meet the definition of “total disability, it’s equally true that rogue insurance adjusters will cut-off benefits unreasonably and unfairly. If this happens, you have the right to contact a disability lawyer to make a claim for benefit reinstatement.
Remember – the longer you wait to hire a Hamilton Disability Lawyer – the longer you go without money coming in the door.
While specific requirements for LTD benefits may vary depending on the insurance provider, policy, there are some medical conditions which often qualify for long-term disability benefits, some of which may include:
Disability claims are extremely complex to litigate and not something for the faint of heart. An experienced Hamilton long-term disability lawyer knows the disability process and can assist you in having your disability income benefits reinstated. Our disability lawyers will review your case with you – at no cost. We can help evaluate your insurance claim and advise you on how the disability laws in Ontario apply to your case, as well as your options with your appeals.
If we decide to work together, our disability lawyers will then take a detailed inventory of your clinical history, request that your medical providers send us your a synopsis of your medical history and clinical records, rehabilitation records and medication records. A claim would be started against your disability carrier, seeking a “declaration” that your disability insurance carrier pay you all of the past benefits owned to you and order that you are reinstated on claim – meaning that your benefits will be re-started and continue. Our Hamilton disability lawyers work with the best experts from all over Ontario and will ensure that the best specialist is hired to provide an opinion on your case. Remember – you have the burden of proving your disability, and to do this, you need to work with experienced Hamilton disability lawyers.
Our long-term disability lawyers are locally based in Hamilton, but we serve claimants all Canada. We are more than happy to travel to your location to meet you if you are located in Southern Ontario and if you are not, we are more than happy to meet you and review your disability policy or other pertinent documents and discuss your case via Zoom, Facetime, Google Meet or telephone. Our technology allows us to represent clients all over Ontario. It is our job as Hamilton Disability Lawyers to try to get our clients paid their disability benefits as fast as possible; therefore it is actually preferred that we have our initial consultation via telephone or Zoom if you live far away.
LTD benefit denials can be discouraging and getting the help you need can be time consuming. If you’ve been denied disability benefits it’s important to understand that it’s not the end of the road. You have the full right to challenge your disability benefit denial and let a Judge decide whether or not you are disabled as per policy definition. Don’t give up without talking to an experience disability lawyer.
Luckily, you do not – even if you are in Hamilton. We’re certainly able to discuss your claim by Zoom or Facetime or by telephone. We are usually able to make a determination as to whether or not your long-term disability insurance company unreasonably denied or cutoff your benefits quite quickly. We are happy to schedule a free consultation with you to discuss your situation. If we are of the opinion that you have a case, we are more than happy to meet with you by Zoom, Facetime or Google Meet anytime you need. We also have the technology to serve clients remotely – for example, you can have access to your file digitally, and any and all signatures or other things we need from you can certainly be done remotely – quite easily!
If you suffer from a disability that renders you unable to perform the substantial and material duties of any occupation for which you have education, training, and experience, then it is vital that you contact a disability lawyer and inform yourself of your legal rights.
Taking on a disability insurer in Ontario is not for the faint of heart — don’t try to do it alone. We see claimants come to us after being bombarded with an endless barrage of anti-coverage grenades that share a single target: preventing them from collecting disability benefits.
How do disability insurers do this? They will often hire their own doctors to conduct medical examinations that will inevitably find you in “perfect” health. Alternatively, the doctors might not be qualified to render an opinion regarding your condition but may do so anyway. In real life, they would surely send their own patients to specialists.
At times, disability carriers might also attempt to manufacture a “choice” argument by offering to retrain or rehabilitate the insured person. If the insured declines the offer, the insurer will argue that the insured has chosen to remain disabled and is therefore not entitled to disability benefits.
Total disability does not signify an absolute state of helplessness. Rather, you must be unable to work in any position for which you are suited by way of education, training, or experience.
If you have been denied disability benefits in Ontario, speak with a Hamilton disability lawyer who specializes in denied long-term disability litigation. Matt Lalande has represented hundreds of individual claimants at all stages of disability claims, including claim denial, denial at the change of definition, or lawsuits to recover disability benefits.
Our Hamilton disability lawyers will fight to see your long-term disability benefits are restored and continue uninterrupted for your maximum period of benefit recovery, which is normally to age 65. In addition to this, our disability lawyers will ensure to claim all past disability benefits owed to you up to the date of your settlement or trial.
If your disability claim was wrongfully delayed or denied, you should absolutely consult an experienced Hamilton disability lawyer who focuses and has experience with long-term disability cases.
We understand that being denied or cut-off long-term disability insurance can be financially disastrous to people that rely on their monthly benefits. Most claimants that we speak to are often surprised and caught off guard when they’re denied benefits. If you are like most disability insurance policyholders, you too are probably surprised by your claim denial. You paid the premiums, privately or through work, for your policy as agreed. You expected to receive your benefits as agreed – and then your turned away.
It’s important that you do not delay in contacting a Hamilton disability lawyer that can help you get your disability benefits back on track. An experienced disability lawyer can provide you with proper guidance and advice on how to advance and appeal your denied disability claim. Our disability lawyers are experienced with marshaling the medical evidence needed to assist you in proving that you satisfy your policy’s definition of today disability – either being your own occupation or any occupation to which you are reasonably trained. Remember – the longer you wait, the longer it will take to get your monthly benefits started again.
Below are some of our disability resource guides to assist you with understanding your disability claim:
Your adjuster might tell you that you do not suffer a total disability because that is the language that is used in most disability definitions within disability insurance policies. Generally speaking, total disability in the context of long-term disability insurance means two things.
The vast majority of long term disability policies in Canada provides that – a person is considered totally disabled within the first 24 months of benefit payments if he or she is unable to perform the substantial duties of his or her “own occupation” and from carrying out its major functions. If the claimant is only able to perform minor functions of the job, then he or she is nonetheless totally disabled. This is typically called total disability of your “own occupation.”
After two years or 24 months, most disability policies disability typically switch to what is called an “any occupation”definition. A policy with the any occupation definition usually requires that the definition of total disability is satisfied when the insured person is prevented from engaging in any occupation or performing any work for compensation – for which he or she is deemed fit by education training and experience.
Normally insurance companies tend to over-ride the claimant’s doctor’s advice stop disability payments at the two-year mark and make the argument that you can engage in “some type” of work for compensation, when, by law, it’s a bit more complicated than this. If your adjuster says that you are not totally disabled call our Hamilton disability lawyers for more information so we can review your case and advise you of your rights.
At Lalande Personal Injury Lawyers, we assist with claims for disability in Ontario, and we always aim for maximum benefits or compensations for our clients. This can be seen through some of our successful past results. Our of hundreds of cases that we have litigated against national disability carriers – here are a few examples of cases where we “lumped-out” the long-term benefits for the client:
Since each case is different, these results do not indicate what you might expect in your claim and are meant as an example of what we can do for you. Each case is different. Each claim is different. However, these examples show that our lawyers work hard to get the benefits our clients deserve, even after an initial denial. Ask help from our Ontario disability lawyers as soon as you can.
The majority of people never need to speak to a lawyer unless they buy a house or make a will. It’s completely understandable that you may be nervous about speaking to a disability trial lawyer about your exact situation – but don’t be. Rest assured, we are approachable, easy to speak to, and will speak to you about your particular disability situation at your convenience – at no cost to you.
Disability claims are complex. Do not try and make the appeal on your own. Hiring a knowledgeable disability lawyer with experience in litigating against every major Canadian disability insurance company is the best thing you can do. Lalande Personal Injury Lawyers are long-term disability lawyers who have been representing claimants who have been wrongfully denied or cut-off their disability benefits since 2003 – and remember – we work on a contingency fee basis. This means that we do not get paid until we win your case. If we don’t recover your benefits or settle your case, there are no fees charged to you. There are NO upfront fees.
Please complete the contact form below or give us a call no matter where you are in Canada at 1-844-LALANDE or local in Southern Ontario at 905-333-8888. Otherwise, you can speak to our live chat operator or fill in a contact form and one of our Hamilton disability lawyers will get back to you within 24 hours.
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We understand that you may be confused and upset – but if you’ve been cut off or denied your long-term disability benefits you need to get legal advice from a disability lawyer now. It’s important to understand that you may still be entitled to your monthly benefits even thought they have been denied.
Talking with our long-term disability lawyers is ALWAYS free. We never ask our clients for money upfront.
Normally most disability policies have a change of definition. The first two years of being on disability, a claimant only needs to be substantially disabled from performing the regular duties of his or her own job. After two years, the definition changes. At that point, in order to qualify for disability benefits, a claimant must be totally disabled from any employment for which he or she is suited by education training and experience. In essence, definition changes becomes more difficult for claimants to obtain disability benefits and, it is the time when most disability carriers cut claimants off the plan.
You do not. We represent claimants all over Ontario. We are happy to meet you on Zoom or Microsoft Teams or whatever words best for you.
Our Hamilton disability lawyers represent denied disability claimants throughout Ontario. We have represented hundreds of disability insurance claimants outside Hamilton and throughout the Golden Horseshoe area—from Niagara Falls to Ottawa to Sudbury. We are happy to discuss your situation at any time. We will never ask you for money up front, and your consultation is without obligation
It depends. When a disability lawsuit if filed, you are requesting that a Judge declare you are totally disabled in accordance with the definition of your disability policy. However like other lawsuits, disability claims do sometimes settle for lump sum payments.
Most, if not all LTD disability policies mandate that a claimant is to apply for CPP disability. Most LTD carriers will request that a claimant apply for CPP disabilty after two years of disability payments. Your LTD insurance company then gets to “set-off” or deduct your CPP monthly payment from the amount of long-term disability payable to you.
It all depends on what your disability policy says – however most policies state that the following may be deductible from your long-term disability benefits IF you are receiving the benefit:
1. Severance packages
2. Ontario Works benefits
3. Ontario Disability Support Plan (ODSP)
4. Workplace Safety Insurance Board (WSIB) benefits
5. Employment Insurance (EI)
6. Financial Gifts
Typically, LTD policies contain a provision that considers a person eligible to receive benefits if he is disabled from working at his own occupation for the first two years. This is known as the “own occupation” (own occ) period. Thereafter, the test changes to a more difficult definition which requires the individual to be disabled from performing any occupation for which he is reasonably suited (language like “qualified, or could become qualified for, by reason of education, training or experience”). This is known the “any occupation” (any occ) period.
Because the test for the “own occ” period is less onerous, and the insurance company’s potential exposure is lower, insurers will often pay benefits during the “own occ” period, but resist paying benefits into the “any occ” period. During the latter period the potential payout, especially for a young person, could be significant. Before the “own occ” period expires, the insurance company may send the insured to one or more independent medical examinations (IMEs) with a view to obtaining medical evidence to use to support terminating the claim at the end of the “own occ” period or conduct surveillance.
There are a variety of reasons why an LTD claim may be denied or terminated:
1. Lack of forms and necessary documentation.
2. Employer did not provide the proper documentation.
3. Misrepresentations on claims forms or other supporting documentation, such as a pre-existing condition that was not mentioned or not fully disclosed.
4. Missed time limit for submitting claim.
5. Failure to have the injury or condition properly documented by the client’s doctors.
6. Failure to participate in treatment regiment.
7. Surveillance evidence contradicting the client’s claimed level of disability.
8. The change of definition.
9. Adjuster inattention.
10. The insurance company not having understood your disorder or disease.
11. A biased insurance company medical expert.
If you been denied long-term disability the best thing you can do is contact our Hamilton disability lawyers to discuss your situation, no matter where you are in Ontario. We can help guide you through the process and offer you options with respect to your denied claim and how to appeal it through the court system.
Total disability in the context of disability insurance typically has two meanings. The vast majority of disability policies provide that total disability within the first two years of benefit payments is established where the insured is unable to perform the important duties of his or her regular job, even though the insured may be capable of performing another occupation. This is otherwise known as the “own occupation” disability provision. After 24 months of disability, most policies provide that payments of benefits will be made to an insured who is unable to perform the activities of any occupation for which he or she is suited by reason of education training and experience.
A person is totally disabled and unable to carry on his or her own occupation if the disability prevents him or her from performing the substantial duties of that occupation and from carrying out its major functions
An Long-Term Disability policy generally pays a portion of the policyholder’s usual salary or income as a monthly benefit until the person (in most cases) is:
1. Able to return to work.
2. No longer meets the definition of being disabled.
3. Reaches retirement age (age 65), so long as the person continues to meet the policy requirements.
Some policies only pay for a defined period (such as 5, 10 or 15 years). Other policies cover the person for life.
Unfortunately, many long-term disability insurance policies have exclusions and limitations that may prevent you from collecting long-term disability benefits. If you read the fine print in your long-term disability policy, you will no doubt notice a provision entitled “exclusions”, some of which are:
Alcohol and Substance Abuse – many policies many policies do not have coverage for absenteeism because of substance abuse.
Self Inflicted injuries or illness – if you have hurt yourself or caused yourself to be sick you may be declined long-term disability insurance.
Medical or surgical care that is not necessary – if you “elect” surgical care that is not vital to receive, you can be denied long-term disability benefits.
Committing or attempting to commit an assault – assault will more likely than not void will cause you to be declined benefits.
Being involved in or committing a criminal act – will probably void coverage.
There are three types of disability insurance coverage:
1. Government Plans – which include the Canada Pension Plan (CPP), employment insurance, and Worker’s Compensation (WSIB).
2. Group Benefit Plans – which are available through an employer or an association. Group plans offer more limited disability protection but at a lower cost to the insured and employer.
3. Individual Long-Term Disability Policies – available directly from an insurance company or broker, on a client by client basis. They offer the most extensive protection but at higher cost to the insured.
Short-term disability (STD) are benefits that carry from the date of onset of disability and the application for long-term disability. STD is often offered through group employer plans. Short-term disability is meant to carry you through the elimination period. Common elimination periods are 30, 60, 90 and 120 days. After the elimination period is over, the claimant would then apply for long-term disability. STD policies are usually paid for by the employer and cover income replacement for the first 120 days of injury or illness.
There is usually a qualifying or elimination period, which can range from 90 to 180 days, during which no benefits are paid but during this period the person may cover their lost wages by drawing on a short-term disability (STD) policy, employment insurance or government sickness benefits, which may provide an additional 15 weeks of sick benefits. STD policies are usually paid for by the employer and cover income replacement for the first 120 days of injury or illness. The longer the elimination period, the lower the disability premium, often dramatically so. The most common elimination that we see is 90 days.
This waiting period is otherwise called your elimination period. Typically most policies have a 120 elimination period. It’s during this period that you would apply for short term disability.
In considering own occupation, if the claimant is able to perform only minor functions of his or her job, the claimant is nonetheless totally disabled.
Most policies may provide benefits equal to:
65% of gross monthly earnings;
75% of net monthly earnings;
Benefits that last:
up to age 65; or
for only fix years.
Reductions may apply so that your total income from all sources does not exceed a certain amount. For example, the policy provision may state that the employee’s total income from all sources is not to exceed 85% of your pre-disability earnings if the benefit is taxable or 85% of the pre-disability net earnings if the benefit is non-taxable. Benefit amounts may also be reduced by other benefits that a person receives or in entitled to receive from sources specified by the policy wording
The deductibility of severance packages depends on the policy wording for the most part. If the wording is clear and unambiguous, you will have to look no further, but that is not always the case. Where the wording is not clear, consideration must be given to the nature of the severance package.
Yes, some policies contain offsets for amounts received through WSIB claims.
In Richer v. Manulife Financial, 2007 CarswellOnt 1713 (Ont. C.A.), the insured’s policy provided for an offset for amounts he was entitled to receive through a WSIB claim. The insured plaintiff had made a WSIB claim but it had not yet been resolved. Entitlement to receive payments was not dependent on an application for compensation being approved. Manulife was entitled to reduce the monthly benefit payable to the insured under the policy by the amount of WSIB benefits to which he would have been entitled had he not elected to proceed with an action. See also Robert Wilken v. Sun Life Assurance Company, 2017 CarswellOnt 19517 (Ont. C.A.), where the court noted, at paragraph 3:
“The plaintiff’s voluntary decision to make a retroactive election, foregoing WSIB benefits to pursue a tort action, effectively would deny the insurer its contemplated and permitted offset, thereby elevating the insurer’s relevant coverage obligation to a ‘first payor’ status that obviously was not intended.”
Typically, a lawsuit must be commenced within two years of the date the benefits were denied unless otherwise specified by the contract. Determining when the limitation period begins to run is not always obvious and often the principle of discoverability complicates matters.
Probably – but you should talk to your accountant to get the proer tax advice. However what we have learned is that legal expenses paid to collect or establish the right to reinstatement of disability insurance benefits or the right to a lump sum disability insurance settlement of past and future benefits are deductible for tax purposes. Where a claimant incurred legal expenses, those expenses are deductible from the settlement amount as being reasonable necessary expenses incurred to realize the settlement that was achieved. Without the legal expense, the settlement amount would not have been realized by the claimant. Where the lump sum disability insurance settlement between the claimant and the disability insurer does not specify the amount of legal costs, the Tax Court of Canada will consider the evidence of what legal expenses were incurred.