By Matt Lalande in Long-Term Disability on October 14, 2021
If Manulife had denied or cut-off your disability benefits, our disability lawyers can help get your disability benefits back on track.
To qualify for long-term disability benefits under most individual or employee long-term disability policies, the onus is on you to prove that you suffer a total disability during the qualifying period and the first 24 months or two years of long-term disability.
Insurance policies generally define total disability as a chronic illness or accidental bodily injury that prevents you from performing the substantial duties of your occupation.
As is customary in long-term disability benefit plans, there is a change of definition of total disability at the two-year mark, which disability companies often fail to properly explain to their policy holders.
The total disability test changes to a definition that requires the individual to be unable to perform any occupation for which he is reasonably suited. (The policy may contain language like “qualified, or could become qualified for, because of education, training or experience”). This is known as the any occupation (any occ) period.
Manulife is like any insurance company in that they do not like to pay claims. They are a company that takes in over $40 billion CA$ in premiums each year, but they are more worried about their profits, and they will look for every excuse possible to either not pay a claim or cut off benefits. The disability claims process changes after two years, giving Manulife a ready excuse to terminate benefits.
This is when many people who are receiving disability payments under their policy learn the benefits will end. You do not have to just accept Manulife’s decision. If they cut off benefits after two years, you have legal rights. First, you need to contact an experienced lawyer who knows the Manulife claims process and how to deal with the company.
At the end of two years, when you have received benefits, Manulife gets to readdress your situation. At that point, it will become tougher to qualify for disability benefits. For the first two years, you may undergo a more relaxed test to receive disability benefits under your Manulife policy. During this time, you would need to show that you cannot do the duties of your particular job that you were in at the time of your disability. If you have a job that requires physical labor, this may be an easier threshold.
After 24 months, Manulife can change the rules of the game. The definition of disabled will tighten. You will need to prove that you cannot perform any job that you would be qualified for based on your training, education, and experience.
This test would expect you to perform some work, even if it is less advanced or involved than the work that you were doing at the time of your injury. For example, Manulife would expect you to do some job. For example, if you worked in a store but could not walk around or put things on shelves, they may expect you to stand at the front of the store as a greeter. One of the main distinctions that Manulife relies on is expecting that you do sedentary work if it is available instead of the more active work you did beforehand.
This is often where you and Manulife will disagree. They do not care about your particular situation. They are looking at things from the perspective of a business that may need to write monthly checks permanently. It is easy for them to say what they think that you could do, not knowing or wanting to know about what you face individually.
However, total disability may not be what you think it is. Many people assume that you need to be completely unable to do anything to meet the legal definition of total disability. According to the Canadian Supreme Court, that is not the case. They have defined the term so people can receive benefits for many injuries. According to the Supreme Court, total disability does not require that a person absolutely cannot work in any circumstances.
The Court stated that the test is whether the claimant exercises good sense and judgment by not working.
However, the insurance companies may still give an overly restrictive interpretation of the language in their policies. They want to put the onus on you to persuade them, even though the Supreme Court has clearly spoken on the issue.
When you need to prove your disability, Manulife will not simply take your word for it. They have every incentive to find that you can work in some vocation, which will allow them to cut off your benefits. On the other hand, you will need to affirmatively demonstrate that you cannot work to meet the policy’s definition of total disability.
At that point, Manulife may have sent you to at least one doctor for an independent medical evaluation. They may have their own ideas on whether you meet the total disability test, or at least how they can classify you as able to work. They may have even followed you or conducted other surveillance (including of your social media accounts) to see if they could disprove your claim because this is how they sometimes try to get out of paying.
Talk to an experienced long-term disability lawyer who can prepare you for the so-called independent medical exam and tell you what you need to avoid posting online.
This is where you need to come with strong evidence to show that you meet the total disability test, so your benefits will not terminate permanently.
You may need to overcome the following arguments that Manulife may use to avoid paying:
An experienced disability claims lawyer can gather and present the evidence you need to overcome Manulife’s denial tactics.
Things get especially challenging when you deal with a condition that does not show on MRI exams or CT scans. These painful and debilitating conditions are a part of your daily life, and they keep you from working, but they may not obviously show on a test that the adjuster reviews. Manulife can make these claims especially difficult.
These unseen conditions could include:
Mental health issues are particularly debilitating. Conditions like post-traumatic stress disorder and anxiety can keep a person from functioning just like any other physical condition.
Your own physician’s documented opinion can help with your claim, but Manulife may be skeptical of it. They like to listen to their own doctors because their in-house physicians have the motivation to give opinions that favor Manulife. You may need something beyond your own doctor’s opinion, especially when you deal with a condition that may not appear in objective test results. In particular, a vocational expert’s opinion can bear heavily on your case if the test shows that you can perform some work.
When Manulife decides to cut off your benefits after two years, they do not have the final word or say over whether you can continue to receive money. Even after you receive notice of a benefits termination, you have legal options to pursue.
The first thing that you need to do is hire a lawyer for your case. Manulife is a huge company, and they have their own lawyers to protect their financial interests. If you do not have a lawyer, Manulife will likely prevail over you, and you stand less of a chance of receiving continued benefits.
You have two options to contest Manulife’s decision to end your benefits. You can either challenge the decision with Manulife itself or take your case to court. Either way, Manulife is not the judge or jury.
If you choose to deal with Manulife first, have your lawyer speak with the claims representative. The first order of business is to understand the basis for the termination of benefits. Manulife will need to explain their decision. Some cases stem from a misunderstanding, and they can resolve through a simple conversation. If that doesn’t succeed, you can continue the process by dealing with a customer service manager.
Manulife has a more formal internal appeals process that you can follow. You can keep escalating the appeal. First, you can contact a customer service manager to begin a more formal process. You will have the ability to submit more documents and evidence to make your case that you deserve continued benefits.
If you have still not received a satisfactory answer after appealing to the customer service manager, there is another step in the process. Manulife has an ombudsman to review denied claims or benefit terminations. This ombudsman could review how the company reviewed your claim and file to make sure that they followed the company’s rules.
The ombudsman will conduct their own independent review and investigation. However, there is a limit to what you may expect through Manulife’s own internal appeals process. Still, Manulife is at least open to listening to what you have to say in their appeals process, and we generally advise clients that going through Manulife’s channels could help in their case if they do so with experienced legal representation.
You have further review options short of taking your case to court. Your lawyer could request that another ombudsman take a look at your case. The OmbudService for Life and Health Insurance is a non-profit service that provides an alternative dispute resolution mechanism for disagreements between policyholders and insurance companies. They do not take on every single case presented to them, but it may be worth asking them to review your case to see what, if anything, they can do to resolve the dispute.
You also have the option of going to court. Generally, you should file your lawsuit after you have exhausted Manulife’s appeals process, but you can also go straight to court if you want. Your lawyer will advise you of what works best in your own situation. The court will review the record and the facts of your case, and they will reach their own decision about whether you are entitled to benefits.
Meeting the definition of total disability is not always easy in the face of Manulife’s arguments to the contrary. Proving this requires persuasive evidence so that if Manulife does not accept your arguments, an ombudsman or court may.
You may even want to consider hiring a lawyer before Manulife tries to cut off your benefits, so you are prepared for the process.
A lawyer could help you prepare for some of the following difficulties that you may face:
Manulife’s plan for your return to work or arguments that you can do some work may look good on paper but make no sense whatsoever in practice. They could have boilerplate suggestions or conclusions in your case that have no connection to reality. It is your lawyer’s job to insert reality into the situation and make Manulife or a judge understand that you have a total disability, no matter what some company-paid vocational expert says. You should tell your story, even if the insurance company does not want to hear it.
If Manulife cut off or stopped your long-term disability benefits after two years and you and your doctor believe that you still cannot work, call our Hamilton long-term disability lawyers at 905-333-8888 or fill out our contact form today.
We are disability lawyers in Hamilton that serve claimants all over Ontario, from Sudbury to Niagara. We can help you with your initial application, any appeals you need to file, or if Manulife decided, contrary to the evidence, to cease paying your benefits because it believes you no longer suffer from a disability.
We Can Help. Contact us 24/7start your case905-333-8888
VOTED BEST LAWYERS IN CANADA 2018, 2019 & 2020