By Matt Lalande in Uncategorized on November 14, 2024
Long-term disability benefits provide a vital lifeline for individuals who find themselves unable to work due to a disabling condition. These benefits, paid by insurers, are granted to those deemed to have a “total disability” as determined by both medical professionals and the insurer itself. The process of obtaining long-term disability benefits can be lengthy and complex but experienced Ontario long-term disability lawyers stand ready to assist claimants in navigating this intricate landscape.
Once an individual begins receiving long-term disability benefits, a common question arises: How long will these benefits continue? The answer, in short, is that the duration of benefits varies from person to person. Each policy is unique, as are the circumstances surrounding an individual’s disability and their specific situation.
It is important to note that there are several circumstances under which long-term disability benefits can and will be terminated, regardless of the actions or statements of the beneficiary. Understanding the distinction between ‘can’ and ‘will’ in the context of insurance policies is crucial. This distinction highlights the difference between guaranteed outcomes and potential outcomes that may be within the beneficiary’s control. Recognizing this difference underscores the importance of comprehending one’s rights and options in the event that benefits are terminated, whether wrongfully or otherwise.
In light of the complexities surrounding long-term disability benefits and the potential for termination, it is advisable for individuals to seek the counsel of our experienced Hamilton long-term disability lawyers. Our team possesses the knowledge and expertise necessary to navigate the intricacies of long-term disability claims, making us well-equipped to assist individuals facing the challenges of benefit termination.
We are known to provide invaluable guidance and advocacy, ensuring that our clients’ rights are protected and that they receive the benefits to which they are entitled under their respective policies. If you find yourself in a situation where your long-term disability benefits have been terminated, whether wrongfully or otherwise, do not hesitate to contact us with any questions you may have.
Long-term disability (LTD) benefits offer financial support to those who cannot work after a severe injury or illness. Unlike short-term disability or Employment Insurance (EI) sickness benefits, LTD benefits offer much longer coverage. Depending on specific policy terms, they often last for many years.
Short-term disability policies and Employment Insurance generally cover temporary conditions for a short period, usually six months. LTD benefits, on the other hand, cover long-term or permanent conditions or disabilities that prevent individuals from working.
Individuals must demonstrate that they have a “total disability,” to qualify for long-term disability benefits. This means they must be unable to perform the core duties of their profession. This definition generally applies for two years.
After two years, the definition of “total disability” changes, and individuals must prove they cannot perform the core tasks and duties of any occupation for which they would be suited through training, experience, and education.
Long-term disability benefits are typically offered by private insurance policies, either through an individual’s workplace or purchased independently. Once accepted, the amount paid is usually a percentage of the individual’s pre-disability income. Most policies offer around 60-70%, but this can vary widely.
Benefits are determined using the salary you earned before your disability. The amount is paid out monthly.
To start receiving LTD benefits, individuals must submit a thorough application. Applications should include medical documentation from healthcare professionals and meet all the insurance company’s specific criteria.
Despite the thorough effort and good intentions of claimants, many legitimate claims are denied. Often, challenging these decisions requires legal assistance, as facing a large insurer can be difficult.
One of the most common reasons long-term disability benefits end is when your disability insurer terminates them. This can happen for many reasons, but it ultimately comes down to the insurer determining that individuals no longer meet the definition of “total disability.”
They may make this decision for various reasons, including the medical tests they require you to participate in or the surveillance they perform. Insurance adjusters will find any justifiable reason they can to determine that you can work in some capacity.
For the first two years of a long-term disability policy, the ‘own occupation’ definition generally applies. This means that to qualify for benefits, you must be unable to perform the essential duties of your current job. If your condition prevents you from fulfilling these responsibilities, you may meet the definition of being ‘totally disabled’ under your policy.
After two years, most policies move to the “any occupation” definition, which you must meet to continue receiving benefits. At this point, you must prove that you cannot perform the core tasks and duties of any job for which you are reasonably qualified based on your skills, experience, and education.
At the two-year mark in a long-term disability claim, many individuals face the unfortunate reality of having their benefits wrongfully terminated. This is often due to a lack of understanding on the part of disability adjusters regarding the intricacies of policy definitions. As a result, claimants who are still in need of long-term disability payments may find themselves wrongfully cut off from this vital support.
It is crucial for individuals in this situation to recognize that they have rights and options. The complex nature of long-term disability policies and the potential for misinterpretation by adjusters underscores the importance of seeking experienced legal counsel. At our firm, we understand the nuances of these policies and are committed to advocating for our clients’ rights. If you have had your long-term disability benefits wrongfully terminated, we encourage you to reach out to our team of skilled attorneys. We will work diligently to assess your case, clarify any misunderstandings on the part of the insurer, and fight to ensure that you receive the benefits to which you are entitled under your policy.
Other reasons include:
Failing to communicate with your LTD carrier: If you do not update the insurance company on your condition, do not send the required medical evidence, fail to answer their questions, etc., they can decide to terminate your benefits.
Failing to participate or cooperate in a medical treatment or rehab plan: Many require claimants to participate in a treatment plan that mitigates the condition to qualify for long-term disability benefits. Failure to cooperate with or participate in this treatment plan can be viewed as a lack of desire to recover. Failure to receive treatment also means recovery becomes delayed or impossible, thus creating an endless need for benefits. However, there are some limits to this, set out by our Courts, which our long-term disability benefits lawyer can help you understand.
Failure to follow medical advice: If you fail to follow your prescribed medical treatments or do not attend rehabilitation, your insurer may terminate your long-term disability benefits.
Failure to provide ongoing medical evidence: Most insurance companies ask that you provide regular updates and medical documents to ensure you are still unable to work. They may suspend or terminate your benefits if you do not provide the required documentation and other evidence.
Substance abuse or addiction: Some policies will not cover disabilities that result from addiction or substance abuse unless claimants participate in an approved rehabilitation program. Benefits may be terminated if you refuse treatment or do not participate as required. However, there are certain limitations to this policy, as established by court rulings. Our experienced Ontario long-term disability lawyers can provide you with a detailed explanation of these limitations and ensure that you have a comprehensive understanding of your rights and obligations.
Refusal to participate in rehabilitation or vocational programs: Some insurance companies offer rehabilitation or vocational training programs that help you get back to work. They may terminate your benefits if you refuse to participate in their programs without providing legitimate medical reasons. These programs are meant to help individuals return to work. The insurer could see declining participation as a lack of effort and desire to recover. Again, there are some limits to this, set out by our Courts, which are essential to know and understand.
Relocation to a different jurisdiction: With some policies, your long-term disability benefits may be impacted if you move to another country. Some policies have geographic restrictions, moving outside of which can result in an automatic termination of benefits unless you arrange something with your insurer beforehand. Again, there are some limits to this, set out by our Courts, which are essential to know and understand.
Fail to apply for collateral benefits: If there are other benefits you could apply for, such as CPP Disability, your policy may require that you pursue these. Failing to do so can be seen as non-compliance and could result in termination of your benefits.
The following reasons are how long-term disability benefits will end in Ontario:
When you are no longer Disabled: Fully recovering from your injury or illness may render you no longer eligible for long-term disability benefits. This is because recovering can mean you no longer meet the definition of “total disability” under your long-term disability (LTD) policy. Your eligibility for LTD benefits changes as you improve and become able to work again.
Long-term disability benefits provide claimants and their families financial support while they cannot work, whether at their own occupation or others they may be suited for. Once individuals can return to work, either in their previous job or a new one they are suited to, they are no longer entitled to LTD benefits.
When you Turn 65: LTD benefits end once you reach the maximum benefit period, which is usually at age 65. At this point, most LTD policies no longer offer coverage, as you’ve reached the age where you would typically retire.
If you go to Jail: Becoming incarcerated will end your LTD benefits. Most policies will suspend or end benefits if the claimant is imprisoned because they are unable to work or participate in the workforce, whether disabled or not.
If you Hurt Yourself: If you hurt yourself on purpose and it causes an injury, your LTD benefits may be terminated. Insurance companies see self-induced injury as indicating that you do not desire recovery or a return to work. In this case, they may interpret this as non-compliance with the objective of rehabilitation and terminate your benefits.
If you Return to Work: Returning to work, whether part-time or full-time, can cause your insurer to determine that you are no longer “totally disabled.” This is especially possible if your earnings exceed a certain threshold set by the policy.
If you Lied or Falsified Information: Misrepresenting your condition or making false claims can cause benefits to be denied or terminated. This is true whether you’re still going through the application or already receiving benefits. Insurers can conduct investigations and deny claims based on their evidence if it contradicts the claims you made on your application.
Each of these potential situations demonstrates the insurer’s position that LTD benefits are to support claimants who cannot work due to their health. The insurer also holds claimants accountable for taking reasonable steps toward recovery.
The termination of long-term disability benefits in Ontario, regardless of the reason, can have profound and devastating consequences for claimants. The potential for benefits to be terminated creates a sense of uncertainty, contributing to heightened anxiety and financial instability for individuals and families already grappling with the challenges of a disabling condition.
Understanding the mechanisms by which benefits may be discontinued and preparing for the possibility is essential in mitigating the emotional and financial toll. Nonetheless, the abrupt loss of benefits can significantly impact an individual’s ability to manage their health, livelihood, and future security. This only emphasizes the importance of careful navigation through the legal and procedural landscape of disability policies.
If your long-term disability benefits have been wrongfully terminated, our experienced disability lawyers are here to help. Since 2003, Lalande Personal Injury Lawyers have successfully assisted claimants across Canada whose benefits have been unfairly terminated or denied. Please don’t hesitate to contact us at 905-333-8888 or send a confidential email through our website.
We would be happy to arrange a free, no-obligation consultation to explain your disability rights and legal options. Remember, you won’t pay any legal fees unless we win your case.
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Long-term disability coverage in Ontario typically ends when a claimant reaches the maximum benefit period stated in their policy, such as age 65, returns to work, or no longer meets the policy’s definition of “disability.” However, the exact timing depends on individual policy terms and medical assessments.
Yes, depending on your policy, working part-time may impact your long-term disability benefits. Some policies allow for reduced payments if you return to work in a limited capacity, while others may terminate benefits if any employment is resumed.
Benefits may end if the claimant recovers sufficiently to return to work, reaches the age limit set by the policy (often 65), or if an insurance company determines that the claimant no longer meets the definition of “disability.” In some cases, benefits also end if the claimant fails to follow medical treatment or to submit required documentation.
If your doctor certifies that you’re still unable to work, you may still qualify for benefits; however, the insurance company may request additional assessments. Insurance companies often rely on their own assessments and may dispute your doctor’s opinion, potentially impacting your benefits.
If your benefits are terminated, you can appeal the decision by providing additional medical evidence, requesting an independent medical examination, or seeking legal assistance. It’s important to review your policy terms and to act quickly, as appeal deadlines are often short.
I was a dental hygienist that suffers from really bad scoliosis. My insurance company ignored my doc & cut my benefits off & told me I could do “something”. Matt got me CPP Disability and and LTD settlement – I don’t know what I would have done without him.
My daughter was killed by a drunk driver and it forever changed all of our lives. It seemed that for two years time stopped. This was no an easy journey. Matt let me sit in on the discovery of the driver and boy, he never let up. In the end, our grand-daughter was taken care of and we were compensated for our loss – which we then donated to a cause we believed in.
I call Matt my knight in shining armour. After I was struck by a car while cycling and permanently crippled, he fielded all communications with my especially difficult and downright nasty insurance adjuster. Every step of my care was a battle and I did not have the strength to fight alone.
I lost my leg in a terrible motorcycle accident and Matt help me recover compensation I need because I could not work and the cost of prosthetics and rehab are out of this world. I don’t know what I would have done without him.
My brother ended up paralyzed after a car accident and Lalande did SO MUCH to help get things straight from him getting out of the hospital to all his care for life. We are so grateful for Matt & Heather. I don’t know how my family could have done this without them.
