Your trusted LTD lawyer will help you submit a strong claim that is supported by the documentation necessary to prove your condition qualifies as a long term disability under your policy. Ideally, the insurer will approve your claim and pay you benefits as soon as the waiting period, also called the elimination period – ends. Unfortunately the disability claim process is rigorous and many claims are denied.
It’s important to keep in mind that if your disability carrier terminates your benefits or denies your claim, it doesn’t mean the claim lacks merit. There is more work to be done and if this is where you find yourself in the LTD claims process, it’s time to consult with an expert long term disability lawyer who will submit a strong appeal that clearly addresses any omissions or issues associated with your claim.
If your appeal is denied, your disability lawyer will start a lawsuit to seek past benefits owed and payment of your ongoing monthly benefits. The skilled disability and personal injury lawyers at Burn Tucker Lachaîne understand how to persuade an insurer to pay fair and timely long term disability settlements and that most disability lawsuits are resolved before trial. However, if the lawsuit does not lead to a reasonable settlement, your LTD lawyer will tirelessly advocate for your rights and for your rightful compensation in court.
Understanding Disability Benefits
Disability benefits generally pay a percentage of the wages you’ve lost due to a serious injury or illness – typically in the form of monthly benefits that replace the income you would have earned on the job. Benefits are calculated according to the formula set out in your policy to pay a portion of your income prior to becoming disabled.
There are different kinds of long term disability insurance policies, and your policy will set out the benefits that are available to you. Employers often carry group policies for their employees.
Self-employed individuals often purchase private policies that allow them a wider range of coverage options, such as business overhead insurance as well as income replacement.
There are also own occupation long term disability policies available that generally apply to high-paid professionals – such as doctors, lawyers, and executives – who require more significant coverage.
Qualifying for Long Term Disability Benefits
In order to obtain disability benefits, you’ll need to qualify under the LTD insurance company’s policy terms. The definition of disability is set out in a qualifying test described as the own occupation test or in the harder to satisfy any occupation test.
The Own Occupation Test
Policies that use the own occupation test base eligibility on whether or not the disability claimant can perform the duties required by his or her own job. Many group insurance policies provide that the disability insurance carrier pays benefits for 24 months under the own occupation definition of disability after which the definition changes to more restrictive any occupation test.
The Any Occupation Test
As the name implies, the any occupation test bases eligibility for long term disability benefits on the claimant’s ability to perform their own work as well as a suitable alternative occupation. This includes any jobs for which they have the necessary education, training, skills, or background.
Qualifying for LTD benefits under the any occupation test is more difficult than under the own occupation test. Some policies implement the any occupation test from the start while others implement it after the own occupation test period has ended.
The Duration of Long Term Disability Benefits
If you qualify for disability benefits, their duration will depend on the severity of your injury or illness and the policy’s terms. If your disability stops you from returning to work in any capacity, your policy may pay benefits until you reach retirement age at 65. Some policies, however, are fixed term, which means that they pay out for a specific number of years – such as for a term of 5 or 10 years.
Regardless of the kind of policy you have, your benefits will end if you recover enough to be able to return to work. If the insurance company believes that a claimant has recovered, it will terminate LTD benefits. Many disability carriers cut claimants’ benefits when the definition changes from own occupation to any occupation in the disability insurance policy. If you know that you cannot work despite the insurer’s decision, you need to hire a lawyer who is an expert in disability insurance law to pursue your rights.
Conditions That Qualify for LTD Benefits
A wide range of conditions can qualify for long term disability benefits, and the unifying factor among them is that the illness or injury you suffer interferes with your ability to do your job for an extended period. Long term disabilities can include:
- Physical injuries, such as fractures, traumatic brain injuries (TBIs), spinal cord injuries, injuries that require amputation, limb loss, serious burns, and injuries that lead to impaired vision or hearing
- Physical illnesses, such as cancer, rheumatoid arthritis, multiple sclerosis, diabetes, and conditions that are associated with chronic pain or fatigue – including chronic fatigue syndrome and fibromyalgia
- Mental health disorders, such as anxiety, depression, post traumatic stress disorder (PTSD), and bipolar disorder
For your long term disability claim to be successful, you’ll need to prove the severity of your injury or illness, which comes down to careful documentation.
Common Reasons for Denied Long Term Disability Benefits
While your LTD claim is unique, disability insurers deny or terminate LTD benefits for a number of common reasons, including:
- Your claim wasn’t complete or contained errors or omissions.
- You failed to comply with the company’s filing requirements, including all applicable deadlines.
- You didn’t provide sufficient medical evidence to support of a long term disability finding.
- Your disability results from a pre-existing condition as defined by the policy and disability law.
- Your injury or illness doesn’t qualify under the policy’s definition of LTD.
- Your injury or illness can be adequately accommodated on the job – for your line of work.
- You provided your disability insurance carrier with inconsistent statements.
- You failed to follow your medical team’s instructions and advice.
- The own occupation period has ended that the definition has changed to the any occupation test and the disability insurer believes that you no longer qualify.
- The insurance company’s independent medical examinations of your case conflict with your medical provider’s opinion.
The surest means of obtaining benefits is with dedicated legal counsel assisting you from the outset.
What to Do If Your LTD Claim Was Denied?
If your disability insurance claim is denied, it can lead to considerable stress regarding your finances, and you may not know where to turn for help. Two very important points to make here include the following:
- Just because your insured denied your claim doesn’t mean you have no legal recourse.
- You are not alone – an experienced long term disability lawyer is standing by to help.
Don’t let a denial letter stop you in your tracks. You have valuable benefits, and they’re worth pursuing.
Seek Legal Guidance
If you haven’t consulted with a lawyer with a strong knowledge of disability law, it’s time to do so. The fact is that your claim may have been wrongfully denied, and obtaining the benefits to which you’re entitled could simply be a matter of correcting misinformation, bolstering documentation, and ensuring compliance with the policy.
Know That There’s More to the Story
Denied disability claims can have an air of finality, but that doesn’t mean the insurance company’s decision regarding your case cannot be challenged. Your experienced disability lawyer has the skill, legal insight, and drive to help guide your claim toward an optimal outcome that provides you with the financial support you’re owed.
In other words, if you have long term disability insurance and you believe that your benefits have been wrongfully denied – you shouldn’t wait to retain the legal help you need.
Why Choose Our Long Term Disability Lawyer
The personal injury and long term disability lawyers at Burn Tucker Lachaîne have over 30 years of experience helping clients like you resolve their LTD claims favourably, and we bring the full force of our imposing experience and legal skill to every case we take on.
Receiving fair benefits in the face of a long term disability is too important not to fiercely pursue a just settlement, and we can help in all the following ways:
- Gathering the documentation necessary to build a strong claim that the involved insurance company will have a difficult time denying
- Guiding you smoothly through the challenging claims process, which includes ensuring that you know what to expect
- Helping you avoid the kinds of common mistakes that can damage your case, such as posting on social media while your claim is pending – which could undermine the information you’ve shared with the insurance company allowing them to resist paying benefits
- Engaging in productive negotiations with the insurance company – in pursuit of a fair resolution
- Skillfully navigating the appeals process if your claim is denied
- Starting a lawsuit against the disability company to have your benefits reinstated and past benefits paid or a reasonable lump sum payment
- Proceeding to court if a fair settlement can’t be reached
Having a capable LTD lawyer handling your claim can make a serious difference in its outcome and in your financial future.
Speak to Our Disability Lawyer in Hamilton to File an LTD Claim
The experienced disability lawyers at Burn Tucker Lachaîne – proudly serving Hamilton, Ontario – have more than 30 years of history representing plaintiffs, and we are committed to sparing no effort in defense of your rights and in focused pursuit of a fair settlement or court award on your behalf. Whether you’re just getting started with your claim, have received a claim denial, or have had your benefits terminated, we’re on your side and here to help. To learn more about what we can do for you, please don’t delay contacting or calling us at 416-365-1223 and scheduling a free consultation today.
March 6, 2025 
