Bildfell Law

How a Lawyer Can Resolve Your Long-Term Disability Insurance Dispute

When faced with an injury, illness or disability, recovery can be difficult. If you are being denied long-term disability (LTD) benefits, your life can quickly become more problematic. In many cases, a LTD insurance claim is denied or payments stop prematurely. By hiring a LTD lawyer who is sensitive to your needs and situation, you should be able to obtain the compensation you deserve by challenging a claim denial.

Advocate for LTD Benefits Where Denied
In cases where you are denied a claim and the insurance carrier informs you that there is not sufficient evidence of a disability, or that your specific condition does not equate to a disability, we can issue a demand letter or provide the insurance carrier with additional medical evidence that supports your claim. Most claims are approved once communication from an LTD lawyer is received by the insurer.

In the event that there is continued refusal of benefits and a resolution is not reached, we can take action before the court. By bringing the matter to court, we have great negotiation power. We have been highly successful in negotiating settlements at the mediation stage of litigation and can bring the matter to trial, if necessary, including any appeals and proceedings of judicial review where applicable.

Advocate To Reinstate LTD Benefits
If your benefits were recently cut off, we can work with you to help get your LTD benefits re-instated. We can submit written documentation of your continuing disability from your doctor instead of waiting for the insurer to change its decision on appeal.

In circumstances where you are improperly terminated while receiving LTD, your employer could face a significant legal matter. We can seek to have your LTD reinstated and inform your employer of the need to prove the claim with medical evidence prior to terminating you on the basis that there is no reasonable prospect of ever returning to work.

Proving Disability to Insurance Carrier
In many cases, the legal question is whether the subjective evidence of the claimant is enough to prove disability. In practical terms, this type of issue arises when a claimant provides self-reporting evidence of his or her disability. Often, the claimant’s subjective evidence is coupled with a report or the clinical notes of a general practitioner who repeats the claimant’s self-reporting complaints. A doctor will then use the self reporting complaints as a means to justify that the claimant is “disabled.” This issue becomes more complicated when there is no determined objective cause for the complaints (e.g., fibromyalgia).

The courts have generally held that subjective complaints are not sufficient to satisfy the onus on the claimant to prove disability. A court is required to “objectively” determine whether there is substantial proof that the claimant, judged on a standard of reasonableness, is unable to physically perform the activities required to continue in a job at his or her employer’s workplace. The court will engage in an objective test to determine whether a reasonable person, after reviewing the complaints along with all the other evidence, would find that the claimant to be totally disabled within the meaning of the benefit plan.

The need for an objective test is not a universal rule, however. The door has been opened to the court accepting the subjective complaints of the claimant as evidence of disability. In Mathers v. Sun Life Assurance Co. (1999) B.C.J. No. 1023, the court held that, while the traditional test for proving disability is an objective one requiring proof of a total disability sufficient to satisfy the reasonable person (i.e. requiring objective medical evidence), there nonetheless may be situations where a judge could find that such a claim to be proven based on the claimant’s own evidence alone.

Further case law has nevertheless followed the need for an objective approach to proving disability. In other words, the normal standard for proof of disability claims requires some objective medical evidence; the claimant’s own complaints are not sufficient to prove disability. As such, the importance of hiring a lawyer to assist in presenting your disability or injury to the insurance carrier as severe, is crucial to a claim.

Contact Us at Bildfell Law
At Bildfell Law we advocate on your behalf to resolve your insurance dispute and receive or reinstate your disability benefits. We understand that this is a difficult time and by seeking an experienced lawyer at our firm, you expect to achieve the maximum benefit. Contact us at Bildfell Law in Sarnia, Ontario, for help with resolving your insurance dispute. In addition to handling LTD, we have also handled countless short-term disability, mortgage and other disability claims on behalf of our clients. If you need to have a legal claim filed, it must be done within the limitation period. Call us today at 519-339-0440.