Long-term Disability Lawyers
in Newfoundland & Labrador

What are long-term disability (LTD) benefits?

Long-term disability (LTD) benefits are monthly payments you receive from an insurance company when you are unable to work for medical reasons.

You may have group insurance through your employer or union. Individual LTD policies are also available. An LTD policy protects you against long-term income loss from an accident, disease, mental health issue, or other form of disability.

To receive LTD benefits, you must first exhaust other forms of income replacement like Employment Insurance benefits (17 weeks) and Short-term Disability benefits (1-2 years). If you’ve exhausted these benefits and are still unable to work, LTD benefits may be available.

Too often, disability insurers deny or minimize legitimate claims. If you’re medically unable to work and your LTD benefits have been denied or terminated, contact the experienced LTD lawyers at Roebothan McKay Marshall – it costs nothing to talk.

What can I do if my LTD benefits have been denied or terminated?

If you’re disabled and unable to work yet your LTD benefits have been denied or terminated, you have two options:

1. Appeal the decision internally by writing to your insurer and going through their internal appeals process.
2. Open a claim against your insurer for breach of contract.

There are different time limits for each option:

1. For internal appeals, deadlines dictating how long you have to submit documents for an appeal will be in your denial letter.
2. For a lawsuit, you typically have two years to file a claim.

There are often advantages and disadvantages to both options specific to your individual circumstances. It’s important to work with an experienced LTD lawyer to ensure your right to fair compensation is protected.

How We Help

Roebothan McKay Marshall will guide you through the legal process, keeping you informed every step of the way.

• Protect your right to obtain compensation
• Guide you through court procedures
• Research supporting case law

• Request medical reports documenting your recovery
• Ensure medical costs are covered
• Negotiate a fair settlement

How are LTD settlements paid out?

LTD settlements are paid out either as a lump sum or as a reinstatement of benefits.

Lump Sum Settlements

A lump sum settlement is a one-time payment made to you that represents the total of your insurance policy (including back benefits and the value of future disability payments). In return, you must agree that the lump sum is all you’re entitled to under the policy, giving up your rights to future benefits.

The benefits of lump sum settlements vary, but may include:

1. Closure: With reinstatement, your benefits could be terminated again in the future. A lump sum settlement eliminates the uncertainty of future benefits.
2. Tax advantages: The Supreme Court of Canada has ruled that only the arrears portion of a lump sum settlement is taxable. The amount allocated for future benefits is not taxable, which could result in significant tax savings.
3. Freedom to return to work: If your health improves and you’re able to return to work, a lump sum settlement allows you to do so without reporting to an insurance company.
4. Security for loved ones: In the event the disability requires end-of-life support, a lump sum payment ensures a set amount of money is available to your family right away.

Reinstatement of Benefits

Reinstatement refers to your regular LTD benefit payments resuming after they’ve been previously denied or terminated.

The court can’t force an insurer to provide compensation as a lump sum. The judge can award legal costs, aggravated damages, back payments, and order reinstatement going forward but cannot award a lump sum amount.

If you accept a lump sum payment, you must give up any further claims you might have under the policy or in court, whereas a reinstatement of benefits offers a return to regular LTD payments.

Which type of LTD settlement should I choose?

Every long-term disability claim is unique. Whether you should seek a lump sum settlement or reinstatement of your benefits depends on a range of factors, including your financial needs, the terms of your policy, and the nature of your disability.

To fully understand which method is right for you, our expert team will work with you to decide which option is best and will maximize your compensation for your unique situation.

Why do insurance companies deny or terminate LTD benefits?

LTD insurers sometimes deny or terminate payments when they believe there isn’t enough evidence to support the claim that you’re unable to work. Insurers frequently refer to your claim’s “objective evidence” and get opinions from their own medical team to support their decisions.

However, many disabling conditions cannot be proven through “objective evidence” like scans and x-rays. Chronic pain and mental health diagnoses, for example, often rely on subjective reporting.

For this reason, it’s important to speak with a lawyer that knows how to collect the best evidence for your disability and fight for your right to compensation.

Experienced LTD lawyers know how to navigate standard insurance denial arguments, including:

• Medical opinion does not prove or provide a sufficient diagnosis to support disability
• Incomplete medical records
• Application is insufficient to prove “total disability” or doesn’t fall within the definition of “totally disabled”
• No “objective proof” of disability
• Claimant has excluded or pre-existing conditions
• Medical opinion by an insurance expert states you are not disabled
• Failure to follow ordered care or treatment prescribed by a doctor
• Failure to participate in a rehabilitation program prescribed by the insurer
• Claimant did not receive a proper diagnosis
• Claimant received the proper care or therapy, but medical personnel did not supply accurate documentation
• Claimant is not under the regular care of a doctor
• Claimant has not complied with certain terms of the policy
• Other policy terms are interpreted by the insurer in a way that denies the claimant coverage

If you’ve been diagnosed with a mental or physical condition that prevents you from working yet your LTD claim has been denied, do not accept the insurer’s explanation for its denial. That decision was made in the best interests of the insurer, not the claimant.

Speak with an experienced LTD insurance lawyer who will consider your best interests and fight for the compensation you deserve. The lawyers at Roebothan McKay Marshall know how to prevent insurers from improperly hiding behind these arguments in cases where they do not apply.

What’s the difference between group and individual insurance?

Standard Group Insurance

Group disability insurance policies are typically obtained through your workplace. They generally cover disability only during the period in which the person is working. Disability insurance applies regardless of whether the onset of the disease or injury is related to work, but if you are laid off, you may not be covered.

Long-term disability benefit amounts are paid monthly, based on a percentage of your regular basic gross earnings at the time of the injury. The usual percentage is 66% of your gross earnings, up to a particular maximum amount. Payment of group disability insurance usually depends on several conditions, including exhaustion of sick leave, exhaustion of short-term disability benefits, whether the individual is approaching retirement age, and whether the individual is disabled from their “own occupation” or “any occupation.”

Individual Disability Insurance and Income Protection

If you don’t have group insurance, there are other sources for claiming disability benefits or income protection:

• Individual disability insurance plans are available through insurance brokers.
• Self-employed individuals may obtain benefits similar to group insurance through professional insurance programs offered by professional associations.
• The Public Service Pension Plan and some other pension plans allow an early retirement benefit, if an enrolled member is unable to continue working because of a medical reason.
• Individuals may be entitled to Employment Insurance (EI) during the first 17 weeks they’re unable to work, if they have sufficient insurable hours.
• Individuals unable to work due to a workplace injury are entitled to worker’s compensation under the Workplace Health, Safety and Compensation Act.

Frequently Asked Questions