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Long-Term Disability Lawyer Toronto

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It’s time for your insurer to honour its insurance contract terms and pay you – but will it? All insurance companies have a financial incentive to lowball or deny long-term disability claims, and the consequences of a disability claim denial are unthinkable. Therefore, winning your disability claim is your only option. So how will you get there?

The long-term disability lawyers at Joshua Goldberg Law can guide you safely through the claims process. Once you enlist our services, you can rest easy knowing that all our Toronto long-term disability lawyers win nearly all the disability claims we file on behalf of our disability clients.

What’s a Long-Term Disability?

It’s nearly impossible for able-bodied Canadians to think of a life that’s derailed by a long-term medical condition or an injury with life-long health effects. The inability to engage in favourite activities, visit friends, or go to work like you once did can take a toll on you. However, with the help of an experienced lawyer, you have the chance to get disability insurance benefits and probably regain control of your life.

Suppose you are ill or were involved in an accident that left you with a life-long inability to resume your work or engage in day-to-day activities. LTD insurance can provide financial relief. It is a type of insurance coverage that offers income replacement for persons who are unable to work because of a disability that is expected to last for an extended period, typically beyond six months.

This coverage is designed to provide financial support to persons who are unable to work and earn an income because of a disability. This allows them to cover essential expenses.

Short-term disability coverage typically provides benefits for a limited duration, often up to six months, following an incident or illness that temporarily prevents you from working. However, if the disability persists beyond the short-term coverage period and is expected to last for an extended period, you may then file a disability claim for LTD disability benefits.

Long-term disability coverage typically kicks in after the expiration of the short-term disability benefits. This provides ongoing income replacement for an extended period, potentially until you reach retirement age or can return to work, depending on the terms of the policy.

Long-Term Disability Insurance

This is an insurance cover that provides compensation to insured individuals if they cannot continue to work for three months or longer. This could be due to injuries associated with an accident or illness that causes LTD disability or impairment as defined by the terms of the insurance cover.

Depending on the nature of your disability, your insurer may pay monthly benefits until you are 65 years old. Thus, LTD disability insurance is a smart investment decision for healthy and employed Canadians, particularly those interested in securing their financial future.

This insurance policy can be sold separately or as a group insurance policy – commonly known as the group benefit. The latter may be available through your employer. In this case, most employers can either pay all their employees’ insurance premiums or require that you and other employees contribute to your long-term disability cover, either partially or in full.

Alternatively, you can buy an individual or private LTD disability policy from a reputable insurance company. These policies are also available to business owners and self-employed professionals. Before you purchase an LTD disability cover, consult one of our experienced disability insurance lawyers. He or she will help you understand all the terms of your policy.

Conditions that Qualify for Long-Term Disability

Most Canadians still wonder how they can know if they qualify for LTD disability benefits. Different conditions are covered under a disability policy. Still, if you are unsure if your disability or illness qualifies for disability benefits, reach out to our lawyers. An experienced disability lawyer understands LTD disability coverage and the related laws. Here are some of the conditions that are covered under most disability insurance policies.

  • Cancer
  • Spinal cord injuries
  • Mental illness
  • Multiple sclerosis
  • Autoimmune diseases
  • Chronic pain

There are many health conditions not included in the disability coverage. Luckily, your disability lawyer can advise on the specific conditions covered under your LTD disability policy and whether you have a valid claim.

Remember, there is no specific condition that triggers the LTD benefits. Your insurer will consider different factors to determine whether your condition can be included in the coverage. Some of these factors include:

Your Injury or Medical Condition

Careful consideration is given to your medical condition or injury in correlation with the insurance policy’s definition of “total disability.” Insurance policies typically define total disability as the inability to perform the essential duties of your own occupation due to a disabling condition. The legal definition of a disability is complicated, and you need an experienced disability lawyer to understand how it applies to your LTD disability claim.

It’s crucial to note that simply having a severe medical condition may not automatically qualify you for long-term disability benefits. Insurance companies may require evidence that demonstrates that your condition prevents you from earning an income or performing key job responsibilities.

For instance, if you were diagnosed with a condition like multiple sclerosis, you may not initially meet the criteria for total disability if you can still work or fulfill the key tasks at your job. However, some insurers may have more lenient criteria and approve disability claims even if you can still perform some tasks at work but cannot maintain your previous level of income due to the disability.

Medical Records

Central to the disability assessment process is a thorough review of your medical records. This provides crucial insight into the nature and severity of your disability. These records help insurers assess the impact of the condition on your ability to work and earn a living. That’s why your lawyer will recommend seeking medical attention early enough and adhering to the treatment and medication prescribed by your doctor.

Treatment Plan

Your disability insurer will also consider the treatment plan outlined by the individual’s healthcare provider. The effectiveness and adherence to the treatment plan play a significant role in determining the continuity and extent of disability benefits. If an insurance company disagrees with the proposed treatment plan or believes it is inadequate, it may result in a denial or termination of benefit payments.

Keep in mind that insurance companies carefully evaluate medical evidence, functional limitations, and treatment plans to make informed decisions regarding LTD disability benefits. This doesn’t mean your insurance company will just hand over money to you. Work with a knowledgeable disability lawyer to ensure your impairment or disability is correctly defined and get the disability benefits you are legally entitled to.

How long do LTD Benefits Last?

Unlike short-term coverage, which has a limited duration, LTD benefits can extend until you are fit to return to work or until the policy’s termination age, often around 65 years. Initially, LTD benefits usually cover the first two years, during which you cannot work in your own occupation (like you did before the illness or injury).

Subsequently, your insurance company may continue benefits payments if you remain unable to perform duties under any occupation. This shift signifies the transition from an “own occupation” period to an “any occupation” assessment.

Own Occupation and Any Occupation

During the “own occupation” phase, benefits are granted if you cannot fulfill essential duties in your chosen field. However, after this period, eligibility depends on your ability to work in any suitable occupation, not necessarily the previous profession.

Reassessment of eligibility often occurs after the “own occupation” phase. It requires you (the insured) to demonstrate an ongoing inability to work in any occupation you may be suited in terms of experience, training, or education.

This periodic review ensures benefits align with your current circumstances and level of impairment. Having a knowledgeable disability lawyer on your side ensures your condition is assessed accurately and prevents your insurance company from ending your benefits payments illegally.

The Elimination Period

Every LTD disability policy has an elimination period. This refers to the time from the start of your condition (disability) and the disability benefits payout. It’s also known as the waiting period or the qualifying period.

The elimination period varies widely depending on the terms of your insurance policy. However, it ranges between 90 days and 120 days. If this period is longer, then your premiums will be lower. Remember, if you need financial support during the waiting period, our lawyers can help you apply for short-term insurance until the elimination period expires.

Long-term Disability Payouts

In Ontario, the amount of long-term disability (LTD) benefits you receive ranges from 70% to 80% of your pre-disability income. However, this percentage may vary depending on the specific provisions outlined in your long-term disability cover. LTD benefits are often subject to a maximum cap based on your monthly or annual income.

Suppose you have a high income; the LTD benefits may not fully replace your pre-disability earnings due to these limitations on the annual income amount. That means if you earn a substantial monthly income, you may only receive a portion of it as LTD benefits.

To address this issue, high-income earners may consider an executive long-term disability plan. These plans often offer adjustable income caps, allowing individuals to customize their coverage to align with their income levels. By opting for such a plan, you can ensure that you receive adequate financial protection in the event of a disability.

It’s advisable for individuals considering long-term disability coverage, particularly those with high incomes, to carefully review the terms and conditions of their insurance coverage. They can also explore options such as executive plans to ensure comprehensive coverage tailored to their needs. A knowledgeable and reliable lawyer can help you avoid mistakes that could lead to disability claim denial if you ever need to claim your accident disability benefits.

Types of Long-Term Disability Benefits

There are three primary sources of long-term disability benefits in Toronto. These include disability insurers in the private sector, Ontario’s long-term disability benefits, and federal long-term disability benefits. If you intend to file a long-term disability claim, consult a disability lawyer who can help you determine the specific benefits to pursue. Here are your disability claim options:

Long-Term Disability Insurance – Employer or a Private LTD Policy

Under long-term disability insurance, there are different disability plans, which include an individual disability policy, employer group disability plans, and special purpose insurance policies.

An individual disability insurance policy is purchased directly from insurers. These policies are common among higher-income earners, business owners, and professionals. Benefits are usually income-based and can last from two to five years or until the age of retirement.

Employer group plans are offered by employers to their employees. These plans provide income replacement benefits should employees become unable to work due to a disability. The employer can pay the monthly insurance premium or require their employees to contribute to the premiums.

Workers Compensation

Workers’ compensation insurance is available under the Workplace Safety and Insurance Board (WSIB). It provides provincial long-term disability benefits to employees injured during their employment. These benefits cover income loss and medical expenses incurred as a result of workplace-related injuries or illnesses.

Ontario Disability Support Program (ODSP)

The Ontario Disability Support Program offers provincial long-term disability financial assistance to eligible Ontario residents. The claimants must meet the financial and disability criteria outlined in the Ontario Disability Support Program Act. Benefits are provided to individuals who demonstrate financial need and meet disability requirements.

Canada Pension Plan Disability (CPPD)

The Canadian government manages the Canada Pension Plan Disability (CPPD) and offers financial assistance to individuals who have contributed to the Canada Pension Plan. Eligibility is based on having a physical or mental disability preventing the continuation of current employment or finding new employment. Payments are made monthly until the individual reaches the age of 65.

Each of these long-term disability benefits serves to provide financial support to individuals facing disabilities. This ensures they can cover essential expenses despite being unable to work.

Filing a Long-Term Disability Claim

Filing a long-term disability claim can be a complex and daunting process. It involves extensive paperwork, medical documentation, and navigating detailed legal requirements. From determining eligibility criteria to gathering supporting evidence and negotiating with insurance companies or government agencies, the process can be overwhelming for individuals already dealing with the challenges of a disability.

In such situations, enlisting the professional assistance of an experienced long-term disability lawyer can be invaluable. A knowledgeable lawyer specializing in disability law understands the application process and can provide expert guidance and advocacy every step of the way. They can help ensure that your application is complete, accurate, and compelling, increasing the likelihood of a successful outcome.

Additionally, in cases of denied claims, disputes with insurers, or benefits terminated wrongfully, a skilled lawyer can vigorously defend your disability rights and pursue the disability payments you rightfully deserve. Remember, our lawyers will use every legal option to ensure you get the amount of disability benefits you deserve.

We are Ready to Help

We are a disability law firm with dedicated and experienced disability lawyers who will provide the legal representation you need to win your disability insurance claim. Since our inception over a decade ago, we have worked diligently and handled many long-term and short-term disability claims successfully. We offer our clients a contingency fee arrangement, which means you don’t need to pay upfront fees.

Schedule a free consultation – we are one of the top disability law firms you can trust to get a positive outcome on your disability case. Remember, this is a confidential consultation.

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What Our Clients Say

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I would like to thank my powerhouse team, Joshua Goldberg. One word WOW! Joshua is amazing! He showed me empathy and honesty. He pushed so that i could get an handsome tort settlement. Even when i honestly did not expected anything he made it happened. Joshua is out of this world!
Zeta Bernard11 Month, 2023

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Awesome team very supportive during my accident. Joshua Goldberg and his team are fabulous i would recommend them to anyone who needs a personal injury lawyer 👍
Nisha Rathod11 Month, 2023

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Josh Goldberg is an amazing lawyer who I would highly recommended to anyone who has been in a car accident . He was very helpful the entire time I’m happy i met him he is the best ! 🙂
Brie Smith11 Month, 2023

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My lawyer, Joshua Goldberg, who handled my car accident case was very professional. He explained everything clearly and made sure that we were on the same page throughout the process, all the way through to the satisfactory conclusion.
Reza Mir11 Month, 2023