Long Term Disability
Disability lawsuits present unique legal tests and engage different legal principles than other injury cases. If you have been denied long term disability benefits or income replacement benefits despite the fact that you are unable to work, it is important to understand the principles that apply and how they affect you. It is important to speak with an insurance claim lawyer who understands disability law.
To begin with, the relationship between the parties (you and the insurance company) is not founded on a common law duty to reasonably protect the safety of others (as is the case with certain car accident or slip and fall cases). Instead, the relationship between you is founded upon a contract – the insurance contract that you agreed to and the insurance policy that insures you.
For the first two years of disability, most claimants are governed by the “own occ” test: a test that requires you to prove that you are, essentially, unable to return to the job that you were working at the time of the accident. Beyond two-years, most claimants are governed by the “any occ” test – a test that requires you to prove that you are, essentially, unable to return to any job for which you are reasonably suited by education training or experience.
Many LTD policies have provisions that allow the insurance company to have you assessed by a doctor of their choosing in order to establish if you are entitled to benefits. The practitioner that the insurance company chooses must be reasonably qualified to do such an assessment and the exam itself must be reasonable. This is often an area of great concern, and if you have any doubts, it is likely in your best interest to seek the advice of a qualified lawyer.
If you have submitted all proper paperwork and supporting documentation, and your family doctor supports your claim, but the insurance company will still not consider making payments, you may need to consider speaking to a qualified lawyer, who will assess whether you should be receiving benefits and explain your options.
Disability insurance contracts will typically give rise to a duty of “good faith”. The insurance company and yourself are governed by this duty and there are serious ramifications for a failure to live up to the duty.