Long-Term Disability Lawyers in Winnipeg

Long-Term Disability Insurance Claims

Aside from requiring additional medical information or claiming that the medical information does not support your disability, sometimes disability insurers rely upon more technical grounds to deny coverage. These may include: 

Long-Term Disability Insurance Coverage

You may have disability insurance coverage under a group policy through your employer, or you may have your own private disability policy. After an illness, accident, or injury, your disability insurer may refuse to pay any long-term disability benefits or acknowledge the full extent of the coverage for which you have paid premiums. 

Disability insurance contracts can be complex legal documents that require an experienced lawyer’s assistance in interpreting and helping you build a successful case against a disability insurer when you are disabled from returning to work. Long-term disability cases require not only the legal interpretation of your policy but also the interpretation of medical documents. Frequently, the only option for pursuing payment of benefits involves initiating a lawsuit. Lawsuits can be complicated, and having a long-term disability lawyer experienced in advancing claims for disability benefits review your case can help you understand if there is merit to pursuing a legal claim.

At Tapper Cuddy LLP we have successfully assisted clients with long-term disability claims that have involved all of the above grounds for termination or denial of benefits. If your disability claim process for benefits has been denied by your insurer, consider contacting us for a free and confidential consultation to discuss how we may be able to assist.

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Many of the cases we assist with involve claims relating to disabilities and diagnoses that are based on subjective reporting of symptoms and/or cannot be established easily through “objective” medical testing. They are disabilities that do not show up on lab tests or diagnostic imagery such as X-rays, MRIs, or CT scans. Many of our clients are in situations where their insurers have denied their claim for long-term disability benefits on the basis of a “lack of objective medical evidence” supporting total disability.

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If you have medical support for being unable to return to work, but your insurer has denied or terminated your claim for benefits on the basis of a “lack of objective medical evidence,” consider contacting us for a free, confidential consultation. We will review your claim with you and let you know what options you might have for pursuing your benefits.

Who Qualifies for Long-Term Disability in Canada?

If you’re looking to qualify for long-term disability (LTD) benefits in Canada, you generally need to be employed and covered by an LTD insurance policy. To be eligible, you must provide medical evidence that shows you cannot perform, initially, your “own” occupation. Often, later, you must show you cannot perform the essential duties of any occupation that you are or may reasonably become trained to do. This is called the “change of definition” period and is where many claimants are at their most vulnerable for termination of long-term disability benefits. Most long-term disability policies have a waiting period of time before benefits begin, and you’ll be required to provide ongoing medical updates and participate in rehabilitation programs as part of the process.

What Conditions Qualify for Long-Term Disability in Canada?

In Canada, long-term disability (LTD) benefits are available to those who can’t work due to a serious illness or injury. You don’t necessarily require a “label” or identification of your illness in order to qualify for LTD benefits. Some of the commonly seen qualifying conditions include

    • Musculoskeletal disorders (e.g., back injuries, arthritis)
    • Mental health conditions (e.g., depression, anxiety, Post-Traumatic Stress Disorder (PTSD))
    • Neurological disorders (e.g., multiple sclerosis, Parkinson’s)
    • Cancer
    • Cardiovascular conditions (e.g., heart disease, stroke)
    • Chronic pain syndromes (e.g., fibromyalgia)
    • Autoimmune disorders (e.g., lupus, rheumatoid arthritis)
    • Severe injuries from accidents or trauma
  • Traumatic Brain Injuries (i.e., significant concussions)
  • Vestibular Issues (i.e., issues related to the inner ear or balance)

Each case is assessed based on medical evidence and how the condition impacts your ability to work.

Which Conditions Are Most Often Approved for Long-Term Disability?

According to Statistics Canada’s Canadian Survey on Disability (2017-2022), the most common disability types among working-age Canadians were pain-related conditions (63%), mental health-related conditions (46%), and flexibility impairments (36%). These findings align with the conditions most frequently approved for long-term disability (LTD) benefits in Canada.

  • Musculoskeletal disorders (e.g., chronic back pain, arthritis) are among the most commonly approved conditions, as they can severely impact mobility and the ability to perform physical work.
  • Mental health issues, including depression and anxiety, are also frequently approved, as they can significantly affect concentration, decision-making, and workplace interactions.

Cancer, neurological disorders (e.g., multiple sclerosis, Parkinson’s), and severe injuries from accidents or trauma are also regularly approved for long-term disability benefits due to their long-term impact on a person’s ability to work.

What Conditions Are Not Considered a Disability?

Not all medical conditions qualify as a disability under disability insurance policies. A condition may not be considered a disability if:

  • It is a minor or temporary illness or injury that does not significantly impact the ability to work.
  • It can be effectively managed with treatment and/or accommodation from your employer without preventing the person from performing job duties.
  • It is a pre-existing condition that became disabling in a particular time frame after insurance coverage began.
  • It does not meet the specific definition of disability outlined in the insurance policy (some policies have specific exclusions in them).

Since eligibility depends on the terms of your long-term disability insurance policy, it’s best to review your coverage and consult a long-term disability lawyer if you’re unsure whether your condition qualifies.

What to Do If Your Long-Term Disability Application Is Denied

Having your long-term disability (LTD) application denied can be frustrating and overwhelming, but a denial isn’t the end of the road. You have options to appeal the decision and improve your chances of getting the disability insurance benefits you need.

Steps to Take After an LTD Claim Denial

  1. Review the Denial Letter
    Carefully read the insurance company’s denial letter to understand why your claim was rejected. Common reasons include insufficient medical evidence, not meeting the policy’s definition of disability, or missing documentation. Identifying the specific reason for the disability claim denial is key to building a strong appeal.
  2. Request Your Claim File
    Contact your insurer and ask for a complete copy of your claim file. This includes all the documents and evidence they used to make their decision. Reviewing this information can help you spot gaps or errors that may have led to the denial.
  3. Understand the Appeal Process & Deadlines
    Every insurance company has its own appeal process and strict deadlines. These details are usually outlined in your denial letter or policy documents. Missing a deadline could mean losing your right to appeal, so be sure to act quickly.
  4. Gather Additional Medical Evidence
    Strengthen your appeal by providing more detailed medical records, new diagnostic tests, or additional statements from your healthcare providers. Make sure your doctors understand the insurer’s requirements and can provide evidence that directly addresses the reasons for your denial.
  5. Write a Strong Appeal Letter
    Draft an appeal letter that clearly explains why you meet your policy’s definition of disability. Address each reason for denial and include medical evidence and documentation to support your case.
  6. Consider Legal Action if Necessary
    If your appeal is denied, you may have the option to file a lawsuit against the insurance company. This process can be complex, so working with an experienced disability lawyer can help you navigate the legal system and increase your chances of a favorable outcome. Remember, there are time frames for filing a lawsuit, and you should consult a lawyer as soon as your claim is denied to determine how long you have to file a lawsuit. If you don’t, you may not be permitted to file a claim.

Need Legal Advice with Your LTD Claim?

If your LTD claim has been denied and you need legal guidance, our experienced disability lawyers are here to help. Contact us today to discuss your case and work toward securing the long-term disability benefits you deserve.

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Can My Employment be Terminated While on Long-Term Disability in Canada?

Yes, an employer can terminate your employment while you are on long-term disability (LTD). However, they must follow specific legal requirements before doing so. The period of time an employer should wait before terminating your employment while you are on LTD is specific to each individual and their employment.

It’s important to note that while an employer can terminate you while you are on LTD, they cannot fire you simply because you are on LTD. The termination must be based on legitimate business reasons and an understanding that the likelihood of you being able to return to your employment is low. In some cases, you may also be entitled to severance pay or other compensation.

If you believe you were wrongfully dismissed while on LTD, consulting an employment or long-term disability lawyer can help you understand your rights and options.

Can I Get EI While on Long-Term Disability?

No, you cannot receive both Employment Insurance (EI) and long-term disability (LTD) benefits at the same time in most of the provinces, including Manitoba and Saskatchewan. If you happen to receive both, you must notify your insurance company and the EI office. In most cases, your LTD benefits will be reduced (offset) by the amount you received from EI.

If you’re unsure how these benefits interact or need help navigating your claim, consulting an experienced long-term disability lawyer can help ensure you receive the full benefits you’re entitled to.

Can I Collect CPP and Long-Term Disability at the Same Time?

Yes, you can receive both Canada Pension Plan (CPP) disability benefits and long-term disability (LTD) benefits at the same time. In fact, many long-term disability policies of insurance require you to apply for CPP Disability. However, most LTD insurance policies require an offset, meaning your monthly disability payments will be reduced by the amount you receive from CPP disability. This prevents you from collecting both benefits in full.

If you’re unsure how your LTD policy handles CPP benefits, reviewing your policy terms or consulting a long-term disability lawyer can help clarify your entitlements.

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