Present Day Value in Long-Term Disability Insurance Claims

Posted on by Taylor & Blair LLP Posted in Long-Term Disability

Insurance denial claims always arise in the context of a contractual relationship, that between the insurer and the insured, which has broken down. While at trial for a long-term disability claim all a judge can do is order specific performance of the contract of insurance, namely a declaration that the plaintiff qualifies as disabled under the definition of their policy, and that the insurance company needs to pay the plaintiff any arrears of benefits and put the plaintiff back on policy and resume monthly benefit payments, often a plaintiff wants nothing more to do with their insurance company and all trust has been lost between the two parties.  While all a judge can do in denied insurance claims is order specific performance, that doesn’t prohibit the parties from coming to a more creative solution to end the legal battle.

Arrears & Future Benefits

There are, generally speaking, two types of … Continue reading

Common Reasons Life Insurance Claims Are Denied

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Life Insurance Claim Denials

Group Life Insurance vs. Private Life Insurance

There are, generally speaking, two types of life insurance products that people pay for in Canada. 

The first type of life insurance is that found in group policies, which come with a set insurance benefits package employers provide to their employees as a perk of employment. Before offering group insurance policies to employers to offer their employees an insurance company will consider things like the type of industry the employer operates in, the demographic of the usual employees for that type of industry and that employer, or other similar employers, claim history with the insurance company. The insurance company will use that information to determine life insurance benefits and the associated premiums. They usually do not look at a specific individual while underwriting group life insurance policies and as such the coverage is usually for a lesser amount.

The second type of life … Continue reading

Own Occupation Period vs. Any Occupation Period – The Devil Is In The Definitions

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Long-Term Disability

When it comes to client’s who have been denied their long-term disability benefits, we have many that when they first contact us are surprised that their own insurance company would treat them so unfairly.  They believe that since they have been paying their insurance premiums for however many years that their insurance company would fight on their behalf to ensure they obtained access to the disability benefits they are entitled to.  Nothing could be further from the truth.

At the end of the day the insurance company has only three considerations when it comes to their operations.  The first is: take in as much money as possible.  The second: pay out as little money as possible.  A far distant third consideration is: try not to get sued.  Concepts of “fairness” do not come into the equation.  The relationship between an insured individual and their insurance company is a strictly … Continue reading

The Important Role Of Doctors In Obtaining Long-Term Disability Benefits

Posted on by Taylor & Blair LLP Posted in Life Insurance Claim Denials, Insurance Denials

All long-term disability policies require a medical report to be approved.  For many people the obvious choice for a medical report is their family doctor as these doctors often have a long history with their patients and are familiar with their physical and mental health history, which is often important in long-term disability applications.  Most family doctors are passionate about caring for their patients and want to help their patients when they can and gladly assist their patients in applying for long-term disability benefits if it will help them at the end of the day.

However, your long-term disability application isn’t about what is good for you or what you or your doctor would like, it’s about the insurance company’s obligations under the terms of your insurance policy.  It is a strictly contractual relationship, and you can be sure that the insurance company won’t provide you any benefits they … Continue reading

Long COVID & Long-Term Disability

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Long-Term Disability, Long COVID

Since the COVID-19 pandemic began in early 2020 most of the news surrounding the virus was focused on the number of hospitalizations and death that resulted from COVID-19 infections.  Over the years as the COVID-19 virus has been better understood and immunity has increased with the roll out of the vaccines and from natural immunity, it has become clear that COVID-19 will be with us for the foreseeable future and the new focus of COVID-19 has become those infected that end up with long-term symptoms, often called Long COVID.

Symptoms of Long COVID

Long COVID is more common than most people think with one study showing that 15% of Canadians infected with COVID-19 end up suffering from long-term symptoms.  Unfortunately, COVID-19 is still not well understood and how and why the various symptoms occur is still a mystery for the most part.  Long COVID symptoms are incredibly varied and require … Continue reading