Long-Term Disability & Return to Work Programs

Posted on by Graham Taylor Posted in Insurance Denials, Long-Term Disability, Return-to-Work Program

As discussed many times in this blog, your relationship with your insurance company is one based on contract. Your insurance policy lays out the responsibilities and obligations of the insured and the insurer.  The basic provisions of all insurance policies are that you pay insurance premiums to your insurance company, and they agree to pay out insurance benefits should an agreed upon event occur triggering coverage under the policy. That’s the broad strokes. However, every type of insurance policy has fine print as well and more often than not it’s the fine print that is the most important part of the policy when a claim for benefits is made.

A common provision in long-term disability insurance policies is that the insured is obligated to participate in a program designed to get them back to work and that if the insured fails to participate in the program the insurance company can … Continue reading

Is Your Long-Term Disability Provider Watching You?

Posted on by Brian Jacobson Posted in Insurance Denials, Long-Term Disability

While this usually comes to the surprise of most people who are currently receiving long-term disability benefits, your insurance company is not your friend. They are providing you with long-term disability benefits because they are contractually obliged to, not out of some sense of altruism.

Not only are they only doing what they are contractually obligated to do, they are also constantly reevaluating your entitlement to ongoing long-term benefits and actively seeking excuses to disentitle you to benefits or to void coverage under your insurance policy.

Your Medical Records and Independent Medical Examinations

Your insurance company will be continually looking through your medical records from the start of your claim until the claim ends to look for ways to deny paying further benefits and to confirm you still meet the definition of “disabled” under the terms of your long-term disability policy.

In the beginning of your claim for long-term disability … Continue reading

Present Day Value in Long-Term Disability Insurance Claims

Posted on by David Goldberg 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 Kevin Blair 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 Graham Taylor 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