Long-term disability denied? 3 things employees need to do
Jenna Paterson-Coutts, Special to CP24.com
Published Thursday, December 29, 2022 7:50PM EST
Last Updated Wednesday, January 4, 2023 11:44AM EST
Long-term disability (LTD) coverage is supposed to give Canadians peace of mind financially if they can’t work due to an illness or permanent injury. Unfortunately, that’s not always the case.
Lior Samfiru, an employment lawyer and co-founding partner of Toronto-based Samfiru Tumarkin LLP, claims that insurance companies often incorrectly deny legitimate LTD claims.
“My firm has seen this happen so many times and it always breaks our hearts,” says Samfiru, who appears weekly on CP24’s Ask a Lawyer.
“Insurers will argue that you aren’t disabled enough to be off work, so they will turn down your LTD claim or cut off your disability benefits. However, if your doctor says you can’t work due to your condition, that should be enough.”
He adds it’s very important for claimants to understand that the insurance company’s decision isn’t final in many cases.
If your LTD claim is denied, don’t panic. Here are three things you need to do:
Get the insurance company’s decision in writing
Once your LTD claim has been turned down, Samfiru says it’s very important that you request a denial letter from your insurer.
“Not only will this document explain why your claim was denied, it should also outline how you can appeal the decision as well as the two-year window you have to pursue a legal claim.”
In some cases, insurance companies will try to explain over the phone why you were denied LTD benefits.
“Before the call ends, make it very clear to your insurer that you would still like a written version of their decision by mail or email,” Samfiru adds.
“Even before you receive the denial letter, contact us for free legal advice immediately. Do not waste any time. My firm can identify the mistakes that the insurance company made when denying your disability benefits and walk you through your legal options.”
Skip the appeals process and file a legal claim
After your LTD claim has been denied, you will likely receive an invitation to appeal the insurance company's decision.
However, Samfiru says employees are much better off filing a legal claim instead.
“Appeals almost always fail in our experience because the process is typically handled by the same insurer that refused to provide you with disability benefits in the first place. This system appears to be designed to frustrate claimants and run out the clock on the two-year window that you have to take legal action after your claim has been denied.”
He adds that once the two years are up, the insurance company may not have to provide you with disability benefits and you may not be able to file a legal claim to get the money you are owed.
“That’s why it’s so important for employees to contact a lawyer as soon as their LTD claim is turned down, and even if they are told that their benefits will stop on a specific date in the future. Even if you already appealed, my firm can help you determine, for free, if you can still take legal action – as long as it’s been less than two years since the denial.”
Speak to an employment lawyer if you lose your job after being denied LTD
After learning that the insurance company has denied your claim for disability benefits, your employer may decide to end your employment.
Samfiru says that companies often make this choice either because they think the employee is being dishonest about their medical condition, or they simply want to avoid the responsibility of accommodating someone’s injury or illness.
“Your employer can’t ignore your doctor’s assessment that you are unable to work, regardless of the insurance company’s decision,” says Samfiru.
“I will never forget a call I received from a 52-year-old employee who received a termination letter from his boss after his long-term disability benefits were denied following an accident,” Samfiru says. “He was completely shocked after his insurance provider turned its back on him and his employer told him that they were letting him go because he couldn’t work due to his medical condition.”
It is illegal for employers in Canada to fire someone for discriminatory reasons, including physical or psychological medical issues. Companies are also have a legal duty to accommodate non-unionized staff who experience difficulty fulfilling their role. A business might have to change an employee’s duties, provide someone to help them complete tasks or modify their shifts - even if it makes things difficult for the employer.
If you are fired or let go for any reason, or believe that your company didn’t provide proper accommodation, Samfiru recommends that you contact an experienced employment lawyer immediately before accepting a severance offer.
“Once you sign back a termination package, you throw away your right to get the pay that you are legally entitled to,” notes Samfiru. “Employers often add a deadline as a pressure tactic. They want you to accept a severance payment that may be tens of thousands of dollars less than what you should receive.
For nearly two decades, Samfiru Tumarkin LLP has been helping non-unionized employees in Ontario, Alberta and B.C. that are dismissed without the proper amount of pay - also known as a wrongful dismissal.
“We can secure your full severance package - which can be as much as 24 months' pay,” adds Samfiru. “Our team can also pursue human rights damages and take on the insurance company on your behalf to get the compensation that you are legally owed.”
Contact employment lawyer Lior Samfiru, co-founding partner at Samfiru Tumarkin LLP, to get the advice and compensation you need by calling 1-888-861-4555, emailing Ask@EmploymentLawyer.ca or filling out an online contact form.
His law firm specializes in employment law in Ontario, Alberta and B.C., and long-term disability claims across Canada.