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Short and Long Term Disability Insurance Litigation in Quinte 

Disability Insurance is the safety net that provides you with the ability to earn an income when an unexpected illness or accident makes you unable to work. When an illness leaves you bed-ridden or an accident prevents you from functioning normally at your workplace, it is imperative that you are still able to earn an income, as the consequences of losing that income are detrimental to every citizen of Ontario. In some cases, this disability insurance, meant to protect you and your family from this unfortunate financial situation, is denied, delayed or lowered dramatically. In cases such as these, you and your family are left without pay as you recover from the unexpected incident and yet have to ensure that your bills are being paid. This can be complicated and extremely stressful, which is why there are disability lawyers that will fight for your rights for you - ensuring that you recover financially, just as much as physically. 

Our disability insurance lawyers at  Pretsell Davies and Thompson Benton LLP in Belleville, Ontario are highly experienced with all types of disability insurance denials, delays and undervalued claims. Your financial health is our main focus, as you ensure that your mental and physical health are being properly recovered.

Let our disability lawyers in Belleville fight for you and get you the compensation you deserve!

 

Defining Disability

There is not one single definition of the term “disability” as it relates to the benefits provided within a claim and how an individual can ensure that he/she qualifies, as this is dependent on the situation at hand, the insurance provider of the individual and the insurance plan in question. 

In all cases, this claimed disability must prevent the employee from functioning normally at work. In order to properly define your disability, however, it is important that you specify whether the disability prevents you from working in “any occupation” or within your “regular occupation”. These defining parts of your disability claim will provide information on the extent of your illness/injury as well as the appropriate compensation to negotiate for. 

Disability From Any Occupation 

Disability from any occupation means that the employee is unable to work within any reasonable occupation, due to illness or injury. In this situation, the individual becomes incapable of performing the tasks required of any suitable job that the individual is qualified to work within. This is based on his/her education, experience, abilities, and training. 

Disability From Regular Occupation 

Disability from regular occupation means that the employee is unable to work within their own occupation, or their regular occupation, due to illness or injury. In this type of situation, the individual becomes incapable of completing the duties and responsibilities assigned to them normally within their regular job. 

 

Short Term vs. Long Term Disability Insurance Benefits

Disability insurance benefits can be considered as a form of salary continuation. They provide the employee regular pay reimbursement, whether that be their full amount of pay or a partial percentage, regardless of the individual not being able to perform his/her job. 

Short Term Disability Benefits

Short term disability insurance provides up to 6 months of financial coverage as the injured/ill individual recovers - the amount and duration of compensation is dependent on the case.

Long Term Disability Benefits

Long term disability insurance benefits usually last up to two years and replace 60-70% of the individual’s regular income rate. This amount and duration of compensation is also largely dependent on the specific case.

Continued Benefits

If the individual’s long term disability plan ends after two years, yet they are still unable to perform the requirements of their original job, there may be an option to continue receiving salary; however, this would depend on the company, the company’s benefits plan, the insurance provider, the extent of the injury/illness etc. 

Understanding your rights as an injured or ill employee can be a complicated process, however our knowledgeable lawyers at Pretsell Davies and Thompson Benton LLP are here to make that process simple for you.

 

Disability Insurance Rights

Many individuals have private insurance policies that provide income protection in the unfortunate event of them becoming disabled. These types of insurance plans are generally obtained through group benefits provided by the individual’s employer. In many cases, however, the individuals who filed a disability claim are often denied by their insurance company the ability to receive this compensation, based on the claim being labelled as invalid.

 The insurance company is able to delay, deny, or possibly undervalue the claim put forth by an injured or ill employee. This can be based on their reasoning of an invalid disability claim, but it can also be based on less subjective errors;

Simple Reasons to Deny Disability Claims:

  • Failure to Sign Claim 
  • Missing Documentation 
  • Incomplete Documentation 

Pretsell Davies and Thompson Benton LLP lawyers in Belleville, Ontario have ample experience with all types of denied disability claims and are prepared to handle these cases for you with the expertise required to get the results you deserve.

When you hire one of our qualified disability lawyers, you are hiring them to:

  • Handle your case with expertise 
  • Review your policies in detail
  • Prepare your paperwork and documentation 
  • Represent you in court/meetings/hearings
  • Communicate on your behalf
  • Protect your rights 
  • Negotiate on your behalf 

 

Types of Disability Litigation Appeals

When an employee’s disability claim is denied, delayed or undervalued, this is when the employee has the opportunity, and legal right, to appeal their denied claim with their insurance company. This can be accomplished either internally or externally, and is dependent on the complexity of the claim. 

It is important to note that both internal and external appeals take time - an internal appeal could take a series of months while an external appeal could take increasingly longer! Our disability lawyers at Pretsell Davies and Thompson Benton LLP understand that disability claims are a time sensitive issue and will take the necessary course of action in terms of processing the appeal towards your best interest.

Internal Disability Denial Appeals:

When appealing a denied claim internally, the injured/ill employee is returning to their insurance provider with the request to re-evaluate the denial. In this scenario, there is no external third party involved in the re-evaluation. If the denial was made because of a small error (ie. failure to complete paperwork properly), an internal appeal could be the best possible route in terms of gaining appropriate compensation.

External Disability Denial Appeals:

When appealing a denied claim externally, the injured/ill employee is not only having the insurance company review their denial, but is also involving an external third party in the scenario. In these types of complex cases, it is best to involve an unattached third party member. 

 

Let Our Disability Lawyers  Fight For You 

Are you in need of a disability lawyer within Quinte? At Pretsell Davies and Thompson Benton LLP in Belleville and Picton Ontario, our disability lawyers have the necessary expertise in bringing action against these insurers in order to assist the disabled individual in obtaining your entitled benefits. It is important to note that there is generally a limitation period of two years in which a disability claim must be advanced within, after which the disability benefits may discontinue. If your disability appeal is in need of immediate attention, please give us a call today and we will give you a free consultation! Our team of disability lawyers typically take these matters on a contingency fee.

As a full service law firm, providing the best legal expertise and representation in the Quinte, Prince Edward County, and surrounding regions, we strive to meet and exceed the expectations of each of our clients.