Litigating Long-Term Disability Claims
According to a recent Canadian Survey on Disability, “one in seven people aged 15 years and older reported having a disability. This represents 3.8 million Canadians whose everyday activities are limited as a result of a long-term health condition or health-related problem.”
Disabilities, which are most commonly associated with illnesses (such as cancer or multiple sclerosis) or injuries that result in persistent pain and/or reduced mobility, could result in a person losing their ability to work, their security, and their independence.
Between employee group benefits and private insurance plans, a significant number of working Albertans have short- and long-term disability insurance coverage; in the event that an employee experiences an injury that prevents them from working, these benefits provide a level of stability and financial security. Unfortunately, insurance companies do not make money by paying out claims, and may seek to reduce payments, refuse further benefits, or even deny claims outright.
Many Albertans are fortunate enough to have short-term and long-term disability (LTD) coverage through their employee benefits package. Some Albertans have LTD coverage through private insurance plans. Regardless of whether the coverage comes from an employer plan or a private plan, LTD benefits are intended to provide financial security if you experience an injury that prevents you from working.
Insurance companies, however, do not make money paying out full compensation amounts for every LTD claim—it’s their business to reduce claim payments, refuse further benefits, or to even outright deny claims. If you are in the Calgary area, your best option to receive the maximum claim for which you are entitled is legal representation. You need the negotiating experience and representation of an established personal injury lawyer, like the team at Pipella Law.
Qualifying for Long-Term Disability Claims in Alberta
In Alberta, LTD eligibility criteria are unique to each insurance policy. While the specific eligibility criteria may vary, in most cases LTD cases are divided into, and evaluated based on, two time-based categories:
- Initial 2-year period: during this period, you are unable to perform your agreed responsibilities at your regular job.
- Post 2-year period: during this period, you are unable to perform ANY job responsibilities at your regular job, and can continue to receive benefits until age 65.
It is not uncommon for an insurance company to cut off benefits in spite of data from medical staff showing that you have not recovered; this is where individuals making LTD claims need the support and representation of a long-term injury lawyer who can defend their claim and get you the compensation you deserve.
Litigation Can Work
In 2016, Alberta Court of Queen’s Bench ruled in favour of Calgary teacher Jenna Tyson after she sought long-term disability following a brain tumour diagnosis. Jenna began suffering headaches, nausea, and dizziness in early July, 2012, but was not diagnosed with a brain tumour until September 13, 2012—three days into her teaching contract with the Calgary Board of Education.
Although Jenna sought treatment for her tumour and filed a total disability claim that sought coverage indefinitely from the date of her surgery onwards, her claim (and all subsequent appeals) was denied. The Alberta School Employee Benefit Plan contended that Jenna Tyson’s brain tumour was a pre-existing condition. With legal support, Jenna was able to argue that ambiguous language in the Alberta School Employee Benefit Plan’s exclusion clause did not apply to her case, and the presiding Justice agreed. The court awarded Jenna the full entitlement of her claim plus her legal costs.
Jenna Tyson is not alone in successfully obtaining long-term disability coverage through legal action:
- An Ontario woman whose insurance company claimed she was fit to work because she was able to provide care for her severely developmentally-delayed son had her long-term disability reinstated after she filed a claim.
- A Federal Court ruled in favour of 6,800 Canadian Armed Forces veterans that were “shortchanged” on their long-term disability payments.
- 1,056 RCMP veterans were awarded a multimillion-dollar class-action settlement after their long-term disability payments were clawed back.
A quick scan of any search engine will show multiple cases where Canadians from every walk of life were able to successfully obtain LTD coverage through litigation.
Consider the case of the Calgary schoolteacher that fought in court for long-term disability after she recovered from brain tumour surgery—her insurance company said the brain tumour was a “pre-existing condition”. She won.
Consider the Ontario woman whose insurance company claimed she was fit to work because she was able to provide care for her severely developmentally-delayed son. She fought for her long-term disability in court and won.
Consider the thousands of Canadian Armed Forces and RCMP veterans—people that were left with debilitating injuries in service of their fellow Canadians—that waged class-action cases in court after the their long-term disability payments were clawed back. They won.
They all won, and you can too.
Do Not Get Pushed Over By Insurance Companies
Cases of long-term disability are complex and require strong negotiating skills from those who are dedicated to personal injury law. At Pipella Law, our long-term disability lawyers bring decades of experience and success in representing a wide array of long-term injuries. If you are dealing with a long-term injury, contact our personal injury lawyers in Calgary for a free consultation and take action toward preserving your insurance coverage.
Protect Your Long-Term Disability
If you, or someone you love, have suffered due to the actions or negligence of another, the team at Pipella Law is here to help. We will represent your interests long-term, regardless of the challenges tomorrow may bring. If you have questions or concerns about legal representation, please give us a call to book a free consultation with our personal injury team. We are dedicated to advocating on your behalf and operate on a contingency fee basis—you will not pay until we deliver the settlement you deserve.