Protecting the Benefits You Paid For
DISABILITY INSURANCE LITIGATION
Disability insurance is intended to provide financial security when illness or injury prevents you from working. Many people purchase disability insurance and responsibly pay their premiums for many years, often without ever making a claim, and trust that when they need coverage most, their insurance company will be there for them. Unfortunately, obtaining and maintaining disability benefits is rarely so straightforward. As insurers seek to maximize their profits, claims may be denied at the outset, benefits may be terminated after years of payment, or insurers may conclude that a claimant is capable of returning to work despite ongoing medical limitations.
At Rodin Law Firm, we have a decades-long history of helping individuals navigate these disputes and pursue the disability benefits they are entitled to receive. We understand the stress that arises when your health, livelihood, and financial stability are affected at the same time, during your most vulnerable periods.
Disability Claims Involve More Than Medical Evidence Alone
EXPERIENCE MATTERS
Disability insurance disputes can be complex and highly technical. While medical evidence is often central to the claim, many disputes also involve questions regarding policy language and the application of precise definitions, occupational duties, functional limitations, independent medical assessments, and even insurer-conducted surveillance.
Many claimants are surprised to learn that an insurer may accept a disability claim for a period of time and then later terminate benefits based on a reassessment of their condition or ability to work. Others encounter difficulties when transitioning from short-term disability benefits to long-term disability coverage. At Rodin Law Firm, we help clients understand these issues and effectively challenge an insurer’s decision to deny, limit, or terminate disability benefits.
Whether the claim involves physical injuries, chronic pain, mental health conditions, neurological disorders, or other disabling conditions, we work tirelessly to ensure that our clients’ circumstances are fully and fairly represented, and that the benefits to which they are entitled are paid.
Understanding How Disability Claims Are Evaluated
Disability insurance claims are often determined by the specific language contained within each claimant’s policy. Issues such as whether a claimant is unable to perform the duties of their own occupation, whether they are capable of performing the duties of some alternative employment, and whether medical evidence supports ongoing restrictions, and to what degree, can have a significant impact on entitlement to benefits.
Our lawyers have extensive experience dealing with many of the issues that commonly arise in disability disputes, including:
- Outright denial of benefits;
- Termination of previously-approved benefits;
- “Own occupation” vs. “any occupation” disputes;
- Benefits for “invisible illnesses” such as fibromyalgia, chronic pain, and mental health conditions; and
- Insurer investigations and surveillance.
By understanding how insurers assess and evaluate these types of claims, we are able to identify the issues that matter most, and advocate effectively on behalf of our clients. Our approach begins with understanding the medical, vocational, and practical challenges facing each client, and we then develop a strategy tailored to the circumstances of each claim. Throughout the process, we remain focused on one objective: helping our clients obtain the benefits they are entitled to receive, as quickly, efficiently, and cost-effectively as possible.
FREQUENTLY ASKED QUESTIONS
Disability insurance claims can be frustrating and difficult to navigate, and it is natural to have questions about your rights, the claims process, and the obligations owed by your insurer. Here, you will find answers to questions which are most commonly asked by our clients.
Please do not hesitate to contact us at any time. We would be pleased to meet with you at your convenience, and your initial consultation is without any charge or obligation.
What medical conditions qualify for disability benefits?
What is the difference between “own occupation” and “any occupation” disability benefits?
Under most long-term disability policies, benefits will be payable to a claimant only when they are deemed to be “disabled” under the terms of the policy. The majority of long-term disability policies will contain two separate definitions of “disability”, commonly referred to as the “own occupation” and “any occupation” periods.
Typically, during an initial period not usually exceeding two years from the date of disability (though this period may be longer or, more commonly, shorter, depending on the specific terms of the individual policy), a claimant will be deemed disabled and therefore entitled to benefits if they are unable to perform the essential duties of their own occupation. This is referred to as the “own occupation” period.
However, after that initial period of time, most policies will transition to an “any occupation” definition of disability. At this point, a claimant will only be deemed disabled and therefore entitled to benefits if they are unable to perform the essential duties of “any occupation” for which they are reasonably suited by their education, training, and experience. This “any occupation” definition of disability is much wider, and makes it far more difficult for claimants to qualify for benefits.
For example, consider a construction worker who suffers a serious back injury. During the “own occupation” period, they may qualify for disability benefits because their injury prevents them from performing the physically demanding duties of their actual job, such as lifting, climbing, and operating equipment. However, once the policy transitions to the “any occupation” period, the insurer may terminate benefits on the basis that the claimant is capable of performing a less physically demanding job, such as a dispatcher, estimator, scheduler, or an administrative role. At that point, the question is no longer whether the person can perform their actual job, but whether they can perform “any” job for which they are reasonably suited by their education, training, or experience.
This transition from “own occupation” to “any occupation” is one of the most common points at which disability benefits are denied or terminated. Whether an individual continues to qualify for benefits will depend on the specific language of the policy, the nature of their medical condition, and the evidence available regarding their functional limitations and vocational abilities.
Can my benefits be terminated after they have already been approved?
Yes. The approval of a disability claim does not guarantee that benefits will continue indefinitely.
Most disability policies require claimants to periodically provide updated medical information, treatment records, and other evidence relating to their condition. The insurer will review this information and may conclude that the claimant no longer meets the policy’s definition of disability. Benefits may be terminated based on new medical information, changes in a claimant’s functional abilities, surveillance evidence, vocational assessments, or other information obtained during the insurer’s ongoing review of the claim.
However, the fact that benefits have been terminated does not necessarily mean that the decision is correct. Whether an insurer’s decision is justified will depend on the specific language of the policy, the available medical evidence, and the circumstances of the individual claim.
If your benefits have been terminated, it is important to seek legal advice promptly. Disability insurance policies often contain strict contractual limitation periods, and a delay in obtaining legal advice may affect your ability to challenge the insurer’s decision. An early review can help clarify your rights and ensure that important deadlines are not missed.
What should I do if my claim is denied or my benefits are terminated?
How long to I have to file a lawsuit after my claim has been denied or my benefits have been terminated?
The answer will depend on the specific circumstances of your claim and the language of your disability policy.
In Alberta, civil claims – including claims against your disability insurer – are generally subject to a two-year limitation period. However, many disability policies also contain contractual deadlines, notice requirements, appeal processes, or other provisions that may affect the steps that must be taken following a denial or termination of benefits.
Because of the various deadlines and procedural requirements inherent with disability insurance contacts, it is important to seek legal advice as soon as reasonably possible following a denial or termination of benefits. An early review can help identify important timelines, preserve your rights, and ensure that the appropriate steps are taken within the time permitted.
In certain cases, an insurer may invite a claimant to participate in an internal appeal process. While these appeals can be a means to resolving your dispute with the insurer, it is important to note that limitations and other deadlines may continue to run even while the appeal is underway. For this reason, it is important to seek legal advice as soon as is reasonably possible, so that you are fully aware of your rights and of the deadlines which you are facing.