If your disability claim has been denied, there are several steps you should take:

Return to your specialist and request more detailed information that specifically addresses the issue of why you cannot work so that you may then submit this information to the insurance company as part of your appeal. It is appropriate and acceptable to pay physicians in Ontario to write a detailed report for you, and could be the motivating factor if your doctor is managing a heavy patient load.

Make a claim to Canada Pension Plan disability benefits. They may be available to you if you have made enough contributions to CPP. The CPP definition states that a disability has to be both "severe" and "prolonged," and must prevent you from being able to work at any job on a regular basis. Applying for CPP disability benefits may also strengthen your case against the insurance company. You can obtain the application online at http://www.sdc.gc.ca.

Apply for Ontario Disability Support Program income support. The program provides financial asssistance to eligible people with disabilities. To meet the requirements, you must qualify financially and have a "substantial physical or mental impairment that is continuous or recurrent and is expected to last one year or more." More information is available on the wbesite of the Ontario Ministry of Community and Social Services at http://www.mcss.gov.on.ca.

Hire a Lawyer. Upon notification that their insurance company has denied their disability claim, many claiimants fail to take action. They may believe that their options have been exhausted; others may be tired and simply ready to concede to defeat. It is important to know your rights, what options are open to you, and waht resources are available. You should be aware of and understand your policy's many provisions, such as waiting periods, pre-existing conditions, financial entitlement, time and other limitations, and the maximum policy benefit. Your policy's provisions will be lengthy and deliberately complex. The best way to ensure that you understand your rights and obligations is to seek the help of a lawyer experienced in the area of disability insurance. A lawyer can level the playing field nad successfully navigate the complex policy roadblocks the insurance companies intentionally put in your way. Without a lawyer, claimants are at the mercy of their own limited knowledge.

Insurance companies operate under a business model that involves underwriting risk (placing a dollar value on your risk of becoming disabled and filing a claim), taking in premium dollars from its policyholders (you or your employer), investing those dollars, and, when necessary, paying out on claims made on its policies. For the insurance company to prosper, or even stay in business, it must maximize premium dollars and return on investments while minimizing the cost of claims.

Insurance companies operate in highly competitive markets, and it is not uncommon for insurance companies to pull out of an unsustainable or unprofitable market. In essence, insurance companies cannot make a loss for any considerable length of time. Thus, insurance companies vigorously manage their claims process and pay out on as few claims as possible. Insurance fraud is a relatively common crime and, understandably, insurance companies wish to protect themselves as much as possible against it.

To control claims and combat fraud, insurance companies operate defensively, with a strategy far from the best interests of you, the claimant. Policies are written with clauses, sub clauses, limitations, and exceptions. When the terms of a policy are ambiguous, they will inevitably err on the side of the insurance company. Claims adjusters are responsible for verifying the validity and acceptability of claims. These professionals are trained to control claims. A claims adjuster who is paying out on too many claims is simply not performing and could jeopardize his or her job. Many insurance companies do not have training manuals for their claims adjusters, preferring instead that they learn on the job. It has been suggested that this is because it would be risky to put down on paper what is supposedly the shady side of their business, namely, that adjusters are encouraged to deny claims.

To combat fraud, insurance companies routinely hire investigators to monitor disability claimants, which can include physically following them during their daily activities. The result of this surveillance can be used to make cursory decisions on whether the claimant could perform their job if they were back at work. They also hire their own independent medical examiners (IMEs) to improve their chances of obtaining a medical evaluation in their favor, one that ultimately means your claim may be denied.

The result of this vigorous defense of claims is that processing of disability claims can be unduly lengthy, complicated, and overly burdensome on individuals who may be already overwhelmed by daily activities in the face of an injury or major illness. Efforts to control claims and combat fraud have created overwhelming amounts of paperwork, requests for information, delays, and unfair denials.

The defensive tactics of the insurance company have created an uneven playing field, in which the average claimant, inexperienced in the process of filing a disability claim, is pitted against a powerhouse opponent. These tactics have the potential to create an adversarial relationship and can lead to frustration and aggravation, exacerbating an already difficult time for an injured or ill worker.

The term "life-changing diagnosis" can sound like the understatement of the century if your partner has abandoned you due to your illness.

A 2009 study published in the journal, Cancer, entitled Gender Disparity in the Rate of Partner Abandonment in Patients with Serious Medical Illness, found that a married woman diagnosed with a serious disease is six times more likely to be divorced or separated than a man with a similar diagnosis. Among study participants, the divorce rate was 21 percent for seriously ill women and 3 percent for seriously ill men.

Those statistics are saddening, and it is difficult to cope with marital problems when you are already dealing with physical and emotional pain from your symptoms and treatments, financial troubles from being unable to work or being denied your insurance claim, day-to-day logistics of getting to and from doctor's appointments, and all the other challenges that come with illness.

If your partner is neglecting you or has abandoned you in your hour of need, you need to look for help elsewhere. Focus on creating a new support network of family, friends, spiritual counselors, therapists and doctors who you feel comfortable turning to. Consider joining an organized support group and meet new friends who are going through the same experience that you are.

Request a personal support worker to help with chores that your partner used to take care of, such as housework, cooking, administering your medication, bathing and anything else you may need. Your insurance may cover the cost of a personal care attendant, and there are government-supported programs that provide attendants at no cost.

If your partner's absence has left you with a huge financial burden, apply for disability benefits if you have group or private insurance, or make a claim for benefits if you have critical illness insurance. If your claim is denied, contact us at 1-888-777-1109 as we may be able to recover benefits for you.

If you do not have insurance coverage, look into government programs such as Employment Insurance Sickness Benefits, the Ontario Disability Benefit Support program (ODSP), or the Canada Pension Plan (CPP) Disability program.

While this may be the most difficult experience of your life, remember that help is out there if you look for it. As Marilyn vos Savant said, "Being defeated is only a temporary condition; giving up is what makes it permanent." Choose not to give up today.

Scientists at Northwestern University have developed the first ever blood test that can diagnose depression and anxiety, based on a study that focused on depressed and non-depressed teens and the 11 genetic markers that differentiated the two groups from each other.

The study concentrated on teens because they are at larger risk of being misdiagnosed due to the regular mood changes that occur at their age; however, the blood test is inarguably a significant breakthrough for people of all ages who are struggling with this prevalent mood disorder.

Currently, depression and anxiety can only be diagnosed using subjective testing, which relies largely on the patient's ability to describe his or her symptoms to their doctor.

Lead investigator Eva Redei, a professor of psychiatry and behavioural sciences at Northwestern University Feinberg School of Medicine in the United States, said: "Without an objective diagnosis, it's very difficult to make that assessment. The early diagnosis and specific classification of early major depression could lead to a larger repertoire of more effective treatments and enhanced individualized care."

Using a blood test to diagnose depression could have a major impact on the current social stigmas surrounding the disease and will also provide highly valuable objective medical evidence to support disability insurance claims that are often challenged or flat-out denied by insurance companies.

Tamara Fric, a B.C. woman injured in a motor vehicle accident in 2008, must hand over her private Facebook photos to be reviewed against her claim for damages.  Keith Fraser of The Province reports:

Fric, who has 890 Facebook friends with access to the private content on her site as well as 759 digital photos and a video, is in possession of a total of 12,000 photos, though it wasn't clear whether all of the photos were stored electronically, the court heard.

The defendants claimed that Fric's Facebook profile and various photos are relevant to her claim for both ongoing physical impairment and also a plea of loss of amenities of life.

She argued, however, that the defence request for disclosure was overly broad and not substantiated by the evidence and that her right to privacy and those of others would be breached by the disclosure.

But in a ruling released Monday, B.C. Supreme Court Master Carolyn Bouck concluded that some of the photos, including those on her private Facebook profile, should be disclosed.

"Photographs which show the plaintiff engaging in a sporting or physical recreational activity - from hiking to scuba diving to curling to dancing - are relevant in discovering the plaintiff's physical capacity since the accident," she said."I do not agree with the plaintiff's submission that such information is only relevant when there is a claim or evidence of total disability."

Using social media to mine for evidence against plaintiffs in disability, personal injury or MVA cases has become a common legal practice not only in British Columbia, but all of Canada.

It should make any individual involved in such litigation think before posing for photos that will inevitably find their way on the Internet. Even innocent status updates can have a significant influence on the outcome of your claim.

If you do not have a Facebook account, be mindful of the fact that your family and friends probably do and may post photos of you without your permission.

The best way to avoid a ruling similar to Fric's is to consider how every one of your words and actions could be construed in the context of your claim.

What is an independent medical examination?

An independent medical examination or "IME" is an assessment carried out by a medical specialist who has never previously had the individual in their professional care.

Technically, an IME is supposed to provide an unbiased and professional medical exam as evidence in legal matters such as disability, personal injury and motor vehicle accidents. The medical professional carrying out the examinations cannot be under the employ of the party requesting the IME; i.e., the insurance company or the plaintiff's legal representative.

The technical definition is arguably a misnomer, because a party will request an IME in order to get a medical report that supports their position, whether they're on the side of the plaintiff or the defense, and will choose a doctor who they believe will be partial to their position. Insurance companies typically use the same doctors over and over again to have some control over the outcome of the report. An IME requested by the defense would be called a Defense Medical.

Which types of medical professionals are qualified to be independent medical examiners?

That will depend on the statute of law your case falls under. They may include but not be limited to family physicians, specialists, chiropractors, physiotherapists, psychiatrists and psychologists.

Is it mandatory to have an IME if my insurance company has made a request?

You always have a choice to decline an IME, but it is important to weigh out the possible consequences.  

How much do you have to lose? If your claim has already been denied and you are not receiving any benefits from the insurance company, declining an IME will not affect your situation. However, if your claim is still pending or you are already receiving benefits, refusing to undergo an IME may result in being denied or cut off from benefits.  The decision to refuse an IME should be made in concert with your lawyer, who will determine whether the insurance company's request for an IME is lawful.

Can I record the IME session?

You may record the session with the doctor's consent in order to have an accurate record of the doctor's questions and your answers. A recording may also determine whether the doctor's examination techniques are competent and whether their report corresponds with the insurance company's decision about your claim.

If the independent medical examiner concurs that the plaintiff's medical condition is not disabling or not related to the accident in question, the insurance company may deny the claim for benefits.

Can I request a copy of the IME?

If your claim has been denied based on an independent medical exam requested by the insurance company, you will want to know why. You do have the right to request a copy of the IME report. If you are unsure whether the report written by the independent medical examiner was legitimate, call our office at 1-888-777-1109 for answers.

Critical illness insurance can be purchased through an insurance agent as a private policy or provided to you as part of your group benefits by your employer. It is meant to provide you and your family with a lump sum payment of benefits if you find yourself diagnosed with a critical illness, even if you make a full recovery.

The main difference between critical illness insurance and disability insurance is that benefits do not depend on your inability to work; but rather, on your being diagnosed with one of the listed illnesses, some of which are noted below:

Cancer, stroke, heart attack, heart surgery, kidney failure, organ transplantation, brain tumor, paralysis, coma, permanent disability, Alzheimer's, Parkinson's Diseases, and Multiple Sclerosis may qualify you. You should review the specific provisions carefully to see if you qualify.

Insurance companies often deny critical illness claims based on two factors: 1) allegations of misrepresentation at the time the policy was purchased; and 2) the illness diagnosed is not a listed illness or does not meet the specific criteria outlined in the policy.

If you are struggling with a critical illness and have received a denial on your claim for benefits, you shouldn't have to fight alone. Call now to book a free consultation with one of our experienced lawyers--1-888-777-1109. We'll fight for your benefits on your behalf so you can focus on getting better.

The province recently placed a ban on the powerful and addictive painkiller, OxyContin, and made a changeover to a drug manufactured by the same company called OxyNeo. This tablet is allegedly harder to abuse since it is difficult to crush and subsequently chew, snort or inject.

While OxyContin has been banned in order to reduce abuse, public health officials are expressing concern for those with addictions who are currently experiencing withdrawals now that supply of the drug is dwindling and is soon-to-be nonexistent. Rehabilitation programs are already at capacity in Toronto. What's worse, some people are not seeking help for their addiction and instead are turning to illicit drugs such as heroin to fill the void that OxyContin has left behind.

For those who are ready to get help for their addiction and are seeking treatment, it may be a huge relief to know that your group or private insurance policy might cover addiction as an illness. This means you may be eligible for benefits when you are in rehabilitation and unable to work. Check out the wording in your policy or benefits booklet to be sure. If the high cost of rehab is the difference between you getting help or struggling with your addiction alone, it doesn't hurt to look over your policy. 

Short-term benefits will cover most treatment periods; however, if you find yourself relapsing over a long period of time and your doctors believe your addiction is leaving you unable to work, you should then apply for long-term disability benefits. If your insurance company denies you even though your policy states that it covers addictions, give our office a call to discuss the reason for their denial. We may be able to fight for the benefits you need.

Did you suffer injuries in a motor vehicle accident where the other driver was at-fault? You may be wondering if and when you need a lawyer.

If your injuries are not getting better within 10-12 months after the accident, we can assess whether your injuries are serious enough to sue for economic losses, healthcare expenses and pain and suffering. To be able to sue for pain and suffering, the injury must result in death, permanent serious disfigurement, or permanent serious impairment of an important physical, mental or psychological function. This is sometimes referred to as the "verbal threshold". 

Another scenario that may require you to hire a lawyer is if your insurance company stops paying your accident benefits and you are still not able to return to work or perform your regular day-to-day activities. In this case, we may be able to help you pursue further benefits through dispute resolution or legal action.

We may also be able to help if you are entitled to receive disability benefits from an individual or group long-term disability policy and you are denied benefits or cut off.

For more information on your legal rights following a motor vehicle accident, contact the Financial Services Commission (Ontario) at 416-250-7250, or visit their website at www.fsco.gov.on.ca.

It is very important to remember that any court action must be started within 2 years from the date of the accident. Call us at 1-888-777-1109 or email us at legal@sharelawyers.com if you have any questions or concerns about your situation.

You have a medical condition that is legitimately disabling. You're preparing a claim to submit to your insurance company. A lot is riding on this: your health, your finances, your future. You've heard that insurance companies have high denial rates and you worry that they will deny you like they have so many others.  

It's at this point that you might be tempted to exaggerate your symptoms. However, it is important to remember that if the insurance company finds out, your claim will be immediately dismissed with little chance of appeal. 

Your claims adjuster has years of experience handling disability claims, and he or she is eager to weed out what they consider to be "invalid" claims. Don't attempt to outsmart the powerful insurance company; they've heard it all.  Instead, arm yourself with legitimate proof to support your claim, and don't allow feelings of fear and intimidation to get the best of you.

The truth is that if you have strong support from your medical doctors validating that your disability prevents you from working and you have followed the claims submission process as outlined in your insurance policy, you have a valid case. All you can do is present the facts and hope that your insurer lives up to their end of the bargain.

If you do receive a denial, that's when you need to hire a lawyer experienced in the area of disability law to fight for your benefits on your behalf.  Be proud of yourself for being honest and following the rules, and remember that with our help, you will get what is rightfully yours.