Recently in Insurance denied Category

President, Share Lawyers, Lawyers

If your disability claim has been denied because the insurance company says that they don't cover pre-existing conditions, you may still be able to do something about it.

Most Group Long Term Disability Policies have a pre-existing exclusion that will disqualify entitlement for individuals who submit a disability claim for a condition that arose in the period prior to them being covered under their employer's group benefit plan.     Historically, the pre-existing exclusion period has been for the 1^st year after coverage commences, and it appears that the maximum pre-existing exclusion period should be 2 years, as set out in s.311 of Ontario's Insurance Act.  Our office was recently involved in a case where the pre-existing exclusion was 60 months, or 5 years.     The case was recently settled, and the issue of the pre-existing exclusion was largely ignored on the facts of this particular case. 

So, if your LTD claim has been denied, based on a pre-existing exclusion that exceeds 2 years, you should definitely consult with a disability insurance lawyer, to examine whether the denial of your claim was lawful.

To find out how, contact Share Lawyers.  We're Focused on Disability Insurance Litigation.

Our lawyers will fight for your disability insurance claim with aggressive legal maneuvering and strategic planning. If you have a long term or partial disability claim, and have been denied benefits, find out what Share Lawyers can do for you.

When you suffer from depression or anxiety, exercise can seem like the last thing you want to do. But once you get motivated, exercise can make a big difference.  Research on anxiety, depression and exercise shows that the psychological and physical benefits of exercise can also help reduce anxiety and improve mood.  Depression is so common most of us have either experienced it or know more than one person who has. Medication and therapy are common treatments, but exercise is another tool that can bring relief. Study after study has shown that exercise can fight mild to moderate depression because it:

·         Increases your sense of mastery, which helps if you don't feel in control of  your life

·         Increases your energy

·         Increases self-esteem and confidence

·         Provides a distraction from your worries

·         Improves your health and body, which can help lift your mood

·         Helps you get rid of built-up stress and frustration

·         Helps you sleep better, which can often be a problem when you're depressed

·         Provides some social interaction

·         Releases feel-good brain chemicals that may ease depression

Most short term and long term disability policies pay a percentage of salary as the benefit. Having the correct salary information can make the difference of thousands of dollars. Typically, the salary information comes from the employer. Salary as defined in most disability policies are base salary and not overtime, bonuses or commissions. The employer reports salary on a periodic basis and premiums are adjusted accordingly.

It is important to ensure that your employer is reporting the correct salary to the insurance company. Premiums that are taken off of your salary do not always reflect your current salary level. At the time of a claim for long term disability benefits, the insurer will be looking at the salary as reported by the employer on the date of disability. If the reported salary and premiums that are taken off are lower then actual salary the insurance company will try to use the lower amount. So before making a claim make sure your current salary is being properly reported to the long term disability insurance company.

By David Share L.L.B.

President, Share Lawyers, Lawyers

Under most group Long Term Disability policies disability payments are made during the initial assessment period if you are unable to perform the essential duties of your "own occupation".    Most often this period is for 24 months (although it differs from one policy to the next).    If you have been receiving LTD benefits and are approaching the end of the Own Occupation period, you may face a termination of your benefits based on the change of definition in what constitutes total disability after the own occupation period expires.

The change of definition is usually referred to as a transition from an "own occupation" definition, to an "any occupation" definition.  Typically this means that in order to qualify for LTD benefits in the any occupation period, you must be totally or substantially disabled from the duties of any occupation for which you have the requisite education, skills or experience.     There are variations on the wording, but this summarizes the typical "Change of Definition".

You may think that it is impossible, or extremely difficult to persuade your insurance company that you qualify for LTD benefits after this change of definition, but you should not give up hope.   With supportive medical evidence, you may have a strong case to fight against the termination of your LTD benefits based on the "Change of Definition".

To find out how, contact Share Lawyers.  We're Focused on Disability Insurance Litigation.

Our lawyers will fight for your disability insurance claim with aggressive legal maneuvering and strategic planning. If you have a long term or partial disability claim, and have been denied benefits, find out what Share Lawyers can do for you.

By David Share L.L.B.

President, Share Lawyers, Lawyers

With some degree of frequency, we see people getting a letter from their disability insurance company saying things like "...as you are no longer disabled, your file has been closed.", or "...as we have denied your claim for disability benefits, your file has now been closed."  Don't make the mistake of simply accepting this statement without seeking advice on whether that can really be true.

The truth about such a statement is that the insurance company would like your file to be closed, and they hope that you simply accept the statement without questioning it.   After all, how can you question or fight a decision made by a large insurance company with unlimited resources?

To find out how, contact Share Lawyers.  We're Focused on Disability Insurance Litigation.

Our lawyers will fight for your disability insurance claim with aggressive legal maneuvering and strategic planning. If you have a long term or partial disability claim, and have been denied benefits, find out what Share Lawyers can do for you.

The recent mistrial in the Mendieta murder trial in Toronto has some lessons for people involved in civil litigation as well.    In the Mendieta case, a mistrial was declared because a Crown lawyer who had handled the previous murder trial, where a verdict could not be reached, was present in the courtroom during the cross-examination of Ms. Mendieta, all the while allegedly making faces that the jury, not to mention the witness, found distracting.

There is no doubt that such conduct cannot be tolerated and the resulting mistrial is at great expense to the taxpayers and also the parties involved in the matter.    It will likely put the outcome of the case very much in doubt, one way or the other.

In Civil lawsuits, such as disability litigation or personal injury matters, a party smirking in the courtroom at the jury or the witnesses could just as easily result in a mistrial.    The lesson of this story goes beyond cases that proceed to trial.   It underscores that parties engaged in any type of litigious matter must show respect for the process and the participants in the matter.   Poor or disrespectful behavior is unlikely to result in a favourable settlement or negotiation at mediation, and poor behavior during examinations for discovery by witnesses or counsel gives the process a bad name.

Respectful disagreement and submissions are an obvious part of passionate advocacy, but the system only works if all parties are given a voice.   As lawyers who represent plaintiffs in their insurance disputes, we take this obligation seriously.    Providing passionate, respectful representation so that our clients are given a voice that follows these principals.

 The next time you see one of those feel-good ads on TV, in a newspaper or on the radio for a insurance company, don't forget that it really is all about the money for insurance companies.   Okay, lawyers work for money too, but we earn it based on the results we get for our clients in pursuing claims against large insurance companies.

A recent case, illustrates just how much money gets thrown around by insurance companies in their efforts to grab further market share.   The Ontario Superior Court released its' decision in Sun Life v. Metropolitan Life, 2010 ONSC 558 (CanLII) on January 22, 2010.   This case is a reminder of the type of stakes involved when one insurer acquires another.   In July, 1998, The Mutual Life Assurance Company of Canada (which changed its' name to Clarica and was then purchased by Sun Life in December 2002), paid $2.2 billion dollars to Metropolitan Life for its' Canadian life insurance related businesses.

The case is about one insurer alleging that they are entitled to further reimbursement or indemnification from liabilities flowing from policies issued by Metropolitan Life prior to its' takeover by Sun Life.    The concern that Sun Life has is that they do not wish to be stuck with the cost of fixing the cost structure of certain policies that Met Life had issued in the past, where their allegations of misrepresentations about the cost of these policies to the end individual policyholders. 

The ins and outs of this particular case will not matter to you if your claim has been denied, be it for long term disability benefits, life insurance or critical illness, but it certainly does reinforce the notion that money really does matter to insurance companies.    Does anything else matter to them?   Absolutely, just nothing matters more than money.

By Shira Bernholtz LL.B.

Many people find it hard to organize the paperwork required as a result of a motor vehicle accident.  There is no simple alternative to having the correct documentation and information available.  Perhaps we can provide some insight and guidance.

The best strategy is to obtain a receipt for any expense even remotely connected to the accident.  It may not be compensable but trying to get proof of spending at a later date is very difficult.   Make sure receipts include a date, reason for the payment, location and of course an amount.  You can write-in any missing details.

At the same time, maintain a log of all related trips whether for medical services or otherwise.  Again, include the date, starting point, end location, reason, mileage each way and expenses incurred. 

Some expenses require a medical assessment, evaluation or report.

Be sure you use the correct form and include a cover letter indentifying submissions made to the insurance company.   Lastly, keep copies of all paperwork.

There is no guarantee that an insurance company will pay all submissions and not all expenses are eligible for repayment.  However, you won't lose money on a technicality or for not having sufficient proof of an expense.