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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.

 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 Kirk Sloane B.A.(Hon), LL.B.

Many disability claimants have heard or read about the following scenario: your disability insurer calls you on the phone, sends a representative to your home, or sends a letter proposing a lump sum payment to "buyout" either the future of your disability claim, a disputed portion of unpaid past benefits, or both. In many instances a buyout can be a desirable outcome, but a disability claimant needs to understand the ramifications of such a payment, have confidence that the proposed deal makes sense, and that the proposal is the best available option. Using experienced legal counsel can be an invaluable tool in assessing whether a buyout is the right thing to do and to ensure that the best deal possible is obtained.

One of the first considerations for an individual already receiving benefits is to determine the likelihood of the claim being terminated if the buyout proposal is rejected. Some insurers use the fear of a claim termination as a tactic to convince the claimant to accept a reduced amount. If the claim may truly be on the verge of a termination, however, there needs to be an assessment of the potential costs of a lawsuit and the likelihood of winning or losing the lawsuit. Those factors are essential in arriving at a sensible buyout figure.

Another important piece of the puzzle is to have a realistic assessment of the nature, extent and potential duration of a claimant's disability in order to make appropriate adjustments to the total future expected disability payments. In addition, a disability claimant needs a thorough understanding of the concept of the "present value" of future benefits in order to calculate the true value of the investment power of a proposed lump sum payment of future benefits.

When it comes to a buyout during litigation, the cost and risk factors for further litigation and the potential outcomes are much more prominent factors than in the claim context. In summary, buyout strategies can be complex and it is critical that a disability claimant utilize a lawyer with expertise in dealing with disability claims in order to ensure a satisfactory outcome.