Legal Team Fights the Insurance Company!

Legal Team Fights the Insurance Company!

At age forty-eight, Karen Long had built up a career in financial administration that led to a new job as Chief Financial Officer with an Ontario manufacturer. At the time of her hire, Karen was promised a comprehensive benefits package, including medical, dental, and long-term disability insurance. She didn’t expect to hear “denied disability benefits” from her insurance company.

Denied Disability Benefits - Legal Team Fights Insurance Company | Share Lawyers
FULLY COVERED AFTER THE FIRST THREE MONTHS

As with many group benefit plans, Karen understood that the insurance coverage would not come into effect until after she held her new position for three months. After three months, she would be fully covered with the full benefits package. Her employment contract said so.

COVERAGE CONFIRMED

After the three-month point in her new position, Karen made medical and dental claims on the group benefits plan, which were paid. This seemed to confirm that all of the benefits promised to her were in place, and it reinforced her job satisfaction. Even so, she kept copies of the insurance application forms that she had submitted, as well as her employment agreement, which listed all of her benefits.

KEPT THE PAPERWORK

Keeping all of the paperwork not only reflected Karen’s professional habits as a financial officer but also proved to be invaluable later on.

SUDDEN NEED FOR CARE

One weekend in the springtime, when she had been working for the company for over a year, Karen made some purchases at a local garden centre. Once she got the gardening supplies out of her car, she felt sharp shooting pains in her back and found herself hobbling, rather than walking upright. Only her husband and son would do gardening work, that weekend. As she sought comfort, she felt confident that her company benefits plan would support her.

FINDING PEACE OF MIND

That Monday morning, Karen called in sick, then began the day getting her situation diagnosed. She had a spinal subluxation. According to her doctor, the subluxation was probably not caused by the single incident of unloading garden supplies from her car, but had been developing over time – possibly over years. Correcting the problem could also affect her for years. Karen took comfort in knowing that the long-term disability benefits of her group benefits plan would cover her wages.

DISABILITY BENEFITS DENIED – “YOU’RE NOT COVERED”

When Karen informed her employer that she would need more than one day off work, she mentioned that she was happy to have the insurance and needed to apply for benefits. The employer provided the forms and Karen attempted to make the claim. The insurance company responded by saying that they never received an enrolment form for long-term disability insurance for Karen, and so she was not entitled.

“I FILLED OUT THE FORMS”

Despite dealing with acute pain, many inconveniences, and interruptions to her personal and professional responsibilities, Karen provided proof that she had applied for long-term disability coverage. “Look,” she said, “here are the forms I filled out, date-stamped.” The insurance company replied, “Sorry. You’re not covered.”

EMPLOYER’S OMISSION

Karen was referred to Share Lawyers by a friend who had been fighting for her disability benefits. Share Lawyers accepted the case and soon learned that the insurance company never received Karen’s enrolment form for long-term disability coverage. Share Lawyers sued the employer for this omission.

EMPLOYER SETTLES

Share Lawyers won the case and Karen received the income replacement payments necessary to carry her financial responsibilities during her recovery.

COVERED AND RECOVERED

Now, Karen is back at work. She thanks her friend very much for the referral to Share Lawyers.

 

Has your long term disability claim been denied? Contact Share Lawyers and put our experience to work for you. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.

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