What Are Long-Term Disability Benefits?
Long-term disability (LTD) benefits are sometimes provided by an employer or a private insurance broker. They are intended to protect employees in circumstances where they cannot work for an extended period of time due to sickness or injury. LTD benefits generally provide between 60 and 70 percent of an insurance policyholder’s employment income. Whether or not you are entitled to LTD benefits depends on the policy, and the definitions of disability therein.
Long-term disability is not synonymous with permanent disability. Most policies have a prescribed definition of total disability. Some policies require that the insured cannot continue working in their current occupation, while other policies require that the insured cannot continue working in any occupation.
The terms of LTD policies can be confusing. Many insurance companies also appear to work on a “deny now investigate later” system by denying LTD claims without adequate support.
Mental Health Injuries
LTD benefits are not only provided to policyholders who have sustained physical injuries. People suffering from mental injuries might also be eligible to receive LTD benefits. Examples of mental health disorders that might qualify someone to collect LTD benefits include:
- Post-traumatic stress disorder (PTSD)
- Agoraphobia
- Adjustment disorder
- Major depression
- Panic disorders
- And more
Most of these injuries take time to treat and can be more disabling than physical injuries. Insurance companies may prolong the process, causing further financial and emotional damage to the insured. They may then unfairly deny the claim.
Unfortunately, many people who are entitled to LTD benefits fail to make a legal claim and never receive the benefits they are owed, forcing them to rely on low social assistance rates.
If you are dealing with a mental injury, depending on the terms of your insurance policy, you may be entitled to LTD benefits.
Duty of Good Faith
The common law has long established the “insurer’s duty of utmost good faith.” Insurance companies have the duty to deal with claims in a timely manner and to deal with them fairly (Source: 702535 Ontario Inc. v. Non-Marine Underwriters Members of Lloyd’s London, 2002).
The duty of the insurer to act in utmost good faith is distinct from the insurer’s obligation to pay an insured’s benefits. (Source: Whiten v. Pilot Insurance Company, 1999).
In the case of Tanious v. The Empire Life Insurance Company, 2016 BCSC 110, the court reiterates that: (1) a person claiming benefits under a policy of disability insurance has the onus of proving his or her entitlement on a balance of probabilities, and (2) being able to perform one or more important aspects of the occupation separately will not necessarily disqualify the insured from coverage; they do not need to be totally helpless. Someone can also be capable of some work and still be entitled to LTD benefits.
In Gascoigne v. Desjardins Financial Security Life Assurance Company (Desjardins Insurance), 2019 BCSC 1241, the plaintiff alleged that she was totally disabled within the meaning of the policy and therefore entitled to LTD benefits. The court found that once a plaintiff establishes that they are disabled the onus then shifts to the defendant to prove that the plaintiff is or may be suited for some occupation. The court further determined that the defendant failed to establish that the plaintiff can engage in other occupations, and that they did not act in good faith in denying the plaintiff’s claim.
Contact Preszler Injury Lawyers Today
Even if you qualify for LTD benefits, your insurance provider might make it difficult to access the payments you are rightfully owed. Our British Columbia long-term disability lawyers have experience helping unfairly denied policyholders recover the benefits they deserve.
If you have questions about your LTD claim, contact our long-term disability lawyers serving all of British Columbia for a free initial consultation.
