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Key Takeaways
- Our long-term disability lawyers in Ontario provide specialized guidance through every stage of the claims and appeals process, significantly improving your chances of success.
- Matthews Abogado Long-Term Disability operates on a contingency fee basis, meaning you pay nothing unless we successfully secure your benefits or settlement.
- From gathering compelling medical evidence to countering insurance company tactics, our LTD lawyers in Toronto and Hamilton handle all aspects of your claim while you focus on your health and recovery.
Long-Term Disability Claims in Ontario
Facing a long-term disability can turn your life upside down. When health issues prevent you from working, long-term disability (LTD) benefits provide financial support during recovery. Unfortunately, many valid claims are rejected by insurance companies, leaving claimants confused and financially vulnerable.
At Matthews Abogado Long-Term Disability, our experienced long-term disability lawyers have guided countless Ontario residents through the complex claims and appeals process. Insurance companies often employ tactics to minimize or deny legitimate claims, but you don’t have to face them alone.
Whether you’re preparing an initial application, dealing with a denied claim, or considering legal action against your insurer, our team provides the knowledgeable representation you need. With offices in Toronto, Hamilton, and throughout Ontario, our LTD lawyers offer personalized support during this difficult time.
Don’t let insurance companies dictate your financial future. Contact Matthews Abogado Long-Term Disability today to learn how we can help secure the benefits you deserve.
The LTD Claims Process
Step 1: Determine Your Eligibility
Before filing a claim, it’s important to understand the requirements of your policy. Most LTD policies require:
- A qualifying medical condition that prevents you from performing your job
- Employment during the coverage period
- Completion of any waiting period (often 3-6 months)
- Medical evidence documenting your condition and limitations
Our LTD lawyers can review your policy to confirm your eligibility and identify any potential issues before you file a claim.
Step 2: Gather Complete Medical Documentation
Comprehensive medical evidence forms the foundation of a successful claim. You will need detailed medical records from all treating physicians, diagnostic test results, treatment history and plans, specialist reports and assessments, and documentation of limitations and restrictions.
Insurance companies scrutinize medical evidence closely, looking for reasons to deny claims. A lawyer for long-term disability can help ensure your documentation clearly establishes your inability to work.
Step 3: Complete Application Forms
Your LTD application typically includes multiple forms: an employee statement describing your condition and limitations, an employer statement confirming employment details, and a physician statement detailing your diagnosis, treatment, and prognosis.
Forms must be completed accurately and thoroughly. Inconsistencies or missing information can lead to delays or denials. Our long-term disability lawyers in Toronto assist clients in preparing comprehensive applications that meet all requirements.
Step 4: Submit Your Claim and Monitor Progress
After submission, insurance companies may request additional information, arrange independent medical examinations, conduct surveillance, or interview colleagues or family members.
During this evaluation period, having legal representation can protect your interests. Our LTD lawyers maintain communication with insurers, respond to information requests, and ensure your claim receives proper consideration.
Step 5: Respond to the Insurer’s Decision
If your claim is approved, we’ll help you understand your ongoing requirements to maintain benefits. If denied, we immediately begin preparing your appeal strategy.
Denied LTD Claims and the Appeals Process
Receiving a denial letter can be devastating, especially when you’re dealing with a disability that prevents you from working. However, a denial doesn’t mean the end of your claim. Our long-term disability lawyer in Toronto can help you understand why your claim was rejected and develop a strategy to appeal the decision.
Common Reasons for Denial
Insurance companies deny claims for various reasons, some of which are legitimate, while others are questionable. Frequent denial reasons include:
- Insufficient medical evidence documenting your disability
- Missing application deadlines or incomplete paperwork
- Surveillance evidence contradicting your claimed limitations
- Policy exclusions for pre-existing conditions
- Failure to meet the policy’s definition of disability
- Discrepancies between your reported symptoms and medical records
Understanding exactly why your claim was denied is crucial to building an effective appeal. Our LTD lawyers carefully review denial letters and your file to identify the specific issues that require attention.
The Internal Appeal Process
Most insurance companies offer an internal appeal process as the first step after a claim is denied. This process typically requires:
- Filing a written appeal within the specified deadline (usually 30-90 days)
- Submitting additional medical evidence to address the reasons for denial
- Possibly obtaining specialized assessments or expert opinions
- Preparing detailed arguments addressing each reason for denial
While this administrative appeal can be successful, insurance companies often maintain their original decision. Our LTD lawyers have experience preparing comprehensive appeals that effectively challenge insurer decisions.
External Appeals and Litigation
If your internal appeal is unsuccessful, the next step is typically legal action. Filing a lawsuit against your insurance company can be intimidating, but it’s often necessary to receive the benefits you deserve. The litigation process generally follows these stages:
- Your long-term disability lawyer in Toronto drafts and files a Statement of Claim that details how the insurer breached its contractual obligations to provide benefits despite your qualifying condition.
- The insurance company responds with a Statement of Defence, arguing that their decision was reasonable based on available evidence.
- Both parties engage in document exchange, where all relevant claim materials, internal notes, and assessment reports must be shared.
- We may attend mediation to negotiate a settlement. If unsuccessful, your case proceeds to trial, though most cases settle before reaching this stage.
Throughout this process, our long-term disability lawyers in Ontario advocate assertively for your rights while managing all legal complexities.
Contact Us
Don’t struggle with your disability claim alone. Contact Matthews Abogado Long-Term Disability today to speak with a knowledgeable long-term disability lawyer in Toronto who will fight for the benefits you’ve paid for and rightfully deserve.
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FAQs About LTD Claims and Appeals
How Can a Long-Term Disability Lawyer in Ontario Help with My Denied Claim?
A long-term disability lawyer in Ontario provides assistance when your claim has been denied. An LTD lawyer can guide you toward resources that can help with your claim, such as the Ontario Disability Support Program (ODSP) or Canadian Pension Plan Disability (CPPD) Benefits.
If your claim has been denied, we help with gathering additional medical documentation, obtaining specialized assessments from appropriate experts, and building legal arguments that directly counter the insurer’s reasoning. Our long-term disability lawyers also handle all communication with the insurance company, protecting you from potentially damaging interactions.
If your claim requires an internal appeal, we prepare and submit compelling written arguments supported by enhanced evidence. Should litigation become necessary, we manage every aspect of the legal process. Throughout these proceedings, our experienced LTD lawyers in Hamilton and Toronto anticipate and counter insurance company tactics designed to minimize your claim.
Beyond technical expertise, having legal representation for your LTD claim significantly shifts the power dynamic with insurers. Insurance companies know that represented claimants are prepared to challenge denials, often leading to more favourable treatment of your claim. Our involvement demonstrates that you’re serious about pursuing your rightful benefits.
How Much Does It Cost to Hire a Lawyer for Long-Term Disability Claims in Ontario?
At Matthews Abogado Long-Term Disability, we understand that people facing disability-related financial challenges often cannot afford substantial upfront legal fees. We operate on a contingency fee basis for LTD claims, meaning you pay no legal fees unless we successfully recover benefits or a settlement on your behalf.
The contingency arrangement aligns our interests with yours – we only get paid when you receive your benefits. This approach removes financial barriers to quality legal representation, allowing you to focus on your health while we handle the complex legal work of securing your disability benefits.
How Long Does the LTD Claims Process Take with an Experienced Ontario Disability Lawyer?
The timeline for resolving long-term disability claims varies depending on several factors, but having an experienced LTD lawyer in Ontario typically expedites the process. For initial applications, proper preparation with legal guidance can take 1-2 months to gather comprehensive medical evidence and complete documentation accurately. Insurance companies then generally take 30-90 days to make their initial decision.
If your claim is denied and requires an internal appeal, the process usually takes an additional 2-4 months. This includes time for your long-term disability lawyer to obtain additional medical evidence, prepare appeal arguments, and for the insurer to review and decide on the appeal. Throughout this period, our team actively manages the process to prevent unnecessary delays.
For claims that proceed to litigation, the timeline extends, typically taking about 12-24 months. However, many cases settle before reaching trial, often during mediation or pre-trial conferences. While our LTD lawyers focus on resolving your claim as quickly as possible, our primary goal is to secure the maximum benefits you deserve, which sometimes requires additional time to build a strong case.
WHO WE ARE
M. Greg Abogado
Partner
Greg is an experienced trial and appellate counsel. Before joining Linda Matthews to form Matthews Abogado LLP, Greg was a partner at one of the leading boutique civil litigation firms in the province. He brings to the firm more than 25 years experience in civil litigation. He has successfully acted as lead counsel in a number of jury trials and private arbitrations. He also has extensive involvement in alternative dispute resolution particularly private and court annexed mediations.
Education: LLB, 1988, University of Windsor; BA, 1984, York University
Andrew Franklin
I’ve always wanted to serve and help people
Service to others matters to me. I have always been a problem solver. After completing my graduate degree in neuroscience, I worked in research studying the environmental causes of Autism Spectrum Disorders.
I pursued a career in law to help others solve legal problems. My passion for science and medicine led me to work on cases involving people facing medical issues, injuries, and disabilities.
Within 6 years I became a partner at Matthews Abogado LLP in Toronto. My service to others continues and I remain deeply committed to helping people. I strive to demonstrate the highest level of care, compassion in every Long Term Disability (LTD) case I manage.
Tom Yen
It’s about making things right for you and your family
I’ve always wanted to be a lawyer to defend people’s rights, to right injustices on a personal level. After earning an Hon. B.Sc. at the University of Toronto, I entered the University of Ottawa Common Law program and was called to the bar in 2009.
Since then, I’ve successfully negotiated, litigated and arbitrated countless cases. I have the unique perspective of having acted for both injured persons and insurance companies. That deep understanding of the inner workings of the insurance industry gives me a strategic advantage to most effectively advocate for my client’s rights.
Away from my work, I try my best to keep fit, travel and enjoy great food and wine with my family and friends.
Sara Azghadi
My journey has always involved helping those in need.
While obtaining my psychology degree, I witnessed the pain that all disability, but particularly mental-health disability can have on a person’s ability to work. Now as a lawyer, I defend the rights of victims and help navigate them through the overwhelming process of being approved for or appealing the denial of disability benefits.
With the pandemic behind us, I have seen many hard-working Canadians suffer from the psychological aftermath of the last few years. While I represent clients with all types of disability, I have a keen interest in helping those who cannot work due to stress or anxiety related disorders, depressive disorders, or post-traumatic stress disorders.
Having a background in insurance law has allowed me to learn the language of insurance companies to the benefit of my clients. I hope to continue providing fair and effective legal representation for clients for years to come.
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