In London, a Long-Term Disability (LTD) denial can significantly complicate your civil personal injury claim. Because the at-fault party’s insurance often expects your LTD benefits to cover a portion of your lost income, an LTD denial forces you to either vigorously appeal the decision or sue your LTD provider alongside the at-fault party.
Suffering a severe injury in a car accident or a catastrophic slip and fall is devastating enough, but the financial anxiety multiplies when you are unable to return to work. 💔 Many residents in London rely on Long-Term Disability (LTD) insurance policies provided by their employers to keep them financially afloat. However, insurance companies frequently deny these claims, arguing that you do not meet their strict definition of “totally disabled.”
What many injured people do not realize is that an LTD denial directly impacts their ongoing personal injury lawsuit against the person who caused the accident. In Ontario law, civil courts frown upon “double recovery.” Therefore, the at-fault driver’s insurance company is legally entitled to a deduction for the LTD benefits you are supposed to receive. If your LTD claim is denied, it creates a complex legal battle over who is ultimately responsible for paying your lost wages.
Step-by-Step Process in London, Ontario
Managing an LTD denial while simultaneously fighting a personal injury lawsuit requires a highly coordinated legal strategy. 📝 If your disability benefits are cut off, you must act swiftly to protect both of your claims.
Step 1: Review the Denial Letter Immediately
When you receive the denial letter from your LTD carrier (such as Manulife, Sun Life, or Canada Life), read it carefully. The letter will outline the specific medical or administrative reasons why they believe you can return to work. Provide this letter immediately to the personal injury lawyer handling your accident claim, as it directly affects your claim for past and future income loss.
Step 2: Obtain Updated Medical Evidence
LTD insurers often deny claims by relying on their own “paper-reviewing” doctors who have never actually examined you. ㊘c; You must counteract this by having your local treating physicians in London, or specialists at hospitals like Victoria Hospital, provide detailed, updated reports explicitly stating why your injuries prevent you from performing the duties of your occupation.
Step 3: Coordinate the Legal Claims
It is highly recommended to have the same law firm handle both your civil personal injury claim and your LTD dispute. If different lawyers handle them, contradictory medical evidence might be submitted, which defense lawyers will exploit. A unified legal team will ensure that the narrative regarding your inability to work is consistent across all legal fronts.
Step 4: Issue a Statement of Claim Against the LTD Insurer
If the internal appeal process with the LTD company fails, your lawyer will likely need to sue them for breach of contract. 👱⚖️ They will file a Statement of Claim at the Superior Court of Justice in London against the disability insurer, often litigating this simultaneously with your lawsuit against the at-fault driver, to ensure you recover your lost income from one source or the other.
How Much Does it Cost in London?
Fighting two well-funded insurance companies at the same time may sound incredibly expensive. 💰 Fortunately, most personal injury lawyers in Ontario structure their fees so you do not have to pay out-of-pocket during this financial crisis.
| Service / Expense Type | Estimated Cost (CAD) |
|---|---|
| Initial Legal Consultation | Free |
| Lawyer’s Contingency Fee | Usually 25% to 33% of the final combined settlement |
| Medical Specialist Assessments | $2,000 – $5,000+ (Typically advanced by your law firm) |
| Court Filing Fees (per lawsuit) | $229 CAD to issue a Statement of Claim |
How Long Does the Process Take?
Disentangling an LTD denial from a personal injury claim takes significant time. 🗓 Internal LTD appeals can take 3 to 6 months. If a lawsuit is required against both the at-fault party and the LTD provider, the entire litigation process in London can easily stretch from 2 to 4 years. It is vital to note that you generally have exactly two years from the date your LTD claim was clearly denied to file a lawsuit against the disability insurer.
Frequently Asked Questions (FAQ)
Why did my LTD provider deny my claim if I am clearly injured?
LTD policies contain strict definitions of disability. Often, after 24 months, the test changes from being unable to do your “own occupation” to being unable to do “any occupation.” Insurers frequently deny claims at this transition point, arguing you could work a less physically demanding job.
Can I just claim all my lost wages from the at-fault driver instead?
No. Under Ontario law, the at-fault driver is legally entitled to deduct the LTD benefits you are eligible to receive from their payout. You are legally required to make a good-faith effort to secure those LTD benefits; otherwise, you might lose that portion of your income entirely.
Can one law firm handle both my car accident and LTD denial?
Yes, and it is highly recommended. Many personal injury law firms in London possess the expertise to litigate both tort claims (the car accident) and contract disputes (the LTD denial) concurrently, preventing conflicting legal strategies.
Do I have to pay back my LTD if I win my injury claim?
If your LTD provider pays you benefits, and you later win a lump-sum settlement from the at-fault driver for past lost wages, your LTD policy almost certainly contains a “subrogation” clause. This means you must repay the overlapping amounts to the LTD company to prevent double recovery.
What if my doctor says I cannot work but the insurer disagrees?
Insurance companies frequently hire their own doctors to perform Independent Medical Examinations (IMEs) to contradict your family doctor. Your lawyer will challenge these biased reports by hiring highly respected, independent medical specialists in Ontario to testify on your behalf.
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