What happens in an LTD lawsuit?

In my legal practice, I represent people across Ontario whose short-term disability (STD) and long-term disability (LTD) claims have been denied or terminated. My clients are often shocked and stunned when their insurance company denies their disability claim.

You have seen insurance premiums deducted out of every paycheck for years, confident that you and your family would have income protection if you ever became too sick to work. You may have never thought about it until you got sick – you just assumed that you would be protected. The news that your claim was denied can leave you feeling helpless and unsure of how you will provide for your family now that your insurance company has let you down. The reasons given by the insurance company may not seem to make any sense.

The good news is that there are steps you can take right away. The sooner you and your lawyer get started, the sooner you may be able to secure financial protection for you and your family again.

Deciding whether to appeal or sue

The first decision I help clients make is whether they should appeal the insurance company’s decision or start a lawsuit against the insurance company. I discussed this decision at length in another article.

The short answer is that if there is important medical documentation that the insurance company did not have when they made their decision to deny your claim, it may make sense to appeal their decision. Your lawyer can help with your appeal. If, however, the insurance company already has all of the medical information that they needed to approve your claim, but they denied it anyway, you can save valuable time by proceeding with a lawsuit as soon as possible.

How does a lawsuit start?

Under Ontario law, you generally have up to two years to from the date your claim was denied to start a lawsuit against your insurance company. But you and your lawyer shouldn’t wait that long. The sooner you start your lawsuit, the sooner it will be over and you can put it behind you.

Your lawyer will start by reviewing your insurance policy and explaining your rights to you. Then your lawyer will request medical documents from your doctors and other treatment providers and start your lawsuit by sending a document to the insurance company called a Statement of Claim. The insurance company must then respond.

Now that you have started your lawsuit, the insurance company has a choice: either they will start paying you benefits or settle your case, or they will see you and your lawyer in court. Fortunately, most cases settle without anyone needing to go to court.

What happens next?

The next step in your case will either be discoveries or a mediation.

Many disability cases settle at mediation. A mediation is a day set aside for the purpose of trying to settle your case. A specially trained lawyer with experience in disability cases acts as a mediator, carrying offers between you and your insurance company, who are sitting in separate rooms. If you can agree on a settlement at the end of the day, your case is over.

I often explain to clients that getting a good settlement at mediation has a lot less to do with what your lawyer does at the mediation and a lot more to do with what your lawyer did before the mediation to build up your case with medical records, reports by medical experts, and written arguments. Your lawyer’s work starts from the first time you meet.

The two sides in a lawsuit also have a right to ask each other questions under oath, during a process called discoveries. This is a day when your lawyer asks questions of an insurance company and the insurance company’s lawyer asks you questions. Discoveries can be stressful and it is important to prepare for them well. We often find in our practice, though, that it is possible to go to mediation before discoveries, which means that your case can settle sooner and you may not have to attend discoveries at all.

Don’t be discouraged

It is shocking to receive a letter from your insurance company denying your claim, but you do not need to accept their decision and you do not need to fight them alone. Thousands of Canadians have been in your position before. If you stand up for yourself and get the right advice and assistance, you can work toward a result that lets you continue to take care of yourself and your family while you fight the real battle: getting your health back on track.