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Denial of Long-term Disability Insurance and the Right to Sue

People seeking long-term disability benefits must undertake certain actions. In Ontario an insured is under an obligation to help mitigate their damages – that is, they must participate in rehabilitation programs and actually attempt to get better. In some instances, where the insurance company refuses payment outright due to the non-cooperation of the insured, complete denial of benefits may not be regarded as appropriate. However, individuals who refuse to cooperate in the rehabilitation process risk having their damages reduced by the court.

Further, where the insured is given ample time to pursue damage mitigating solutions, such as pain management therapy, and fails to do so or in cases where the refusal of any rehabilitative measures is unreasonable long-term disability benefits could be denied by the courts completely. Simply put, the insured also carries a rather crucial responsibility to reduce the damages, otherwise they risk having their benefits denied outright, or proportionately lowered.

Furthermore, the denial of long-term disability benefits may also arise in situations of pre-existing conditions. Insurers may contract out of paying for both diagnosed and undiagnosed pre-existing conditions; as such it is crucial to examine the policy closely to determine if a right to sue exists. For instance, an insurer’s policy may only indicate diagnosed pre-existing conditions; as such an individual could sue for their long-term benefits successfully if they can prove that the pre-existing condition was undiagnosed or otherwise unknown.

In situations involving group coverage, termination of an employee may ultimately result in the denial of their long-term disability benefits. The employer carries the duty to inform their employees of any such limitations on the policy. Thus, the lack of such information or the untimely termination of an insured employee prior to their chance to apply and be considered for long-term disability benefits may give rise to a cause for a lawsuit. However, it is crucial to remember that an employee may be liable for contributory negligence, which will reduce the damages sought, if they failed to inquire or at least attempt to inquire about the limitations of the group coverage policy.

There are many intricacies and caveats in situations requiring the cooperation of the insured via rehabilitative measures as well as situations involving the termination of an employee with a disability. It is crucial to consult a lawyer that is both experienced and knowledgeable so that they may direct your case towards the most fruitful result possible. Zeilikman Law has lawyers that balance both litigation experience and in-depth knowledge of the law to ensure that the most favourable solution will be reached in your given situation.