Posts Tagged ‘disability claims toronto’

Benefits of Having Both Disability Benefits AND Critical Illness Insurance

Sunday, January 29th, 2012

Would your way of life survive a critical illness or a serious injury?

If you survived a critical illness would you have enough money to pay for private nurses, home care, special medical treatments inside or outside Canada, job or career retraining, daily living costs such as food, mortgage or rent and taxes?

Critical Illness Insurance is offered by several Canadian insurance companies. CI pays a lump sum benefit upon a diagnosis of one of the covered conditions listed in the insurance policy.

Critical Illness Insurance is considered to be a “living benefit” insurance that offsets lost income and its main purpose is to help pay for additional expenses incurred by those who survive a major illness. Traditional life insurance won’t help in these circumstances.

With CI, you don’t have to dip into your RRSPs or savings. You are paid a lump sum amount as per your policy terms.

For more details about what critical illness insurance covers, and long-term disability benefits refer to our previous blog posts concerning this topic.

If you are a business owner or self-employed, you may want to consider critical illness insurance as well.

CI Insurance does not replace LTD or Life Insurance but is meant to complement these products.

It has been said that insurance is one thing you pay for but never really want to use. But, the reality is, insurance can allow a person to get back to where they need to be financially and can alleviate financial stress in many cases.

Turning to Disability Insurance, LTD insurance is a percentage of your pre-disability earnings and the benefit period ends at age 65. With individual policies, you can choose the level that works for you, from 50-100% of your wages. The higher the percentage, the higher the premiums are.

If you became disabled as a result of a car accident, having LTD benefits will allow you to afford your monthly expenses, like your mortgage payments, car payments, basic necessities and in general, protect your lifestyle if you have purchased enough coverage.

These 2 insurance products should be part of your financial portfolio. Being financially prepared is responsible, and will pay off.

Aaron Waxman and Associates is a personal injury law firm that handles car accident claims, critical illness claims and long-term disability claims.

Chronic Pain in the News Part IV

Monday, January 2nd, 2012

In Germany, a new Pain Initiative has been developed with respect to treating chronic pain. Pain is a multi-dimensional condition that requires the involvement of a multidisciplinary team of healthcare professionals. The guide that was developed, by the CHANGE PAIN Advisory Board, called “Towards a multidisciplinary team approach in pain management” provides guidance for healthcare professionals on how to set up a multidisciplinary team. The guide is endorsed by the European Federation of IASP (International Association for the Study of Pain). According to the IASP guidelines, the team should include at least 2 physicians from 2 medical specialties and a clinical psychologist if one of the physicians is not a psychiatrist.  A pre-condition for a successful multidisciplinary team approach is clear referral pathways for primary care physicians. The primary care physician plays a large role in the treatment of the chronic pain patient.

The protocol is known as “CHANGE PAIN” and the guide is found here.

NBA Superstar Kobe Bryant travelled to Germany twice during the off season to seek treatments for his chronic pain in his knee and ankle. A new type of treatment has been developed for pain management. Bryant visited Dr. Peter Wehling, a molecular orthopedist in Dusseldorf for a new type of blood treatment. Dr. Wehling is the founder of the Centre for Molecular Orthopedics in Dusseldorf.  He developed a gene test to genetically screen patients to personalize their treatment and claims to have achieved a 90 percent success rate.

The therapy is called “Regenokine Therapy”, and it involves removing a small amount of blood from a patient.  Natural anti-inflammatory and pain inhibiting proteins are harvested from the blood, processed, and then injected back into the affected part of the body. Dr. Wehling calls the proteins the “body’s own medicine” and claims they can “stop inflammation of joints and nerve roots, regenerate joint cartilage and accelerate healing of fractures.” The therapy is not available in North America.

Bryant visited Wehling last summer to get treatment for his arthritic right knee. Bryant’s knee has troubled him for several years and he’s had three knee surgeries. The Lakers star returned to Dusseldorf in October to get his ankle treated.

Aaron Waxman & Associates is a Toronto Personal Injury Firm that handles all types of personal injury cases.

Kusnierz Decision Released

Saturday, December 31st, 2011

The long-awaited decision regarding Kusnierz v. Economical Insurance was released on December 23, 2011.  The Ontario Court of Appeal overturned the 2010 trial decision and the Court of Appeal Judges, in the Disposition, state:

“I would allow the appeal, set aside the judgment of the trial judge, declare that the appellant meets the definition of “catastrophic impairment” under cl. 2(1.1) (f) of the SABS and, accordingly, is entitled to enhanced medical and rehabilitation benefits thereunder, and direct the respondent to pay such benefits to the appellant.”

What the Ontario Court of Appeal did in this decision was confirm that that psychological impairments should be combined with physical impairments to determine whether a car accident victim has suffered a catastrophic impairment. When the trial decision came out in 2010, plaintiffs lawyers were very worried about what it would mean if the combination of psychological impairments and physical impairments were not allowed.

Pre- September 1, 2010 insurance changes, for those accident victims whose accidents took place before September 1, 2010, and who were not declared catastrophic, had access to $100,000 in medical and rehabilitation benefits. Post- 2010 changes, the amount changed to $50,000 for accidents occurring after September 1, 2010.

If an accident victim is declared to be catastrophic, the med/rehab benefit amount changes to $1 Million. You can understand why a person with serious injuries, like Mr. Kusnierz who suffered an amputation to his legs, with complications to his stump and with his prothesis and serious psychological issues, 10 years after his accident, would need more than $100,000 in medical and rehabilitation benefits.

By allowing Mr. Kusnierz’s appeal, it was the first time an appellate court weighed in on the issue of combining psychological and physical impairment.

In Desbiens v. Mordini, a 2004 decision which was the decision that the courts previously followed with respect to the definition for catastrophic impairment combining psychological and physical impairment, the trial judge, Justice Harvey Spiegel found that an accident victim’s psychological impairments should be combined with physical impairments when considering whether he or she suffered a “55 per cent whole person impairment” (one of the definitions of catastrophic impairment). What this case did for plaintiff was confirm that catastrophic impairment status could be sought by a wider range of accident victims than previously thought.

Desbiens had been followed by the court and the Financial Services Commission of Ontario until the judge at Kusnierz’s October 2010 trial disagreed. The Court of Appeal stated that it preferred Spiegel’s conclusion and reasons in Desbiens than those of the trial judge in Kusnierz.

For a more detailed look,  canadianlawyermag.com posted a great synopsis of the decision and what it means for plaintiffs and plaintiffs’ lawyers.

What remains to be seen is what will happen with the definition of catastrophic impairment. What changes will the government implement and will this decision have any impact?

One of the issues discussed in FSCO’s Expert Panel Report was the very issue of combining factors to achieve CAT impairment.

The fight isn’t over yet.

Bad Faith Claims Part 2: Duties of the Insurer and the Insured

Friday, December 30th, 2011

Previously we blogged about Bad Faith Claims, which are claims that arise when an insurance company has grossly mishandled the claim of its insured, the policy holder/policy member.

In this blog post, we will take a closer look at what duties the insurer has/is supposed to follow and look at what duties an insured person has as well.

Insurer’s Duties:

Duty to Assess the Evidence in a Balanced and Reasonable Manner: The insurer should assess the merits of the claim in a balanced and reasonable manner. The insurer cannot dismiss credible, alternative evidence that does not support its pre-conceived ideas.

Duty to Reasonably Interpret the Policy: Policy language must be reviewed and checked, the policy should actually be read.

Duty to Adequately Investigate: A timely and thorough investigation of the claim should be made before a claim is denied, this is essential where a claim for disability is being made under a long-term disability policy. Medical investigations are to be made and all reports are to be considered, from the insured person’s doctors as well.

Duty to Inform: The insurer has to inform the insured person of the nature and extent of the benefits that are payable to him/her, and assist the insured in the completion of the necessary documentation (provide instructions). When an insurer decides to deny a claim, there is a duty to properly inform that the denial has been made, the insured person should not be told or misled by stating “the matter is under investigation”.

In a lot of cases, we do see that insurance companies write to our clients and postpone the actual denial of benefits by saying that a final decision has not been made, the matter is under investigation pending further documentation etc. This is incredibly frustrating to our clients!

Duty not to misinform: For example, not providing a copy of the actual policy.

Duty not to Take Advantage of an Insured’s Economic Vulnerability: E.g. Submission- by trying to get the insured person to settle at an early stage in the claim, for a lesser amount than the claim is worth.

Duties of the Insured:

The insured person, as this is a contractual relationship has duties as well, to act in “Good Faith”.

Duty to be Honest: For example, in any type of disability policy, to disclose all relevant health information, all employment details, all previous claims, details of WSIB claims, anything that may be relevant. You do not want the insurance company to find out information about you any way except from you yourself.

Duty to Rehabilitate and Mitigate: You have the duty to attend rehabilitation (physiotherapy, massage etc), whatever type of therapy that helps you try to feel better. You must actively be under the care of a physician and actively be trying to get better. Mitigation refers to the attempt to return to work. You must try to return to work, and advise the insurance company of your attempts, even if unsuccessful.

Duty to Give Notice of a Claim in a Timely Manner: If you are seriously injured and believe you qualify for LTD benefits, you should not wait too long to apply. Most policies allow you to apply after a 6 month waiting period. Sometimes people apply after 2 years and their claim is accepted. But reasonable notice of a claim should be given if you want your application to be considered and not denied from the outset.

At Aaron Waxman & Associates, we handle many disability claims. We are experienced lawyers who are able to help you with your fight against insurance companies.

We offer free no obligation consultations.


 

 

Bad Faith Claims: What constitutes bad faith in LTD claims?

Sunday, December 18th, 2011

Aaron Waxman and Associates is a Toronto Personal Injury Law Firm. We handle all types of personal injury claims, including long-term disability claims. Bad Faith Claims can arise in long-term disability cases.

When our clients’ benefits are denied or terminated, we commence an action against the Long-Term Disability Insurer. In the Statement of Claim, which is the court document that starts the legal process, we include a section where we plead bad faith. In order to make a claim for bad faith, we must include it in this document so that the insurance company knows this type of claim is being brought.

In Canada, the courts tell us that the duty of good faith requires that an insurer act both promptly and fairly when assessing claims. Breaching the duty of good faith in an insurance claim can lead to punitive damages. In order for the court to find that unfair conduct has taken place, and to award punitive damages, the court must find that the insurer acted unfairly and ‘delinquently’.

The idea is to reveal how the claim was handled from the outset and by what means the insurer actually arrived at the decision to stop payment or deny the claim. For example, an insurance company cannot terminate your LTD benefits while you are awaiting a decision from CPP regarding your disability benefits.

Bad faith claims are meant to act as a deterrent so that insurers will not exploit the vulnerability of the insured.

Morrison J., in Asseltine v. Manufacturers Life Insurance Company (Plaintiff sues disability insurer) said:

“A duty of good faith and fair dealing requires an even-handed evaluation of all evidence before the insurer by the insurer. Just as one cannot cherry pick the information to send to an assessor for a rehabilitation opinion, one cannot choose only to accept certain medical evidence in the face of compelling conflicting evidence.”

Examples of bad faith are:

1. Not rendering a decision about benefits in a timely fashion, even though medical info shows insured is totally disabled

2. Denial of benefits without medical certification indicating the insured is able to resume regular occupation

3. Unreasonable interpretation of policy

Our firm has successfully handled many LTD cases. Contact us for a free consultation.

Chronic Pain in the News Part III

Sunday, December 18th, 2011

Aaron Waxman & Associates LLP specializes in personal injury claims and helping clients receive the compensation they deserve.  Our “Chronic Pain in the News” series is meant to be a source of information for our readers and clients. We keep apprised of the latest medical developments with respect to chronic pain, and fibromyalgia.

Lyme Disease is a chronic disease that causes chronic pain. The Vancouver Sun recently reported that the government of British Columbia pledged $2 million for a new clinic where those with Lyme Disease and other complex and chronic diseases could go for help in managing their symptoms. The BC Women’s Hospital has been named as the home for the new clinic.

In Bancroft, Ontario, council has joined the fight against Lyme Disease. A growing list of municipalities are petitioning the province of Ontario to improve awareness, detection and treatment of Lyme Disease in Ontario. Pressure is being put on the provincial government of Ontario to update its Lyme Disease protocols. The Lyme Disease Association of Ontario (LDAO) says that the disease is regularly is regularly is regularly misdiagnosed because it mimics a variety of other diseases and neurological disorders including autism, arthralgias, arthritis, autoimmune disorders, chronic fatigue syndrome, fibromyalgia, depression, multiple sclerosis, Parkinson’s Disease, Alzheimer’s, schizophrenia, sleeping disorders, Lou Gehrig’s Disease, Lupus and more.

Currently, OHIP does not cover all testing for Lyme Disease. There is dispute over how the disease is transmitted. If Lyme Disease is caught early, it can be successfully treated with antibiotics.

Canada Newswire posted a Press Release about Canada’s need for a National Pain Strategy. Chronic pain is an under-treated health crisis affecting 1 in 5 Canadians. It is said that pain is often poorly managed in Canada, has a major impact on the quality of life and the ability of people to function.

The Canadian Pain Society (CPS) and the Canadian Pain Coalition (CPC) have issued a blueprint to outline the social, economic and personal impact of chronic pain on Canadians.

On April 24, 2012, the first ever Canadian Pain Summit will take place in Ottawa.

 

Canada Pension Plan Disability Benefits – What You Need to Know

Wednesday, December 7th, 2011

In a previous post, we mentioned that your LTD insurer, as part of your contract may ask you to apply for CPP Disability Benefits. You might be wondering what this process involves and what to do if your CPP application is initially denied.

Our firm has assisted clients with their CPP Disability Applications and with successfully appealing decisions of the CPP Review Tribunal.

The Application Process:

We will help you right from the beginning, starting with the application. You can find the application online on the Service Canada website. There is an application form, consent forms, a questionnaire form for you and one for your doctor to fill out. When submitting an application, it is very important to make sure that the information provided is accurate and the correct documents are enclosed. Supporting documents must speak to your level of disability and inability to work. Records and medical reports from your family doctor, treatment providers, psychologists, psychiatrists, x-rays, and other diagnostic imaging are examples of documents that can be submitted.

CPP Disability Rules:

According to the Service Canada website, to qualify for CPP Disability Benefits, you must be under 65 years old and meet the following 2 rules:

1. You must have sufficient earnings and contributions:

  • You must have paid into the CPP for at least 4 of the last 6 years, or
  • You must have made valid CPP contributions for at least 25 years including 3 of the last 6 years, or
  • You must have paid into CPP in each year since any previous CPP Disability benefit was cancelled

If you meet the first rule, CPP can then review your medical information to see if you meet rule number 2.

2. You must have a disability that is both severe and prolonged. Severe means you have a mental or physical disability that regularly stops you from doing any type of work (full time, part time or seasonal), not just the work you usually do. Prolonged means that your disability is most likely to be long term and of indefinite duration or is likely to result in death.

What happens after I submit my Application?

If you are eligible to receive benefits, you will receive a letter confirming same. If your application to receive benefits is denied, you are able to submit an appeal, a request for reconsideration.

If you disagree with the decision, you have to request an appeal in writing within 90 days of receiving the decision letter.

What happens if my Application is denied? Can I Appeal the decision?

IF CPP has sent you a decision stating you are not eligible for benefits as you do not meet the criteria for Rule 1 or Rule 2, you can submit an appeal. If you have legal representation, you can authorize your lawyer to do so on your behalf.

If you disagree with the decision, you have to request an appeal in writing within 90 days of receiving the decision letter.

In your request, you have to include the following items:

  1. Your name, current address, telephone number, social insurance number;
  2. An explanation of why you are asking CPP to reconsider its decision;
  3. Any new medical information that could affect the decision; and
  4. Your signature and the date

The average time it takes for CPP to reconsider its decision is 3 months. Sometimes it can take longer as additional information may be requested.

If you do not reach the desired result after appealing this decision, you can appeal again to the Office of the Commissioner of Review Tribunals (OCRT), within 90 days of receiving the decision from Service Canada. You will then be contacted by the Tribunal staff and a hearing will be arranged before a 3 member Review Tribunal (these parties are not members of Service Canada). As above, send any new medical information to the OCRT in advance of the hearing.

If you are unhappy with the decision of the Review Tribunal, you can request permission to appeal to the next level, being the Pension Appeals Board, within 90 days of receiving the decision from the OCRT. You have to receive permission from the PAB before you are able to have your case heard. This is the highest level you can appeal to. You can however submit the decision to for a judicial review, within 30 days of receiving the decision to have the court review if the decision process was conducted in a fair manner.

If you are in the process of applying for CPP Disability Benefits, if your LTD insurer has asked you to apply for these benefits, or you need help during this process, please contact our firm and we can guide you through this process.

 

Chronic Pain in the News- Part II

Monday, November 28th, 2011

Our firm handles many types of cases. We do handle many car accident claims. Often times, as a result of car accidents, our clients go on to develop a chronic pain syndrome. Chronic pain is not an imagined symptom.

A recent article in the Wall Street Journal proposed an alternative way for people suffering from chronic people to treat their pain, by using guided meditations and hypnosis. In fact, recent articles appearing on the Internet about treating chronic pain have focused on alternatives to pain medications.  According to the article, “Rewiring the Brain to Ease Pain“, chronic pain represents a malfunction in the brain’s processing centres and this actually be seen on brain scans. The pain signals take detours into areas of the brain involved with emotion, attention and perception of danger and can cause gray matter to atrophy. Studies were conducted, and brain activity was measured while subjects participated in a guided meditation. The results demonstrated that being distracted from pain and thinking about the pain was effective and the study subjects found a new way to look at their pain.

Locally, a chronic pain treatment centre in Vaughan, Ontario is receiving attention. Dr. Ron Nusbaum moved his Canadian Headquarters Clinic just north of Toronto. This is the first in Canada to offer the cutting edge Class IV K-Laser therapy, a unique, painless and side-effect free approach to treatment that stimulates healing, reduces inflammation and pain. Dr. Nusbaum is the founder of the Back Clinics of Canada. He has created a new comprehensive non-surgical, drug-free and integrative approach to diagnosing and treating those who have suffered for years from back pain and chronic pain- the “High Performance Healing System”. He offers an alternative to risky neck or back surgery.

How about talk therapy? Cognitive behavioural therapy is an effective way to help manage chronic pain.  A study in the United Kingston found that exercise and CBT were two successful alternatives to consuming pain medication. Introducing these interventions within the first six to nine months of treatment is preferable.

It is also worth mentioning that women who experience poor sleep are at elevated risk for developing fibromyalgia, according to a Norwegian study. Sleep disturbances and excessive fatigue are known symptoms of fibromyalgia. Sleep deprivation also has been linked with increased levels of circulating inflammatory markers and a loss of pain inhibition.

The company Medtronic received FDA approval for a device meant to help treat chronic pain. The device is called “AdaptiveStim with RestoreSensor” and is a Neurostimulator using innovative motion sensor technology, similar to that used in smartphones and gaming systems by automatically adapting stimulation levels to the needs of people with chronic back and/or leg pain. This device does away with manual changes, and instead is an automatic device that recognizes and remembers the correlation between a change in body position and the level of stimulation needed. It also records and stores the frequency of posture changes, and allows the doctor or therapist to understand how a patient’s individual stimulation requirements are changing over time. This device is also approved by the FDA for use in MRI head scans if recommended by a physician.

Aaron Waxman & Associates: Spreading Expert Knowledge in the Community

Monday, November 28th, 2011

At Aaron Waxman & Associates, we believe it is important to be informed. We are happy to appear as guest speakers at events or community meetings to explain how the legal process works, or how insurance claims work.

Yesterday, November 26, 2011, Aaron Waxman spoke at the Fall 2011 meeting at the Lyme Disease Toronto organization, which is an organization set up to assist people who have developed lyme disease, to provide them with resources, support an information.

Aaron spoke to the attendees about potential issues that people with a chronic illness may have with their insurance companies such as difficulties with paying for medication, short and long term disability payments and medical procedures. Aaron also talked about how our firm can assist with the process for obtaining CPP disability benefits.

Lyme Disease is a serious bacterial infection spread through bites from ticks.

Untreated Lyme Disease can spread to the brain, heart and joints.

 

Are your LTD benefits at risk?

Wednesday, November 23rd, 2011

A recent article on moneyville.ca posed the question, “Are your disability benefits at risk?”

What is meant by this, is what type of disability benefits are your employers providing you with? If you have long-term disability benefits available to you through your employer, is there an insurance company underwriting these benefits?

Some companies/employers have moved to a “self-insured” arrangement, where they set aside money to pay for their employees’ disability benefits…Unfortunately, you may not be aware of this until your employer gets into financial trouble, meaning your LTD payments are at risk.

An example is what happened with Nortel employees, a company who decided to go this route. About 400 employees were in receipt of LTD benefits. Nortel filed for bankruptcy protection in 2009 and employees found themselves cut off from disability benefits. The disabled employees received a lump sum benefit that will cover them for a couple of years only.

Employees of Nortel were under the impression that they were insured by Sun Life as their disability insurer. Sun Life handled the administration and communication for Nortel’s long-term disability benefits but did not cover the payments.

Independent financial analyst Diane Urquhart provides her advice in the article and it is noteworthy that approximately 1.1 million people  (7% of the workforce) are in employer-sponsored long-term disability plans that are not underwritten by insurance companies.

If your LTD plan is underwritten by an insurance company, you should take comfort in knowing that insurance companies are regulated for solvency by the Office of the Superintendent of Financial Institutions. They must set aside reserves to pay for current and future claims.

At the law firm of Aaron Waxman & Associates, we specialize in long-term disability claims and can help you in your time of need.