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long term disability

Chronic Fatigue Syndrome

chronic fatigue syndrome

Chronic Fatigue Syndrome and Long-Term Disability

by Tim Louis

Chronic Fatigue Syndrome is considered by some to be an orphan illness. This is because there is no cure for the disease and because there is no accepted medical test to diagnose it. In fact, many doctors do not recognize it. However, for the individuals suffering this debilitating condition, it is very real. Even what they call it is in dispute. Most patients prefer “myalgic encephalomyelitis,” or ME. However, the medical literature uses “chronic fatigue”.

Chronic Fatigue Syndrome is profoundly disabling. It renders individuals unable to get out of bed for days at a time. Sleep is no longer ever refreshing. It also strikes very quickly – one day the individual is healthy, and the next day the individual wakes up with the sensation of a bad flu. However, the “flu” never goes away. In some cases, it is so disabling as to paralyze a limb or even cause temporary blindness.

It is not unusual for individuals to believe they are going crazy when they first get Chronic Fatigue Syndrome.

Figures for Canada are not available, but it is thought that CFS afflicts between 836,000 and 2.5 million Americans.

For many years, a number of doctors believed the disease was all in the patient’s head.

Chronic Fatigue Syndrome – Denied Long-Term Disability Benefits?

I have represented many individuals suffering from Chronic Fatigue Syndrome. When denied the Long Term Disability Benefits they are entitled to, they hire me to sue their insurance company. One thing I noticed is that “good days” were always followed by “bad days”. In fact, because the “good day” was a gift from heaven, my client would do everything she or he wanted to do on that day. The sad result is that they would then be much much worse the following day. The trick was to always limit their activities on “good days” to half of what they felt they could do. This would result in a much better day the following day.

Long-Term Disability Benefits for Chronic Fatigue Syndrome Denied?

Long Term Disability insurance companies typically reject applications from CFS patients because the patient is unable to objectively prove the presence of the condition. I address this problem head on. I rely on witnesses who give evidence as to my client’s day to day activities. If my client has witnesses that confirm an inability to get out of bed for days on end and an inability to carry on a normal life, then my client’s lawsuit is much stronger.

I also warn all of my Chronic Fatigue Syndrome long-term disability clients that their insurance company will almost certainly hire a private investigator to capture them on video on a “good day”. Insurance companies think this will be devastating at trial. However, as I mentioned above, witnesses who give evidence that my client simply has good days and bad days, will usually outweigh the video evidence.

I have encountered this many times, representing Chronic Fatigue Syndrome long-term disability clients. In one case, one year into the lawsuit, the insurance company hired an actress to knock on my client’s door. When he opened the door, she told him that her car has stalled in front of his house. He willingly agreed to her request that he push her car out of the way. Unbeknownst to my client, all of this was captured on video by the private investigator. Fortunately my client’s landlord was an RCMP officer who was witness to the fact that my client literally spent days on end in bed. The case settled out of court with the insurance company paying my client over $300,000.

If you have Chronic Fatigue Syndrome and your Long-Term Disability insurance company has denied you the benefits you are entitled to, call me for a free initial consultation. I have been suing Long Term Disability insurance companies for over three decades.

Learn More about Chronic Fatigue Syndrome

What is Chronic Fatigue Syndrome?

What is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)?

Chronic fatigue syndrome and fibromyalgia in Canada

 

 

Long-Term Disability Claim


Long-Term Disability Claim

by Tim Louis

Long-term disability insurance is designed to protect you in the event of serious injury or illness. If your psychological or physical condition prevents you from being able to work, the insurance company should pay out a monthly benefit. This is designed to provide some financial support for your care and treatment.
Long-Term Disability Claim

However, Insurance Companies Deny Long-Term Disability Claims

Unfortunately, the reality is that insurance companies deny long-term disability claims. Sometimes rehabilitative therapy for people suffering from a long-term disability can be helpful, but it is not always the case. Permanent disability can sometimes be the result as well. However compensation of long-term disability benefits is the least you should expect if you have insurance.

Dealing with insurance companies can be very difficult, particularly if you are dealing with a serious illness or condition. Having a lawyer, like Tim Louis, to guide and protect you through the process is the key to getting the compensation you deserve. If your long-term insurance claim has been denied, call Tim Louis at (604) 732-7678 for a free consultation.

Long-term Disability Claim Denied

H.G. contacted me just over two years ago. She was referred to me by a previous long term disability client of mine who was very pleased with what I did for her. H.G.’s long term disability insurance company had just denied her claim for LTD benefits. H.G. had lost the ability to work at her very physically demanding position. She had developed Activity-Related Soft Tissue Disorder (ASTD) with myofascial injury to her cervical spine and shoulders. She had also aggravated her pre-existing degenerative disc disease.

She suffered from chronic joint and muscle pain, muscle spasms, numbness, neck pain, shoulder pain and pain and stiffness whenever she would bend, lift or walk.

I immediately obtained a copy of her insurance policy and then filed her lawsuit in the Vancouver Registry of the Supreme Court of B.C. Her insurance company filed a boilerplate response. They actually denied that she was disabled!

Insurance companies take me seriously and so it did not surprise me that fairly soon after the lawsuit had started they began to make offers of settlement. With my client’s instructions I rejected offer after offer.

The insurance company then conducted an Examination for Discovery of my client. At this step in a lawsuit there is no judge present. There is a court reporter who takes down a transcript of all the questions asked by the opposing lawyer and all of my client’s answers. I always prepare my clients extremely well before this step in the lawsuit. With H.G., this was no exception. While H. G. was a credible witness, I knew the insurance company lawyer might try to get her confused and then take advantage of the inevitable inconsistencies as she spoke.

A few days before the Discovery, I engaged her in a mock Discovery so she could practice what it would be like to be under a bit of stress. She did very well at the Discovery. H.G. came across as a likable, believable and reliable witness. After the Discovery, she told me how helpful our preparation together had been for her.

Shortly after the Discovery, the insurance company lawyer asked if we might be agreeable to Mediation. I recommended to H.G. that she accept the insurance company’s suggestion of mediation. Mediation is off the record, that is if settlement is not reached during mediation and the lawsuit proceeds to trial, nothing said at Mediation can be used against the client.

Mediation is a process whereby the parties engage in active negotiation with the assistance of a trained professional mediator. Throughout the day, the mediator will alternate between bringing the two parties together into the same room for face to face negotiations and separating the parties into two separate room shuttling back and forth between the parties. A mediator is different from an arbitrator in that an arbitrator makes a decision that is binding on both parties whether they liked the decision or not. Whereas a mediator only makes recommendations.

At the mediation, the insurance company slowly increased their offer of settlement – one-hundred thousand, one-hundred twenty thousand… two-hundred thousand and then finally two-hundred twenty-five thousand. I calculated that this was more than my client would receive at trial if she won. With great pleasure and a lot of relief, H.G. accepted the offer and we had a settlement. I had achieved the goal I aim for with all of my long-term disability clients – settle for nothing less than trial dollars without going to trial.

Has your Long-Term Disability Claim Been Denied?

If your long-term disability claim has been denied, call Tim Louis at (604) 732-7678 for a free consultation. Get the compensation you deserve.

Get the help you need. Give Tim Louis a call today at (604) 732-7678 for a no-fee telephone consultation, during which he will answer all your questions, no matter how complex. If you have received the insurance claim denial in writing, he will also review the letter and schedule a second no-fee telephone consultation to review and assess that long-term disability claim denial.

Don’t let the insurance company bully you into a settlement. Before you accept any decision, contact Long-Term Disability Lawyer Tim Louis.

Have a question? Use our convenient “Get Help” chat below.

Long Term Disability Plan Regulation

Tim Louis” target=”_blank” title=”Learn more about long-term disability plan regulation in BC”>Learn more about how the BC Government regulates long-term disability plans and long-term disability claims.

Fibromyalgia and Long-term Disability Claims

Fibromyalgia and Long-Term Disability Claims

 

Fibromyalgia – Getting the Long-Term Disability Claim You Deserve

by Tim Louis

Fibromyalgia is a painful medical condition that many people in Vancouver and British Columbia face, and it is often misdiagnosed. About 2% of the population is affected by this very painful disease, and it has many side-effects that can make it very difficult to work or go about daily life. Going to work everyday and dealing with its symptoms of pain, fatigue, depression, sleep issues, memory troubles, headaches and even digestive problems can become extremely difficult. The chronic pain alone makes getting through a day of work impossible. While this is a long-term disability insurance issue, many insurance claims are denied. A long-term disability lawyer, like Tim Louis, can help you get the compensation you deserve if you are unable to return to work because of your diagnosis.

Fighting with your insurance company for long term disability benefits is an uphill battle no matter what your disability. This is why many people will choose to hire an experienced lawyer. However it is even more difficult if you have fibromyalgia. Bad enough that it causes pain throughout the entire musculoskeletal system and is known to cause mental problems such as issues with memory and maintaining a stable mood. Even worse is the fact that the symptoms are subjective. There is no objective way of testing fibromyalgia as there is with say a broken bone – an x-ray. This gives your insurance company an unfair advantage – you have no way of proving that you have this disabling condition.

There is no question that fibromyalgia can be profoundly disabling and is a disability. The federal government recognizes this. Canada Pension Plan disability benefits are awarded to many people with fibromyalgia every year.

Fibromyalgia and Chronic Pain

As fibromyalgia causes chronic pain, it can be impossible for individuals who suffer from it to continue working. In Vancouver and all over British Columbia, I have acted for many fibromyalgia clients whose long-term disability benefits have been denied by their insurance company. I will always collect evidence from collateral witnesses. For instance a spouse that gives evidence that the insured is in pain all day can be decisive.

Many people with fibromyalgia will have good days and bad days. A good day is a gift from heaven, and my client will be tempted to do all the things they cannot do on bad days. Unfortunately this is not just a gift for my client, but also can be a gift from for my client’s insurance company. If they can obtain video surveillance of my client on this good day, they will try to use it to destroy my client’s case.

I once had a fibromyalgia client who heard a knock on his door one evening. He opened the door and a very charming woman told him her car had stalled and asked him if he could push the car. He was having a good day and kindly did so. Unbeknownst to him it was all a set up – he was filmed pushing the car. I am very proud of the fact that I still obtained $300k for him.

Long-Term Disability Claims

Living with such a painful disease as fibromyalgia can be difficult, and you deserve long-term disability benefits. If you have fibromyalgia and your insurance company has denied your claim for long term disability benefits you should retain an experienced lawyer. By working with Tim Louis & Co, our team will carefully gather the evidence, make a case and help you get the long-term disability benefits you deserve. Get started with a free consultation.

Hire a Long-Term Disability Lawyer to get Long-Term Disability Benefits for Fibromyalgia

When you need a long-term disability lawyer to truly represent your best interests and not the interests of a big law firm’s bottom line, you need Tim Louis in Vancouver BC.

Give Tim Louis a call today at (604) 732-7678 for a no-fee telephone consultation, during which he will answer all your questions, no matter how complex. He will gather the information about your condition of fibromyalgia needed to make a case for your need for long-term disability coverage, and answer all of your questions.

Tim Louis’ goal is to obtain for his clients an out-of-court settlement equal to what the client would achieve by going to trial. He does this by thoroughly preparing for trial, even though the goal is to settle before trial.

Contact us at (604) 732-7678 or send us an email at timlouis@timlouislaw.com.

Learn More

Fibromyalgia – Learn More
Symptoms of Fibromyalgia
Fibromyalgia Association of Canada

 

 

Client Reviews

Long-Term Disability Lawsuit

Long-Term Disability Insurance Lawsuit

Long-Term Disability Lawsuit:

Expert insights from long-term disability lawyer Tim Louis.

Many of my long-term disability clients are under the mistaken belief that if they win at trial the judge will order the insurance company to pay my client one lump sum equivalent to the amount of each monthly payment multiplied by the number of months from the trial to the date of my client’s retirement. Unfortunately, this is not the case. If you win your long-term disability lawsuit the court will order your insurance company to begin paying you monthly. There will be no lump sum representing what is referred to as “future benefits”.

With the above in mind, I was quite interested in the Court of Appeal decision in a case approximately three years ago. The Plaintiff, Nadine Lydia Gascoigne, had successfully sued Desjardins Financial Security Life Assurance Company for her long-term disability benefits. Her lawyer had asked the trial judge to aware a lump sum for Ms. Gascoigne’s future benefits. The trial judge refused to do so and instead ordered Desjardins to begin making monthly payments. Her lawyer appealed the trial judge’s decision not to award a lump sum for future benefits.

The BC Court of Appeal turned down Ms. Gascoigne’s appeal. Here are two paragraphs from the BC Court of Appeal Decision:

[29] In short, in my view, the trial judge correctly found he was bound by Warrington, as we are, to find that a non-contracting beneficiary of a group policy is entitled to enforce the payment of benefits, but not entitled to terminate the group policy or accept the insurer’s repudiation.

[30] The appellant did not advance any basis other than fundamental breach of the policy as a ground upon which she might be entitled to a lump sum award. It is not necessary, therefore, for us to determine whether such an award can be made for the breach of a disability insurance contract and breach of the duty of good faith. However, in this case, two obstacles stood in the way of such an award. First, the bad faith established was not found to be such as to preclude continuing performance of the parties’ contractual obligations, and second, the appellant’s own expert witness testified that she has “not yet reached the point of maximal medical improvement”. Some further interventions were contemplated, and she would suffer “some degree of vocational disability” for “an unknown period of time”. There was clearly a basis for the judge to say the evidence did not establish that the appellant would remain disabled from any occupation. He could properly regard that as a reason not to grant any relief other than the declaratory order made with respect to continuing benefits.

This means that the law remains as it always has been – if you successfully sue your long-term disability company, you will not be awarded a lump sum for future benefits, but rather begin receiving monthly payments.

Read more about the long-term disability lawsuit case here:

Gascoigne v. Desjardins Financial Security Life Assurance Co. (c.o.b. Desjardins Insurance), [2020] B.C.J. No. 1821, 2020 BCCA 316, British Columbia Court of Appeal, November 3, 2020, M.E. Saunders, P.M. Willcock and G.B. Butler JJ.A.

 

 

 

Client Reviews

Chronic Pain & Long-Term Disability Claims

Chronic Pain and Long-Term Disability Claims

Chronic Pain & Long-Term Disability Claims – Contact Tim Louis

Suffering injuries from an accident or mishap can be a frustrating experience. Ongoing chronic
pain some individuals experience is a general term but is a reality that numerous accident
victims have to learn to cope with even after fulfilling their medical treatments.

If you find it challenging to get through the workday and cannot fulfill your daily work-related
duties or function day-to-day, you are not alone. According to the Canadian Pain Task Force
Report (Sept 2020), an estimated 7.63 million, or 1 in 4 Canadians aged 15 or older, live with
chronic pain.

What is Chronic Pain?

Chronic pain is the result of changes within the nervous system. The nerves continue to fire and signal, leading to pain that remains long after an injury has healed. It may take weeks, months,or even years to completely heal. Lingering chronic pain can take control of your life and causefurther damage, especially to your mental state. Chronic pain can result from a musculoskeletal
injury, nervous system dysfunction, chronic diseases, and autoimmune disorders.

In 2019 chronic pain was recognized by the World Health Organization (WHO) as a disease inits own right for the first time, resulting in updates to the latest (11th) version of the InternationalClassification of Diseases (ICD-11). This distinction is significant as it validates the struggle forthe millions of people around the world who are living with chronic pain.

Chronic pain is classified as chronic primary pain or chronic secondary pain. Acute pain is short-lived and typically lasts no more than 30-60 days, whereas chronic secondary pain can range in intensity and lasts from 6 months or longer.

Chronic Pain Education & Support

For more information, we highly suggest visiting Pain BC, a non-profit, helpful organization that
works to reduce the burden of chronic pain for individuals in BC. They empower people who live
with pain; providing them with a wide variety of helpful, informative resources and the support
required to enhance their well being: https://www.painbc.ca

The Most Common Claims Associated with Chronic Pain

Several injuries are commonly associated with long-term disability claims:

  • Neck pain
  • Lower back pain
  • Shoulder pain
  • Pain stemming from Fibromyalgia
  • Recurring headaches and migraines
  • Cancer pain
  • Arthritic pain
  • Musculoskeletal pain
  • Chronic migraines and headaches
  • Pain associated with Lupus
  • Chest pain
  • Abdominal pain

Symptoms of chronic pain include:

  • Burning sensation
  • Sensitivity to touch, cold, heat, and more
  • Flare-ups
  • Dull Ache
  • Throbbing
  • Soreness
  • Stiffness

What Causes Chronic Pain?

Filing a Long Term Disability Claim for Chronic Pain

If chronic pain has affected your ability to continue working, you may have the option of
receiving long-term disability benefits if you are covered under such a policy through your
employer. You must however present verification that chronic pain has resulted in the inability to
continue working. The evidence required depends on the nature of your condition and any other
associated ailments.

What You Need to Provide for Filing a Long-Term Disability Claim

To file a disability claim for chronic pain, you must document your symptoms and experiences
and discuss them with a medical professional. Your doctor will assess your medical history and
order x rays, tests, and/or scans to determine if there is joint or tissue damage that may explain
your pain.

Examples of documentation that may be required:

  • Any physician statements and an official diagnosis
  • A journal documenting your pain over time
  • Test results
  • Information about your history of treatment
  • Witness statements from family, friends, and or co-workers who can attest to your
    condition affecting your ability to work and function day-to-day.
  • Any accidental reports

Our Law Firm Provides Results-Oriented Representation for Even the Most Complex Cases.

Do not give up hope if your long-term disability benefits have been denied. If you have been
experiencing chronic pain that has affected your ability to function personally or professionally
and would like to discuss legal options, the compassionate team at Tim Louis Law & Company
will provide you with a free, no-obligation evaluation. We represent clients in a broad range of
injury claims and will take all necessary steps to obtain fair and full compensation for injuries.

Contact us today by calling 604-732-7678 or email us at timlouis@timlouislaw.com

Sources:


https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/ext
ernal-advisory-bodies/canadian-pain-task-force/report-2020.html

https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=8340

 

 

Client Reviews

Why You Should Hire a Long-Term Disability Lawyer

Long-Term Disability Lawyer

Why You Should Hire a Long-Term Disability Lawyer

Disability insurance is an affordable option to protect you financially if you have an accident at work and become injured or ill. If you cannot perform your job due to injury, you should receive a monthly benefit resulting from a psychological or disabling physical condition. Sadly, employees are often denied or cut off from receiving benefits before they are able to continue employment. Every insurance policy is unique and outlines conditions that must be met. Although these conditions are outlined, sometimes satisfying these conditions can be challenging.

 

An experienced Long-Term Disability lawyer can help.

If you have applied for long-term disability benefits and your claim has been wrongfully denied, we strongly advise that you hire an experienced Long-term disability lawyer.

 

Why You Should Hire a Lawyer for Long-Term Disability Benefits

  • Communicating with insurance companies can be challenging and stressful. Your lawyer will reduce your stress by handling all the details; so you can focus on your health and well-being.
  • Insurance companies commonly use wording in their policies that can be confusing and may lead to the possibility of damaging your case. A long-term disability lawyer will take charge and will ensure you avoid any pitfalls.
  • Some insurance companies hire Private Investigators to build a case against you by conducting surveillance; documenting your activities and capabilities. They may also edit this footage to discredit you. These are all ways insurance companies can prove to a judge that you are capable of more significant activities than your claim indicates. Your long-term disability lawyer has seen it all before and will guide you through the process and gather evidence to support your claim accurately.
  • Your lawyer will know the information required and the specific questions that need to be asked of your doctor — ensuring that all possible evidence is presented to support your appeal.
    •  

      When You Should File a Claim

      There are statutes of limitations in British Columbia, meaning that there are strict deadlines you must adhere to when you file a disability claim. An experienced lawyer in this area of expertise will ensure that your doctor(s) have provided an adequate amount of information or anything else required to support your appeal. You will want to contact your lawyer as soon as possible to ensure you do not miss any crucial deadlines during the process.

       

      What You Should Do If Your Claim Has Been Denied

      There are several reasons why an insurance company would deny disability benefits:

      • The medical condition does not fall under the definition of ‘disability.’
      • An inadequate amount of evidence to support the injury.
      • The claim was not filed on time.

       

      We highly suggest that you contact your disability lawyer as soon as you find out that your claim has been denied. Even though your claim was denied, this does not necessarily mean your case is closed. A trusted disability lawyer will review your policy and ensure that all information required is submitted to help prove that your condition meets the definition of ‘disability’ according to your insurance policy.

       

      Talk to a Long-Term Disability Lawyer for a No-Obligation, Free Consultation

      You do not have to handle this alone. If your long-term disability claim has been denied, speak with Tim Louis & his compassionate, trusted team of experts by calling 604-732-7678 or email timlouis@timlouislaw.com for a free consultation, and we will provide you with the best possible options.

       

       

       

      Client Reviews

Disability Claims for Self-Employed Professionals

Disability Claims for Self-Employed Professionals

disability claim for self-employed
If you are self-employed and have purchased a disability insurance policy, you have assumed that this policy serves as income replacement if you are unable to run your business for a period of time due to injury or illness.

Private disability insurance is commonly more expensive than group insurance, and generally, the type of coverage it provides is usually more valuable as it often provides benefits in the event you are unable to work in your regular occupation. Unfortunately, just because you have purchased an insurance policy, this does not necessarily mean that the insurer will not make it challenging for you to receive benefits after you have submitted a claim. Insurers often heavily scrutinize claims submitted by independent, self-employed individuals – this is because of the sometimes-large benefit amounts provided by some of these policies.

Know the Terms & Conditions of Your Insurance Policy

To protect your rights, it is integral that you understand the limitations and restrictions outlined in your disability insurance policy. The definitions of certain disabilities can change over time, so it is important to keep up to date and understand these changes that may apply to you.

Know Your Rights about Disability Claims

Once you have purchased your insurance policy, be sure you are aware that although you have coverage, this does not mean you should “rest easy.” In reality, what you are really buying are rights that you can enforce against your insurer if they fail to provide the protection that was sold to you.

Know the Strict Time Limitations

 Many people do not realize that there are strict limitations with regards to filing a lawsuit against insurers, and oftentimes they are missed. If you do miss a limitation period, the insurance company is not required to pay your claim, and therefore your right to sue them is null in void.

Here some common red flags you should be aware of:

  • The claim is taking an unusually long time to resolve
  • Irrelevant information is asked of you
  • A claim has been denied

Hire An Experienced Disability Lawyer

In many cases, filing a lawsuit is not necessary. The first step involves a demand letter, outlining any discrepancies, pointing out the facts, and the law – with the demand that an insurer complies with the terms and conditions of the insurance policy. Insurance companies are often fully aware when they are not in full compliance, and take advantage of policyholders because most people do not know the law in-depth, and are privy to any red flags before signing off on their policy.

Contact Tim Louis & Company

Insurance companies may deny legitimate disability claims, as the majority of individuals will give up instead of fighting for the monetary compensation they deserve. If you are self-employed and an insurance company has denied your long-term disability claim, the team at Tim Louis and Company is on your side and will fight in your corner.

For a free, no-obligation appointment, contact us today by calling 604-732-7678 or email timlouis@timlouislaw.com

 

 

Client Reviews

Surveillance: How You Can Lose Your Long Term Disability Compensation

long term disability surveillanceHow You Can Lose Your Long Term Disability Compensation

Have you applied for Long Term Disability coverage and have the feeling you are being followed while out in public?

If you have submitted an application for disability or are collecting disability compensation, your intuition may be accurate, as there is a good chance an insurer has hired a professional private investigator to conduct surveillance on you, seeking an excuse to save money and attempt to deny your claim.

Insurance companies, like all businesses, are profit-based and lose money if they approve too many claims — so it is in their best interest to prove that you can work without the need to receive compensation for your reported medical condition.

Disability claims are on the rise, and surveillance is an efficient way for insurance companies to gather evidence against you – intending to prove that you are fully capable of fulfilling your job duties and do not require financial support.

Surveillance May Work Against You

Insurance companies may hire a private Investigator, follow you, or set up surveillance in front of your home to observe your daily activities.

Suppose you applied for Long Term Disability due to back pain and then observed via surveillance moving or twisting your body in a way that contradicts what you detailed in your claim. In that case, your credibility may be diminished and lead to a denial of your Long Term Disability insurance benefits claim.

Be Specific On Your Application for Long Term Disability Compensation

Detailing your injuries and being specific about your abilities on your Long Term Disability application is essential. Provide context and be mindful about anything observed via surveillance that may be used against you.

Such that if you are observed merely walking down the street for a more extended period than you mentioned you were able to in your claim, you could be at risk of losing your Long Term Disability insurance coverage.

The same goes for mental health disability claims. For instance, if you claim that you are chronically depressed and unable to leave your home and then observed via surveillance leaving your home on a daily basis, you may be questioned and risk losing your coverage.

Why Surveillance is Not Reliable

Context is everything when it comes to surveillance with regards to Long Term Disability insurance claims. As mentioned in the example above, surveillance is not a reliable measure to understand one’s abilities.

Video evidence does not present the aftermath of the activity, such as the stiffness and pain you may experience immediately after or the next day resulting from specific activities such as reaching, carrying grocery bags, or shovelling snow.

Fighting Against Surveillance Evidence

  • Ensure that you are truthful regarding your disabilities and injuries from the start. Do not stretch the truth because you think it will be more believable.
  • Take extreme caution when posting on any social media channels. Any comments, videos, or images involving events, activities, sports, or vacations, can be used as evidence to affect your disability claim. Be mindful before you post.

Denied Long Term Disability Coverage? Hire an Experienced Lawyer

If you have Long Term Disability coverage, and if you’re suffering from a debilitating illness or injury, then you deserve compensation, and that’s where Tim Louis and Company can help.

When dealing with a Long Term Disability claim, it is essential that you have an experienced, reputable lawyer on your side that specializes in Long Term Disability cases.

Long Term Disability Lawyer Tim Louis has been representing those who suffer from LTD for over 25 years and has successfully sued some of the world’s largest insurance companies on behalf of deserving clients.

Contact Tim Louis and His Team Today

You owe it to yourself to explore your options. Contact Tim Louis and his compassionate and experienced legal team today by calling 604-732-7678 or email timlouis@timlouislaw.com for a no-obligation consultation. We will make sure to evaluate your situation and advise the best possible options for your unique situation.

 

 

Client Reviews

Disability Insurance: Expansion of Special Costs

Disability Insurance: Expansion of Special Costs

disability insurance
 

Introduction

A recent BC Court of Appeal case, Tanious v. The Empire Life Insurance Company, 2019 BCCA 329 [Tanious], gives disability insurance claimants who take their insurers to court greater prospects of obtaining special costs against their insurer, even absent malicious conduct. However, the specific details of the case are very important. This article analyses Tanious with a view to determining the key requirements that will need to be met in future cases to obtain awards of special costs. Leave to appeal Tanious to the Supreme Court of Canada was denied.

Background

Ms. Tanious was diagnosed with multiple sclerosis shortly before beginning a new job. She nonetheless worked at that job for seven years before ceasing work and claiming disability benefits that she was entitled to through her employment. Following her diagnosis, she developed depression and anxiety, and about a year before ceasing work she started using illicit methamphetamines to cope with her deteriorating cognitive capabilities. The insurer, Empire Life, denied that she became disabled during her employment, and further argued that her substance use disentitled her to benefits. At trial, Mr. Justice N. Brown found that she was entitled to disability benefits, and further awarded her $15,000 for aggravated damages for mental distress, loss of peace of mind and of dignity as a person from Empire Life’s refusal to pay benefits.

At the subsequent costs hearing, Brown J. awarded special costs even though the plaintiff conceded that Empire Life did not commit any litigation misconduct. It is this award that was subject to appeal.

The Appeal of Special Costs

The costs scheme in British Columbia is statutory; Rule 14-1 of the Supreme Court Civil Rules sets out the framework for cost awards. It provides that the court may award special costs, but does not set out the circumstances in which they may be awarded. Generally, special costs are only awarded in cases where there has been litigation misconduct. However, there are exceptions, though these are rarely applied. The Tanious case is an example of one such exception.

Overarching Principles

In order to justify a special costs award, the Court of Appeal stated that it is insufficient to simply have a large discrepancy between taxable costs and actual legal costs. There must be some other “unusual feature” in the case, such as “special importance, difficulty or complexity associated with the litigation” (para. 54). The Court cited a handful of examples where special costs had been awarded despite the lack of evidence of misconduct, and explicitly reiterated that in these cases any award of special costs must be made on a principled basis.

Typically, the objectives of costs awards are to provide the winning party with some degree of indemnity for the costs it has incurred during the litigation. However, the Court of Appeal also recognized that costs awards “encourage settlement, deter frivolous actions or defences and sanction unreasonable conduct committed in the course of litigation” (para. 36). Significantly, the Court also indicated that in some instances, “costs may be awarded to enhance access to justice, mitigate severe inequality between litigants and encourage socially desirable conduct” (para. 36).

The Court cited the leading case of Asselstine v. Manufacturers Life Insurance Co., 2005 BCCA 465, which provides that in the context of these objectives, “the application of ordinary costs rules usually produces a just result,” but goes on to say that this does not mean “that the personal and financial circumstances of a litigant can never be relevant on a costs application” (para. 60). The Court acknowledged that such circumstances may come in to play in exceptional cases.

The Court went on to discuss other cases where special costs were “justified in the interests of justice” (para. 65). Given the circular nature of this proposal – that special costs awards are justified by justice – it is challenging to elucidate principled reasons for these awards when they are not related to reprehensible conduct. Instead, these cases are fact-specific and must be considered based on their own merits.

The Court included in its analysis two analogous cases out of the Court of Queen’s Bench in Alberta where special costs were awarded: Hennessy v. Horse Racing Alberta, 2007 ABQB 178, where a judicial review was required to defend the appellant’s livelihood and restore his reputation; and Meleshko v. Alberta, 2013 ABQB 468, where the appellant sought judicial review to reinstate long-term disability benefits, and punitive damages were not available. As well, the Court cited FIC Real Estate Fund Ltd. v. Phoenix Land Ventures Ltd., 2016 ABCA 303 for the proposition that special costs could be awarded if success in the litigation would otherwise “amount to a strictly pyrrhic victory” (para. 65).

The final significant case referenced in the appeal was Carter v. Canada (Attorney General), 2015 SCC 5, wherein the test for awarding special costs was refined by the Supreme Court of Canada, stating that “the plaintiffs must show that it would not have been possible to pursue the litigation with private funding” (para. 63). In these instances, it is not just to ask the individual litigants or their counsel to bear the cost of pursuing the claim.

Factors in Tanious in support of special costs

On its face, the trial judge in Tanious made the decision to award special costs on the basis of very few factors, none of which are unusual in a long term disability insurance case: the purpose of the insurance contract is to provide subsistence level income, and when the insurer failed to pay these benefits, the plaintiff had to bring a lawsuit, which cost money. However, the Court of Appeal recognized that when the trial judge’s reasons were read as a whole, it was apparent that he also considered “the nature of the case, including its unique characteristics and related litigation challenges, complexities and costs, together with Ms. Tanious’ personal and financial circumstances and her need for counsel as established by the evidence” (para. 21).

The particular litigation challenges of this case included several factors that added to the effort required by counsel. Ms. Tanious was a difficult client to represent. She could not meet at counsel’s office; counsel had to drive to her. Similarly, she could not review documents to prepare for an examination for discovery as it was too stressful, and she likely would not be able to remember what she had reviewed. Additionally, she attended hospital 33 times over the course of the case, and often called her counsel from hospital to ask for help with various other issues. Ms. Tanious attempted suicide more than once as her disease progressed; if she had died, her claim for benefits would have ended. In preparing for this case, it was difficult for counsel to predict what Ms. Tanious would say at trial.

Though the insurer did not commit misconduct, it could have acted better. The trial judge noted that the insurer made only a cursory response to Ms. Tanious’ initial application for disability benefits, but once in litigation, mounted a vigorous defence. In combination with Ms. Tanious’ poor mental health and declining cognitive abilities, the actions taken by the insurer necessitated that she obtain legal representation in order to pursue the benefits to which she was entitled.

Notably, Ms. Tanious had separate counsel for the costs hearing. This was perhaps because her original counsel had to testify at the hearing via affidavit as to the many special circumstances in Ms. Tanious’ case; s. 5.2-1 of the Code of Professional Conduct precludes counsel from testifying to controversial matters. Though it was not mentioned by the Court, as a practical matter, this ethical rule adds to the challenges of obtaining special costs.

Future Implications

The courts now recognize that in matters of insurance disputes and also in other exceptional situations, many people do not have access to justice unless they are able to retain counsel. Access to justice is recognized as being one of the policy objectives of the courts that thus far is not adequately being met (para. 81). As the consequences of these shortcomings become clearer, it may be possible to seek special costs as a means of ensuring adequate access to justice for members of otherwise underrepresented and vulnerable populations.

It can be difficult to make a financially viable practice taking long term disability cases to trial. While aggravated damages are sometimes awarded, they are typically small awards that are woefully insufficient in comparison to the costs of litigation. Punitive damages require misconduct on the part of the insurer. The risk of a special cost award, absent litigation misconduct, provides the plaintiff with more leverage in negotiations with an insurer, and may allow a plaintiff to recuperate the full benefits to which they are entitled, while also appropriately compensating their counsel.

 

 

Client Reviews

Long-Term Disability Coverage: How Long Will Benefits Last?

Long-Term Disability Coverage

Long-Term Disability Coverage

Some insurance policies issue payments for a certain amount of years, while other policies may stop payments after up to a decade. The question, unfortunately, does not have a definitive answer, as every insurance policy is unique.

When you read over your employer’s group benefits package, or even if you purchase your own private insurance, ensure that you read through the policy carefully to ensure that you understand the long-term disability requirements. Understanding the requirements, application deadlines, waiting periods and duration of benefit payouts is important.

While every insurance policy handles long-term disabilitycoverage and benefits differently, there are certain aspects to these policies that are mandated by law – this depends on your ability to return to work before your injury and your ability to work, period. There are certain policies that will stop benefits indefinitely after 2 years if you are able to return to any full-time work (regardless if it pays the same as your pre-injury job), while some insurance policies will continue paying out benefits at a reduced rate if you end up securing a new position that pays less than your previous employer. If however, you are unable to return to work, long-term benefits could last for a number of years.

What is Long-Term Disability Coverage?

If you become disabled during employment, Long-term disability insurance coverage pays benefits. Under most LTD policies, in order to qualify for these benefits, you would need to prove that you are unable to continue working as a result of a medical condition. These medical conditions can include physical, psychological, cognitive, and emotional – or a combination of any of the above. If you qualify for LTD coverage, the payout for benefits ranges between 60%-70% of your pre-disability income. There are certain policies that cover less, but most policies will pay benefits for qualified individuals up to age 65.

When Does Long-Term Disability Start?

Long-term disability payments are never available immediately and considered a last resort after short-term disability options have been exhausted. Before you can be approved for LTD payments, you must go through short-term options first – even if following a serious, catastrophic injury. Short-term options may include sick leave and short-term disability benefits.

How Do I Know If I Have Long-Term Disability Coverage?

If you are fortunate enough to have an employer that has provided you with a group medical benefits package, it is likely that you have insurance for Long Term Disability (LTD) coverage, which may also grant you coverage if you have been laid off or terminated from your job. If you do not have group benefits through your employer, you have the option of purchasing a private LTD plan.

Meeting Important Deadlines

There are strict deadlines that go along with long-term disability claims, so it is important to carefully read through your policy to understand the time limits. Failure to submit a claim on time can result in your claim being denied.

What if My Long-Term Disability Claim is Denied?

If you submitted an LTD application and your claim is denied, you will not receive any payments and will be expected to return to work. Claims can be denied for numerous reasons, such as incomplete information, unclear or improper medical treatment or diagnosis etc. Keep in mind, diagnosing mental health can be complex, but insurers are very specific in their guideline requirements. If your claim is denied, you have the right to appeal the decision – an appeal process will commence, which is why it is important that you contact a trusted lawyer that specializes in such long-term disability cases.

How a Long-Term Disability Lawyer Can Help

When understanding the length of your LTD policy, it is important to understand the language and the integral details you should be aware of. At Tim Louis Law, we are experienced with the process of filing long term disability claims and look forward to discussing your unique situation with you. Contact us today for a free consultation by
calling (604) 732-7678 or email timlouis@timlouislaw.com

Source:
https://www.bclaws.ca/civix/document/id/loo69/loo69/13_409_97

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