Private/Individual Insurance Policies

Markham & Toronto LTD Lawyers Advising Professionals With Individual & Private Insurance Policies

If you are a business owner or are a professional such as a lawyer, dentist, doctor, investment adviser/manager, engineer, consultant, veterinarian, chiropractor, independent contractor, skilled tradesperson, or other self-employed professional, you likely purchased long-term disability insurance when you started your business. You may have purchased this coverage through an insurance broker or directly from an insurance company. You may even have both group LTD coverage through your employer and additional coverage under a private or individual policy.

You might not know what disability coverage you have or how to submit a claim. Together, we will assess the nature and amount of your LTD coverage and determine what benefits you are entitled to under your various policies.

Helping individual policyholders is what we do.

Mulqueen Disability Law represents professionals and business owners whose disability claims have been denied or terminated by insurance companies. We have decades of experience appealing and litigating coverage and benefit disputes under individual disability and income loss policies. We know how to interpret and apply the provisions in our clients’ policies in a strategic and persuasive way to leverage successful outcomes for our clients.

When to make a claim under an individual insurance policy

If you have been struggling to work and your condition is not improving, it is important to submit an LTD claim before you are completely unable to work.

We can help you strategize the timing of your claim to maximize your benefits and mitigate your losses.

Applying for LTD before you are completely unable to work, may allow you the financial flexibility to reduce your workload and focus on managing your condition. We can help you determine when your symptoms and limitations would meet the different tests for disability under your policy and when to submit your disability claim.

Applying for LTD too early or waiting too long can have serious consequences for your finances and for your ongoing coverage under your policy. For example, if you begin to make errors or omissions, your business may not be able to recover or you may have professional liability claims or other legal claims made against you. If you are planning on selling your business, when you decide to stop working could also impact the valuation of your business.

What happens if my LTD or Income Loss claim is denied or terminated?

Although we may not think about our LTD insurance often, knowing we have it tends to provide us with the peace of mind that should disability strike, our families, our businesses and our incomes will be protected.

Unfortunately, that is not always the case. The denial or termination of an individual disability claim (including Business Loss or Interruption) can have serious and far-reaching consequences. You will typically have the option to appeal or litigate. Not all cases are the same. It is important that you contact us immediately. The sooner steps are taken to resolve your matter, whether it be by way of appeal or litigation, the better you, your family, and your business will fare.

Why are individual LTD (Loss of Income) & Business Interruption claims denied or terminated?

Not meeting the definition of “disability”

The insurance company may determine that you do not meet one of the various definitions of disability under your policy or that you have not provided “sufficient evidence or support” to prove your claim.

In individual disability policies, there may be multiple definitions of disability used by the insurance company to assess and deny an individual’s disability claim, including “Totally Disability”, “Residual Disability” and “Partial Disability”. Often when a claim for Total Disability is denied or terminated, the insurance company has not assessed the claim under the other definitions of disability and our clients may be unaware of other potential ongoing entitlements.

Misrepresentations made in the claim application or process

Individual disability claims can also be denied on the basis of misrepresentation. Misrepresentation is when the insurance company determines that you failed to disclose your medical or financial information at the time you applied for the coverage and had full disclosure been made, they would not have insured you. Your claim could then be denied on the basis of non-disclosure and misrepresentation.

Claims that are denied based on misrepresentation (whether innocently or fraudulently) are complicated. We know how to pursue these claims and what information we will need, including engaging our own underwriter to prove entitlement.

Lack of understanding of functional limitations & impact on earnings

Your claim may also be denied if the insurance company determines that you did not suffer a loss of income (or your business did not suffer a loss); that you are not receiving appropriate treatment; or they may determine you can work at your business, not fully understanding the functional requirements of your work/business and how your condition prevents your from performing your duties. Often insurance companies underestimate or fail to assess what the cognitive functional requirements are of professional occupations or business owners and this may result in the denial of your claim.

How can Mulqueen Disability Law help me with my professional LTD or Business Interruption claim?

For over 20 years, we have been litigating long-term disability claims that have been denied or terminated for every possible reason, including coverage issues, insufficient proof of disability, and failing to prove a loss of income.

We treat our individual policyholder clients like we would want to be treated.

The services we provide individual policyholders, while similar to those we offer our other clients, are specifically tailored to our clients’ unique individual loss of income (LTD) policies and unique business-loss issues. We offer our individual/private policyholder clients the following services:

  • Assistance with submitting a claim for LTD or Business Interruption/Income Loss under your Individual Policy and/or your Group Policy. We will provide you with  guidance and recommendations to help ensure the payment of your claim.
  • Help you determine how best to proceed if your LTD claim is denied or terminated.  We will assess your claim, weigh your options, and provide you with our strategic recommendations.
  • If you are late to submit your claim for benefits for whatever reason, we will assess your claim, review the evidence and law, and provide you with strategic advice on how best to proceed.
  • Negotiate a Buyout, if your benefits are being paid to you but you would like to stop reporting to the insurance company. We will discuss the risks of a Buyout and strategize an effective approach to achieve your “divorce” from your insurance company.
  • If you are continuing work at a reduced capacity or if you are considering returning to work after a period of disability, we will review your entitlement to Partial, Residual and Total Disability benefits and determine how to prove your eligibility under your policy.
  • Address your questions or concerns about how your insurance company is assessing your claim (for example, their use of surveillance; their demand that you sign overly broad authorizations; or their requirement of your to attend an medical assessment arranged by them).  We will review your claim and determine what has prompted the insurance company to use these claims tactics and how to mitigate any potential adverse consequences.
  • Litigate any dispute for non-payment of benefits and damages resulting from the denial or termination of your benefits and how they managed your claim.  We will include claims for bad faith and for damage for the emotional and financial impact their denial/termination has had on you and your business.

Mulqueen Disability Law: providing professionals in Markham & Toronto with exceptional LTD advice & representation

As a team of professionals, Mulqueen Disability Law understands that your focus is on your professional practice/business and family, not on the possibility of an illness or injury that could potentially cause you to be unable to do your work and run your business. That focus is why professionals can be particularly vulnerable to developing invisible disabilities like depression, anxiety, burnout, panic, PTSD, chronic pain, immunological conditions, neurological conditions, and other difficult-to-prove disabilities. Unfortunately, disability claims for these types of conditions are often denied at the outset or terminated prematurely.

Mulqueen Disability Law provides top-tier, experienced representation to professionals with respect to their LTD claims and appeals. From our office in Markham and meeting room in Toronto, we serve individual policyholders across Ontario and offer our services virtually when clients are unable to meet us in person. To discuss your LTD matter with a member of our responsive team, please contact us online or by phone at 416-900-0368 (or toll-free at 833-363-3LAW [3529]).