Why Long Term Disability Claims Get Complicated?

When the victim of a personal injury realizes that he or she will not be able to return to work, then that same victim can consult with a lawyer about filing a long term disability claim. That lawyer-client team must realize that the amount of any awarded benefit cannot be given at that time. Any benefit awarded will get paid monthly and will equal a given percentage or the client’s annual salary, before becoming injured.

All the factors considered, when calculating the size of that monthly benefit

In addition to the amount of the client’s previous salary, the actuary considers the cost of living allowance. That allowance factors in the degree to which the increase in the cost of living has increased the value of the client’s former salary. That is just one of the factors that determines the size of the benefit that the court awards to the plaintiff in a long term disability case.
The court also looks at those monetary sources that can call for creation of set offs. A set off decreases the size of the awarded compensation. What are some examples of sources that would call for a set off? Those would be things like the availability of CPP disability benefits or WSIB benefits.
After calculating in the size of the set offs and the cost of living allowance, the actuary must also consider the client’s age. A claim for long term benefits covers all the months or years that will pass until the disabled victim reaches the age of 65. After factoring in the age of the person that would be covered by the policy, should it be approved, the actuary gives the final figure to the insurer.

Reasons why the insurer might deny the Long Term Disability benefits

Most policies have a pre-existing limitation period. That period defines the time during which the victim has been working for a given employer. If a new employee becomes severely injured during the first couple of months on the job, the insurance company could deny the first request for long term coverage. With the help of a lawyer, that denial might later be reversed.
The insurance company may feel obligated to deny the claim, if the injured worker had joined a union. Union members are usually asked to settle all their disputes with the employer by means of collective bargaining. In other words, union workers are not supposed to hire an injury lawyer in Georgetown and sue their employer.
Finally, the insurer will look at the age of the victim. How close was that former worker to the age of retirement? An insurer may be more willing to agree to coverage for someone that would soon be reaching the age of 65. After all, an insurance company can look rather generous by agreeing to coverage for such a worker, since the coverage will soon get terminated.

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