Time span of legal process re claim against LTD insurer?


#1

I have been off work on leave due to illness since the spring of 2016, and have been trying to get approved for LTD through my group insurance through my employer. Despite the full backing of my doctor and specialists, my first and second (final) appeal were denied. I have hired a lawyer and they have served a Statement of Claim action against the insurance co. My lawyer has significant experience and success rate with these types of cases, and says I will be meeting with himself and the lawyer for the insurer for a questioning/interview in a couple of months, but that it rarely gets as far as court.

Is there anyone here who could tell me the time frame (just an average) that these kind of legal cases take? It’s all very new to me.


#2

Since he is a good lawyer, I am sure he gave you an approximate timeline. My thought is, Its not as smooth as say litigation for work dismissals or any other civil claims, and having an unapproved claim, I am pretty certain they will want a discovery which could take few months (say 3-4 after statement of claim has been filed). Then, depends on the insurer and how fast they want to move, but I would add another 4-5 months to reach mediation stage. If things get resolved there, you are looking at approx 1 year. If you need to get a trial date and move the case forward then you are looking at 2+ years to get a trial date.


#3

Questioning and mediation (if required) are likely to be on/near the same date, as my lawyer and the insurer’s lawyer can then fly out only once. This would be within the next 3-4 months.


#4

Unfortunately an easy tactic of insurance companies is to wait out claimants. Patience is a virtue that I have been forced to find. In you circumstance I would imagine a year min up to the proverbial seven year timeline.
It is stressful, and as time it to will pass.
Not much help I know but …
Good luck


#5

Thank you! Yes, they’ve already been drawing this out for a long time now with the denials and appeals and requests for further info, so I don’t see any reason why they would be in a hurry now that they are being sued. Fortunately (sort of), I really have nothing to lose by proceeding with the case, so I’ll be damned if I give them the satisfaction of throwing in the towel. :wink:


#6

Good.
I wish you success.
Maybe you can get damages the longer it takes.


#7

Hey Nip - I’m in the same circumstance (mostly). I went on STD Apr 2013 (paid by my Employer) and was accepted to LTD (with the group insurer). I surpassed the 2 year mark (Apr 2014-Apr 2016) but 6 months later they cut off my benefits (Oct 2016). I appealed once - was denied (Feb 2017). I hired a lawyer and a Statement of Claim was sent out (May 2017). The insurer came back in the summer with a lump sum payout amount - which I didn’t find out about until September 2017. Regardless, we’ve declined it because it was a ridiculously low amount. January 17/2018 I meet with my Lawyer to prep for the “Questioning”. He previously mailed me a package telling me what to expect (i.e. the Insurance Lawyer WILL lie to me, etc.). The “Questioning” happens January 25/2018. I am extremely fearful of what’s going to happen. My Lawyer stated it doesn’t usually go to Court either but I suppose that depends on whether you can come to an agreement or not.

My Employer terminated my Employment after 36 years of service (Oct 2017) without notice/severance. I’ll be suing them next. Urghghghgh.

Wonder if David can help us with some of his Wisdom regarding these “Questioning” meetings?


#8

Thanks so much for sharing your experience! Wishing you all the best on your upcoming meeting. What exactly does a lump sum payout offer entail? Does that mean that they still don’t cover you going forward? I know they owe me retro pay plus the monthly disability payments once it’s eventually approved, but I am technically still an employee (on leave without pay due to illness), and my employer still pays my disability insurance premiums to the company that insists on denying me. Ah fun and games.


#9

A lump sum payout means that the Insurer offers you an amount of money and then basically says they owe you nothing more - go away and don’t ever sue them again LOL. They offered me just under a year’s worth of payments (which I then have to pay taxes on and my lawyer). My LTD policy allows for me to be on Disability until I’m 65. So when they cut me off - I had to sue them because they wouldn’t accept my appeal. Most Insurers don’t reinstate - they just say “nope” you haven’t proven you’re disabled - therefore we’re not paying you any longer. So once legal action is taken against them - they opt for a one time payment - and it’s usually such a lowball amount it’s laughable. So you have to make sure you have a strong enough case that could put you both in Court - which is NOT what they want because if they lose - they usually have to pay all legal costs and that’s hugely expensive! Your lawyer would advise you as to whether they think your case is strong enough to go to Court - otherwise they try to come to a consensus on what they think is fair (which it’s usually not - but it’s better than nothing).

If your Insurer reinstates you then yes they will pay retroactively but as my Lawyer said - you’ll just continue to get cut off every 4-6 months until they finally get rid of you - that’s why they usually offer a lump sum payout - it’s kind of like paying you out so you go away. Like I said - it’s a lowball amount so if you think you have a strong case - fight for it but it does come with an intense amount of stress and time.

I remained an Employee for one year from the time they cut me off. However, my Employer had to change my status from LTD (where they paid for all my benefits and pension contributions) to Unpaid Leave. Therefore I had to pay for my own benefits (health, dental, life insurance, pension contribution) on my own. I am forever grateful that my Mom put the money into a bank account from which the Employer could draw the money out of until the anniversary of when the Insurer cut me off. At that point - my Employer then terminated my Employment stating it was a “Frustrated Contract” as I was unable to return to work. I worked there over 32 years - and I got no notice, no accomodation offered and no severance. So I’m going to be suing my Employer as well. You’re very fortunate that your Employer is continuing to pay your disability insurance premiums while you’re fighting with the Insurer.


#10

Yes, I am very grateful that my employer has been cooperative and has basically just required updates and doctor’s notes thus far (I have been off work on medical advice since the summer of 2016). I was hired as a permanent employee and as I am in my 30s I certainly hope to return at some point. Unfortunately no treatment plan has worked so far. It is unbelievable that after all those years of service, your employer would act in that manner - I wish you all the best in persuing the matter against them!

My lawyer does not recommend accepting an initial payout offer if given, I’d have to agree as well as with what you have mentioned! He says that my case is strong and is confident in a positive result, which gives me some confidence after the stress I’ve already gone through. :slightly_smiling_face:


#11

Thanks, jammer. I believe my lawyer is hoping for that. Fortunately I should get a decent tax refund this year, fingers crossed, which will keep me puttering along for a little breathing room for a couple of months!