As teachers, you have been paying 100% of the cost of your LTD coverage with OTIP. You expect LTD benefits to be available to you if and when you need them. Unfortunately, OTIP, like other insurers, often deny legitimate claims, leaving teachers wondering what to do and where to turn. Teachers tell us of conflicting advice and information they receive from OTIP, their school boards, their union representatives, and from other teachers.
If OTIP has denied your LTD claim and you are not able to return to work, you will probably be wondering what options are available to you to dispute the decision and have your LTD benefits paid to you while you continue to disabled from work. It is critical that you are fully aware and understand all options that are available to you and the implications of choosing one option over another.
The OTIP denial letter you received sets out only your option to appeal its decision, internally. The letter provides a list of documentation and information that you may submit for review by its Appeals Committee. OTIP also offers to help you appeal its own decision. You might also be advised that if your appeal to OTIP is unsuccessful, then you can apply to your union to consider taking on your dispute with OTIP by way of arbitration. At its discretion and upon evaluating your claim according to its own criteria, your union may or may not decide to arbitrate the issue of your eligibility for LTD benefits. However, internal OTIP appeal and arbitration are not your only options if your claim has been denied.
What many teachers do not know is that appealing the OTIP denial and then hoping that your union will help you if your appeal is denied, are not the only options to dispute the denial of your LTD claim and more importantly, they might not be the best options for you.
In fact, sometimes the best option and sometimes the only option will be to hire a private bar lawyer to assist you with your appeal and/or to represent you in a Court Action against OTIP for the payment of your LTD benefits.
Many teachers are surprised to learn that there is no requirement to appeal or arbitrate the denial of the OTIP LTD benefits. As soon as you learn that benefits will not be paid as of a particular date, you may forego the appeal process and sue OTIP in Court. That said, commencing a Court Action is not to be taken lightly and the specific facts and evidence must be considered before deciding that a Court Action is the best option.
It is critical that you understand and weigh all of your options before deciding to appeal the OTIP denial (either with or without help from an OTIP representative), deciding to apply to your union to represent you at an arbitration, or commencing a Court Action.
I have been representing teachers in their OTIP LTD benefit disputes for over a decade and before that, I represented OTIP in defending their LTD denials, for nearly as long. OTIP claims are complex and require an in-depth knowledge of the OTIP LTD Plan as well as other important benefits, employment and pension issues and entitlements.
At MK Disability Lawyers we offer trauma-informed, confidential, and free consultations to teachers who would like to better understand their options. During our consultation, we will review your OTIP LTD denial letter, discuss your disability and your LTD claim, and in consultation with you, we will then weigh your options and assess which course of action will best serve you in the context of your claim and your disability.
If you would like our assistance or representation in your appeal or in a Court Action, we provide trauma-informed, experienced legal services dedicated to teachers who are disabled and disputing the denial or termination of their OTIP LTD claims.