What to Know About Insurer-recommended Treatment | Disability Law Show TV – S7 E18

Episode Summary

WHAT YOU NEED TO KNOW ABOUT INSURER-RECOMMENDED TREATMENT on Season 7 Episode 18, the Disability Law Show with Disability Lawyer and Partner, Tamar Agopian.

Watch above to discover the steps you must take when the insurance company cuts off or denies your long-term disability claim anywhere in Canada, on the only disability law show on TV and radio in the country.

Episode Notes

Duration of long-term disability benefits

My disability policy caps coverage after 5 years on long-term disability. After 2 years on claim, my benefits were cut off. What can I do as I am still unable to work?

• Terms in a disability policy: Claimants often mistakenly believe they are unable to continue disability benefits after two years. In many long-term disability policies, claimants are typically unable to continue receiving benefits after reaching the age of 65. This provision ensures that while a claimant remains disabled from working, with the support of treating doctors, they can continue to receive benefits for many years – benefits would not end after two years.

Told to work in another occupation by disability insurer

My insurance company terminated my coverage after over three years. I’ve worked in the banking industry for decades and have been receiving treatment for depression through medication and psychotherapy. The insurer is now saying I can work in a different occupation. How is that possible?

• Any occupation period: Claimants who have been approved past the two-year mark have likely been analyzed by their insurers and found to have been unable to work in any occupation. Insurers must adhere to the advice of a claimant’s treating medical team, but often presume claimants will appeal a denial of benefits.

What you need to know about insurer-recommended treatment

• Insurance companies can suggest treatment or therapies: Claimants are not obligated to follow the advice of insurer-recommended treatment providers. Claimants are within their rights to ask for further information and support from their own treating doctors.
• Judgment of courts: Claims that result in legal action and lead to court, judges tend to prefer the opinion of a claimant’s treatment provider, rather than that of the insurer. Individuals should engage with their medical team and ensure reports and documentation continue to support their claim. 
  
• Pursuing legal action: In the event an insurer threatens to end benefits due to non-compliance, claimants can seek legal action and should seek the advice of a disability lawyer.

Forced to start a return-to-work program

A few months ago, my insurer tried to force a gradual return-to-work program, without consulting my physician, and sent it straight to my employer. Shortly after, they claimed I no longer qualified for their definition of disability and gave me two options: go back to work or appeal, or lose my benefits.

• Returning to work after disability leave: Claimants should look solely to their treating medical professionals regarding a return to work. Returning to work before a claimant is ready can result in further worsening of symptoms. Returning to work is a medical decision, and insurers must look to a treating doctor to act in good faith.

Intrusive surveillance by disability insurer

In the past few weeks, strangers have approached me outside my home, asking invasive questions about my life and daily routine. After some back and forth, they admitted they work for the insurance company paying my benefits. This has seriously impacted my health and aggravated my PTSD.

• Surveillance and disability benefits: Insurance companies are within their rights to implement surveillance; however, it is rarely successful. Surveillance must not impact the claimant’s health and recovery. While surveillance is used to justify terminating benefits, it is rarely used. Insurers are more likely to use social media as a basis to cut off a claim.

PREVIOUS EPISODE: Disability Law Show S7 E17 – How LTD and CPPD Work Together