Preparing for an Independent Medical Examination | Disability Law Show TV – S5 E12

Episode Summary

PREPARING FOR AN INDEPENDENT MEDICAL EXAMINATION on Season 5 Episode 12 of the Disability Law Show with disability lawyer and Partner Tamar Agopian.

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

Episode Notes

Lack of diagnosis leads to LTD cut-off

I worked in a medical environment and was dizzy, had brain fog, etc. My doctors believed I was unable to work but were not sure what my diagnosis was. Despite this, my benefits were cut off. What can I do?

• Diagnosis and prognosis: Claimants who have the support of treating doctors and have exhibited symptoms that ensure an inability to work should receive continued long-term disability. In many cases in which there is a new or undiagnosed medical condition, claimants are often denied LTD by insurers. Claimants should remember that despite their condition, a diagnosis is not necessary in order to receive long-term disability coverage.

Disability benefits cut off at the 2-year mark

I’ve been off work for 3 years and received LTD for 2 of them. I’m currently fighting to get my benefits reinstated. If I get better, does my company have to take me back?

• Change in definition period: Under most disability policies, the initial test in order to qualify for long-term disability requires claimants to prove that they are disabled from working in their own occupation. After the first two years, a change in the definition of disability occurs. Claimants have to prove that they are unable to work in any occupation in which they have the skills and training. Many claimants have their disability benefits cut off as the change in definition occurs.
• Accommodations at the workplace: Employers have an obligation and duty to accommodate employees with a medical condition up until the part of undue hardship. Employers that fail to meet this requirement could face human rights damages.
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    Employment concerns and long-term disability

Preparing for an Independent Medical Examination

• Definition of an IME: The independent medical examination is an assessment conducted by one of the insurance company’s own selected doctors, specialists, or experts. This professional will assess the claimant and provide a report. The insurance company typically spends money on an IME in order to lead to an end of disability benefits.
• Refusing to attend an IME: Generally a claimant must attend an independent medical assessment as it is a provision in their disability policy. A refusal to do so could be seen as non-compliance and lead to further complications, such as a premature cut-off from disability benefits.
• Preparing for an assessment: Claimants should know when the IME will take place and where. In some cases, insurers might be expected to arrange transportation for claimants. Claimants should also ensure that their doctors are aware of the IME and receive a copy of the report after the assessment has taken place.

Late LTD application told to appeal

My brother has been battling health issues for the past few years, including alcoholism. His application for LTD was denied due to a late application, which was due to his employer. We’ve been advised to appeal this decision. What should we do?

• Appealing a long-term disability denial: The appeals process is rarely successful and claimants should instead speak to a disability lawyer to determine their next steps if they have been denied benefits. Appeals are not conducted by a third party and are not considered an objective process.
• Addiction and LTD claim: Insurers generally do not like claims that comprise substance issues. Despite substance abuse issues being considered disabilities, insurers will often use technical reasons, like a late application, in order to deny benefits.

LTD cut off due to surveillance

While on LTD I started seeing a psychotherapist that the insurer recommended. I was encouraged to engage in outdoor activities but after my insurer conducted surveillance, my claim was cut off. I’m still not well enough to work.

• Insurer conducts surveillance: Insurance companies often conduct surveillance in order to justify a cut-off or denial of long-term disability benefits. Claimants that are following the recommended treatment of their medical team and doctors should not worry about surveillance. Surveillance is generally considered unreliable by courts.

PREVIOUS EPISODE: Disability Law Show S5 E11 – 3 common LTD terms you need to know – and why