What to know about medical files while on LTD | Disability Law Show TV – S5 E16

Episode Summary

WHAT TO KNOW ABOUT MEDICAL FILES WHILE ON LTD on Season 5 Episode 16 of the Disability Law Show with disability lawyer and Partner Tamar Agopian and national practice leader and disability lawyer, James Fireman.

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

Disability benefits cut off due to non-compliance

I’ve been on LTD due to mental health concerns. I had a hard time accessing treatment and as a result, my benefits were cut off due to non-compliance. What can I do?

• Mental illnesses and disability benefits: Claimants struggling with mental illnesses, like depression and anxiety, are obligated to pursue and undergo treatment for their disability. All claimants, despite the nature of their illness, are expected to comply with the provisions outlined in their disability policies. Many claimants struggled with treatment options during the pandemic, and insurers are unaware that their behaviour should not add additional stress and a deterioration of health. Claimants that have had their benefits cut off due to non-compliance should seek legal advice as often, insurers pre-emptively deny benefits and can incur future damages due to their conduct.

CPPD deductions while on LTD

My sister is currently on long-term disability. She was being paid LTD but now she is also collecting CPP Disability. Her insurer is now deducting that amount from her benefits.

• CPP Disability and LTD: CPP Disability is a program run by the federal government. Individuals that have paid into the CPP, if they have a disability, they are entitled to apply. The test in order to qualify for CPPD is more difficult compared to long-term disability as the disability has to be considered severe and prolonged. Under most disability policies, insurers are able to claim a credit if a claimant receives CPP disability and deducts accordingly.

What you should know about your medical files while on LTD

• Detailed doctor’s reports: It is vital for a doctor’s report to be detailed as there are many disabilities that an insurance adjuster does not adequately comprehend. Many insurers do not have any medical background and need to understand why specific symptoms can lead to an inability to work. Treatment plans should also be outlined by a treating doctor.
• An absence of a medical report: Generally doctors’ files are concerned with the treatment of patients and test results. Most doctors are not aware of the specifics needed for a disability benefits application. For the purpose of a disability insurance claim, doctors have to include documentation they would otherwise not think of. Claimants should not assume that their doctors are aware of what their job entails.
• Speaking to a disability lawyer: Doctors with patients that are applying for disability benefits are able to seek legal advice and should do so. A lot of the time patients simply provide their doctors with basic forms and no additional context. Important details can be provided to doctors by a disability lawyer.

Switching treatment providers after an IME

After an IME, the insurer has recommended I switch treatment providers to a psychotherapist they believe will be more helpful. If I refuse to change my therapist, can my benefits be cut off?

• Independent medical examinations: Under most disability policies, claimants are required to attend an independent medical examination if requested by the insurer. Claimants should consult with their own medical team before switching treatment providers, particularly at the behest of the insurance company. Treatment providers referred to by the insurer could possess an inherent bias and an intent on pushing a claimant back to work.

PREVIOUS EPISODE: Disability Law Show S5 E15 – What to know about LTD if suffering from depression