If the adjuster or case manager handling your long-term disability claim is difficult to deal with, unresponsive or pressuring you to return to work, you don’t have to simply accept the situation.
The person managing your claim can ask for medical information, discuss treatment and return-to-work plans, arrange assessments and communicate decisions about your benefits.
You should cooperate with reasonable requests, but you can also ask questions, keep communication in writing, raise concerns and request that a problem be reviewed by someone else at the insurance company.
On This Page:
- What Does an LTD Adjuster Do?
- Common Problems
- If They Aren’t Responding
- Can You Request a Different Adjuster?
- How Should You Communicate?
- Return-to-Work Pressure
- Making a Complaint
- When to Contact a Lawyer
What Does an LTD Adjuster or Case Manager Do?
The person managing your LTD claim can be called an adjuster, claims specialist, disability case manager or another similar title.
Their role can include:
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Reviewing your application and medical information
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Requesting updates from you or your doctors
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Asking questions about your symptoms and ability to work
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Arranging medical or functional assessments
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Discussing rehabilitation or return-to-work plans
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Communicating decisions about your benefits
You can have significant contact with this person during a long LTD claim, so problems with communication can quickly become frustrating.
Common Problems With LTD Adjusters and Case Managers
Problems can include an adjuster who:
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Doesn’t return calls or emails
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Keeps asking for information you already provided
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Sets short deadlines for medical forms
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Doesn’t clearly explain what information is missing
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Questions why you haven’t returned to work
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Pushes a rehabilitation or return-to-work plan you don’t believe you can manage
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Is rude, dismissive or aggressive
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Warns that your benefits could end without clearly explaining why
The appropriate response depends on the problem. A missed phone call is different from an insurer threatening to stop your income.
What if Your LTD Adjuster Isn’t Responding?
If calls are going unanswered, follow up in writing.
Your email can briefly state:
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When you previously contacted them
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What question or issue needs to be addressed
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Whether there is an upcoming deadline or missing payment
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When you need a response
Keep copies of your messages and any responses.
If the adjuster continues not to respond, ask for their supervisor or another contact at the insurance company.
If the lack of response is delaying the claim or your payments, don’t let the problem continue indefinitely.
What if the Adjuster Keeps Asking for More Medical Information?
An LTD insurer can ask for updated medical information to determine whether you continue to qualify for benefits.
If you keep receiving requests, ask:
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Exactly what information is missing
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Which period the insurer needs records for
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Whether information already provided answers the request
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What deadline applies
Don’t ignore reasonable requests, but you also shouldn’t have to guess what the insurer wants.
See our guide to medical evidence for long-term disability claims.
Can You Request a Different Insurance Adjuster or Case Manager?
Yes, you can ask the insurance company to assign someone else to your claim.
The insurer doesn’t necessarily have to agree simply because you would prefer another adjuster. Your request will be stronger if there is a specific problem with how the claim is being handled.
For example:
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Repeated communications are being ignored
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Important information is repeatedly lost or overlooked
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The adjuster communicates in an inappropriate or aggressive way
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The relationship has broken down to the point that the claim can’t be managed effectively
Make the request calmly and in writing. Give specific examples rather than simply saying that you don’t like the adjuster.
How Should You Communicate With an LTD Adjuster?
Keep communication accurate, professional and easy to document.
A few simple habits can help:
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Use email for important issues. It creates a clear record of what was requested and how you responded.
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Keep your answers focused. Answer the question being asked without guessing or providing information you aren’t sure about.
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Confirm important phone conversations. Follow up by email if a call involved a deadline, return-to-work plan or important decision.
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Meet deadlines. If you need more time because you are waiting for your doctor, ask for an extension in writing.
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Keep your own claim file. Save correspondence, forms and medical information.
Our LTD claim checklist explains which records are useful to keep.
What if Your Case Manager Is Pressuring You to Return to Work?
Your return to work should be based on your medical abilities—not simply the date preferred by the insurer.
If your case manager proposes a return to work, speak with your treating doctor about whether you can safely return and what restrictions or accommodations you need.
Depending on your condition, that can mean:
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A gradual return
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Reduced hours
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Modified duties
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Workplace accommodations
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Remaining off work because you aren’t medically ready to return
Read our guide to returning to work after long-term disability.
If the insurer says benefits will stop unless you return, get advice before agreeing to a plan that your medical team doesn’t support.
What if Your Adjuster Says Your LTD Benefits Could Be Cut Off?
Take any warning about your benefits ending seriously.
Ask the insurer to explain:
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Why your benefits are being reviewed
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What information it believes is missing
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What evidence it is relying on
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Whether it has set a date for benefits to end
If the insurer has requested an IME, vocational assessment, extensive medical updates or a return-to-work plan, the claim can be moving toward a significant decision.
Read what to do when your LTD benefits are under review or about to be cut off.
Can You Complain About an LTD Adjuster?
Yes. If there is a genuine problem with how your claim is being handled, you can raise it with the insurance company.
Start by documenting the issue. Include dates and specific examples rather than general accusations.
You can then ask to speak with:
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The adjuster’s supervisor or manager
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The insurer’s complaints department
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Another person identified in the insurer’s complaint process
A complaint about the adjuster is different from challenging a decision to deny or terminate your LTD benefits.
If your benefits are at risk, focus on protecting the disability claim as well as addressing the communication problem.
When Should You Contact a Disability Lawyer?
A frustrating adjuster doesn’t always require legal action. But get advice if the problem starts affecting your benefits.
That includes situations where:
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Your claim has been delayed for an unreasonable period
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The insurer keeps demanding information without explaining what is missing
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You are being pressured to return to work against medical advice
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The insurer has scheduled an independent medical examination as part of a review
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Your case manager says benefits could end
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You have received a future cutoff date
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Your benefits have already been denied or terminated
You don’t have to wait until the insurer formally denies the claim to get advice.
If benefits have already stopped, read our guide on what to do when your long-term disability claim is denied or terminated.
Frequently Asked Questions About LTD Adjusters
Can I Ask for a New Insurance Adjuster?
Yes. You can ask the insurance company to assign another adjuster or case manager. Explain the specific problems with how your claim is being handled. The insurer doesn’t necessarily have to agree to the request.
What if My Insurance Adjuster Won’t Respond?
Follow up in writing and keep a record of your attempts to contact them. If the problem continues, ask for a supervisor or another contact at the insurance company.
Can an LTD Adjuster Contact My Doctor?
The insurer can request relevant medical information needed to assess your claim, subject to the authorizations and rules that apply. Read forms carefully so you understand what information you have agreed can be obtained.
Do I Have to Answer Every Question From My LTD Case Manager?
You need to cooperate with reasonable requests related to your LTD claim. If a question seems unclear, overly broad or unrelated, ask why the information is needed before refusing to answer.
Can My Adjuster Force Me Back to Work?
The adjuster can take the position that you are medically able to return and the insurer can make decisions about your benefits. Your actual return to work should be based on your medical abilities and the advice of your treating professionals.
Should I Record Calls With My LTD Adjuster?
A simpler approach is often to keep detailed notes and confirm important conversations by email. That gives you a written record of deadlines, requests and important decisions without creating unnecessary disputes about recordings.
Get Help With Problems in Your LTD Claim
You should be able to communicate with the person managing your disability claim without being ignored, pressured or left guessing about what the insurer needs.
If problems with your adjuster or case manager are delaying your claim, threatening your benefits or making it difficult to protect your rights, get legal advice.
Samfiru Tumarkin LLP helps people with long-term disability insurance claims throughout Canada, excluding Quebec. Our long-term disability lawyers can respond to the insurance company and get you what you’re owed.