3 Common misconceptions about “total disability” | Disability Law Show TV – S5 E22

Episode Summary

3 COMMON MISCONCEPTIONS ABOUT “TOTAL DISABILITY” on Season 5 Episode 22 of the Disability Law Show with disability lawyer and co-managing Partner Sivan Tumarkin.

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

No explanation from the insurer after an LTD denial

I was in a serious car accident over a year ago. As a result, I have a mild traumatic brain injury and chronic pain as well as some mental health issues. Despite my inability to work, I was denied LTD and not given a valid reason.

• Reasons for denying disability benefits: Many insurance companies deny disability claims on the basis that a claimant is not considered “totally disabled” from their own occupation. No other valid reasons are offered by the insurance company, despite the support of treating doctors. In the event of a denial, it is important for claimants to seek advice from a disability lawyer.
• Injuries after a car accident: After a serious car accident occurs, claimants with substantial injuries, like a brain injury, are able to pursue Section B benefits. It is vital for individuals who have been involved in a car accident to seek immediate medical attention, document the incident, and contact a personal injury lawyer.

Applying for CPPD while on LTD

I have been on LTD for over 2 years now after a heart attack and a heart arrhythmia diagnosis. The insurance company has recently been insisting I apply for CPP benefits. Do I have to apply for CPPD?

• Benefits of applying for CPPD: While claimants cannot be forced to apply for CPPD, despite a lack of an application, the insurance company will still deduct from monthly benefits accordingly. Most disability policies will offer credits to the insurance company as a result of receiving approval from other benefit programs, like CPP Disability. Acceptance under CPPD can strengthen an LTD claim as it is more difficult to be considered disabled under CPPD and receive approval.

3 Common misconceptions about “total disability”

• The definition of “total disability”: A common misconception about “total disability” is the very definition of the term. In the context of long-term disability, in order to be totally disabled a claimant cannot perform the essential tasks of their own occupation. To be “totally disabled” does not mean a complete inability to function in relation to disability benefits.
• Insurance adjuster’s role: In order to be considered disabled from working, claimants need the support of their treating doctors and medical professionals. The insurance adjuster is not considered the ultimate determinant of a claimant’s disability.
• Steps after a denial of LTD: While it may seem that a claimant has no further recourse after a denial, there are other options available. Claimants should seek out the advice of a disability lawyer in order to pursue a possible legal claim. The appeals process is generally unsuccessful as it is not conducted by an objective third party.

Denied LTD due to workplace issue

News of a new manager triggered a mental breakdown and my doctor put me off work. I’m under treatment for PTSD and panic attacks. Despite this, my benefits were denied as I was told it was a workplace issue.

• Generalized vs. specific workplace issue: Mental illness disability claims are often viewed skeptically by insurance adjusters. Insurers often deny claims on the basis that a mental illness is a result of a toxic workplace, and does not exist outside of the work environment. Depression and anxiety, as well as other mental health conditions, can arise as a result of a work environment but can develop into a generalized condition.

Losing your job and needing disability benefits

My doctor believes I am ready to return to work but on a part-time basis and with restrictions in place. After speaking to my boss, I was told I can only return as a full-time employee. If I lose my job, will my benefits be cut off?

• Employment issues while on LTD: Claimants should only return to work with the clearance of their treating doctors. A return to work with necessary restrictions must be accommodated by an employer. In some situations, employment and disability issues can overlap. It is important to seek legal advice from a lawyer that is experienced in both employment and disability law.

PREVIOUS EPISODE: Disability Law Show S5 E21 – Applying for LTD because of fibromyalgia