3 Common questions about IMEs | Disability Law Show TV – S7 E04

Episode Summary

3 COMMON QUESTIONS ABOUT IMES on Season 7 Episode 04 of the Disability Law Show with disability lawyer and co-founding Partner Sivan Tumarkin.

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

Opinion of the insurance company’s consultant

I suffer from many chronic ailments and this has led to other mental health issues. I’m continuing to seek treatment and have been on LTD for about a year. My insurance adjuster recently informed me that one of their professionals reviewed my file and didn’t believe I’m “totally disabled”. What can I do here?

• Medical professional’s opinions and recommendations: Insurance companies often hire consultants who will review a claimant’s medical records despite not being a specialist or well-versed in the claimant’s medical condition. The opinion of a claimant’s treating medical team ultimately carries more weight, particularly in court.

Disability insurer harasses claimant

My son had a seizure at work and was later diagnosed with epilepsy. He was on long-term disability, but the insurer repeatedly harassed him to return to work. The harassment from the adjuster led to additional stress and his condition worsened.

• Behaviour of disability insurer: It is not uncommon for individuals on claim to have had a traumatic or stressful communication with their insurance adjusters. Despite this, insurance adjusters are legally bound to act in good faith with their claimants. A failure to do so, particularly if it leads to a regression in recovery for those on claim, can lead to punitive damages.

3 Common questions about IMEs

• Definition of an independent medical exam: An independent medical examination, despite its name, is not independent. The insurance company selects a medical professional to examine a claimant and their file, to determine if they are eligible for disability benefits.
  
• Requirements and obligations in policy: Claimants must attend an independent medical examination if requested by their adjuster. An IME must be relevant to a claimant’s medical condition. Claimants can question the insurer if the assessor they will be evaluated by and should seek legal advice from a disability lawyer.
  
• Cut off from benefits: The results of an independent medical evaluation are used by insurance companies to cut off disability benefits. A disability lawyer can help a claimant prepare for an IME.

Returning to work from LTD

My sister has been on disability leave for the past year due to a concussion and ongoing symptoms. After much therapy, her medical team cleared her to gradually return to work part-time. The insurer is pushing for her to return to her full-time position. What can she do if she returns to work full-time but starts to feel worse?

• Failed attempts to work after disability leave: Insurance adjusters often pressure claimants to return to work before they are medically cleared by their doctors. Claimants should not feel they have to follow these orders. Only treating medical professionals should decide when and how claimants should resume working. A doctor’s report can outline the specifics of a claimant’s ability to return and necessary accommodations. A failed attempt to return to work can trigger the recurrence clause in most disability policies, which permits an immediate resumption of disability benefits.

Subjective symptoms and applying for LTD

I have vestibular dysfunction that leads to frequent falls, and chronic severe migraines. I do physiotherapy and see a chiropractor and osteopath regularly. After more than a year without improvement, I’ve developed anxiety and depression. My results were inconclusive after an MRI and CT scan. Do I have any chance of being approved?

• Reasons for denying LTD: Claimants should not be concerned with whether or not their symptoms are objective. Courts have confirmed that many symptoms entitle one to disability benefits if they lead to an inability to work. Many mental health conditions are considered to be invisible illnesses. Support from a doctor is imperative despite a lack of medical imaging or other objective medical evidence.

PREVIOUS EPISODE: Disability Law Show S7 E3 – Guide to Heart Conditions and LTD