3 Common reasons for an LTD denial | Disability Law Show TV – S5 E27

Episode Summary

3 COMMON REASONS FOR AN LTD DENIAL on Season 5 Episode 27 of the Disability Law Show with disability lawyer and National Co-Managing Partner Sivan Tumarkin, 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, on the only disability law show on TV and radio in the country.

Episode Notes

Disability claimant refusing to take medication

My wife was in a serious car accident and suffered a concussion. After applying for LTD she was denied as she had refused a certain type of prescribed medication. What are her options?

• Following recommended treatment: Claimants on long-term disability are required to comply with the terms included in their disability policies. Terms typically include complying with recommended and reasonable treatments. In some cases, claimants might not be able to take certain medications or continue certain treatment methods. Insurers will often deny claims due to ignoring the specific context of a claimant’s refusal to comply with treatment.

No diagnosis leads to denial

About a year ago, my brother’s health started to decline. After rounds of tests, his doctors have yet to find a diagnosis. The insurance company has denied his claim, saying there is insufficient medical evidence. What can he do?

• Migraine disorders and invisible illnesses: There are many illnesses and medical conditions that are difficult to diagnose or provide physical imaging. Chronic pain, migraines, mental illnesses, etc., despite a lack of diagnosis, can still significantly impact an individual’s ability to work. Treating doctors must document all symptoms of a claimant’s condition and ensure the insurer receives all up-to-date information. The test to qualify for disability benefits does not require a diagnosis.

3 Common reasons for an LTD denial

• You are not considered “totally disabled”: Claimants are often denied disability on the basis that they are not “totally disabled“. This phrase is purposefully misleading and many individuals often assume they have to be completely disabled and cannot function. The term “totally disabled” in actuality refers to a claimant’s inability to function at their workplace based on their symptoms.
• Lack of objective medical evidence: It is vital for claimants to ensure their adjusters have all medical records and documentation pertaining to their disability. Some disabilities are objectively difficult to diagnose and provide imaging. Despite this, the support of a treating doctor and ongoing debilitating symptoms should lead to an approval of benefits.
• You can do another occupation: Under most disability policies, in the first two years of benefits claimants will have to prove they are unable to work in their own occupation. After two years, the test to qualify for benefits changes to an inability to work in any occupation. Insurers often cut off benefits as the change in definition period occurs despite a claimant’s continued inability to work. Insurers often overlook the fact that another occupation must have commensurate income and must be a position claimant has the training and experience for.

Pushed to return to work

I am currently on LTD due to arthritis in both my knees and hip. My insurance adjuster has been pushing me to return to work. I previously attempted a return-to-work program and was unable to make it through. What can I do?

• Returning to work after LTD: Some medical conditions can progress in severity over time. Claimants should only return to work if they are medically cleared to do so by their own doctors. Claimants that attempt to return to work but are unsuccessful should be able to resume benefits due to a recurrence clause. It is inadvisable for claimants to return to work before they are ready to do so as it can lead to a regression in recovery.

PREVIOUS EPISODE: Disability Law Show S5 E26 – 3 Fast facts about cancer and LTD