3 Facts about insurance adjusters that can help your LTD claim | Disability Law Show TV – S4 E19

Episode Summary

3 FACTS ABOUT INSURANCE ADJUSTERS THAT CAN HELP YOUR LTD CLAIM on Season 4 Episode 19 of the Disability Law Show with disability lawyer and national 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 Ontario, British Columbia, or Alberta, on the only disability law show on TV and radio in Canada.

Episode Notes

A failed attempt at a return to work denied LTD

I suffer from Parkinson’s Disease and I’m an account executive. I also suffer from depression. I have been on LTD for over a year and then tried to return to work. Unfortunately, my return only lasted 3 weeks. My insurer informed me I did not try hard enough. What can I do?

• Unsuccessful return to work: The ultimate goal for many on disability leave should be an eventual return to work. It is important to note that claimants who try and return to work and are unsuccessful should be able to return to long-term disability leave if their doctors continue to support their inability to work. Most disability policies contain a recurrence clause that acts as a safety net for claimants who attempt a return to work. Long-term disability benefits should resume immediately for claimants who are unsuccessful in returning to work. Claimants who are denied LTD should contact a disability lawyer as soon as possible.

Off work awaiting surgery but denied LTD

I have been off work from my cleaning job due to severe back and knee pain, for which I am awaiting surgery. While I was approved for CPPD, the insurance company denied my LTD because they said that I’m not “totally disabled”. I have no idea what other work they think I can do now.

• Denied benefits but approved for CPPD: It is important for claimants who are disabled with a severe and prolonged disability to apply for CPPD. The test in order to qualify for CPPD is more difficult than that for long-term disability. It is very difficult for insurance adjusters to justify denying LTD benefits to a claimant who has already been approved for CPPD. Claimants should not assume the insurance company is right in denying their benefits and should seek legal advice to begin a claim. Most cases are resolved within weeks or months of involving a disability lawyer and rarely go to court.

3 Facts about insurance adjusters that can help your LTD Claim

• Deny LTD claims without reading all medical documentation: It is very common for insurance adjusters to skim and miss information in a claimant’s medical records and documentation. It is clear to many disability lawyers upon receiving a claimant’s file, that insurers have not had the time to review all information given.
• Decisions are based on incorrect information provided by consultants: It is quite common for insurance companies to retain or hire a third party to review a claimant’s file that is not a doctor’s. A claimant’s treating doctor’s opinion will always carry more weight, particularly in court, as they have a better relationship with a claimant and has intensive medical knowledge of a claimant’s disability and medical history.
• You are within your rights to report your adjuster: Insurance adjusters are contractually obligated to treat and act in good faith with claimants. Often adjusters can cause further stress to claimants who are trying to seek treatment and better their own health. Claimants are within their rights to file a complaint and request a new adjuster. In some cases, if an adjuster’s behaviour has caused significant harm to the claimant, they can be owed additional damages.

Given a return to work plan despite ongoing mental health struggles

I was told to attend a medical assessment after being on LTD for several years. The doctor confirmed that I’m still not able to work but that didn’t matter to the insurance company. I’ve been told that my benefits will end soon, and I’ll be put on a return-to-work plan. How should I proceed?

• Mental health claims and IMEs: Additional damages can be owed to a claimant if an adjuster has caused stress and harm. While it is common for an adjuster to request an independent medical assessment, it is uncommon for a consultant to confirm the treating doctor’s opinions. Claimants should listen solely to their own medical team when determining whether or not they are ready to return to work. Resuming work before a claimant is ready can cause a regression in health for the claimant.
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Previous Episode: Disability Law Show S4 E18 – 3 Key things claimants with Parkinson’s need to know