3 Fast facts about cancer and LTD | Disability Law Show TV – S5 E26

Episode Summary

3 FAST FACTS ABOUT CANCER AND LTD on Season 5 Episode 26 of the Disability Law Show with disability lawyer 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, with the exception of Quebec, on the only disability law show on TV and radio in the country.

Episode Notes

The insurer insists on another occupation

I was diagnosed with Crohn’s disease but managed to keep working for years in a sales role. After a regression in health, I applied and was initially approved for LTD. After almost 2 years, I was cut off.

• Any Occupation period: After two years on long-term disability benefits, the test in order to continue to qualify changes. The change in the definition of disability shifts from an inability to work in a claimant’s own occupation, to any occupation. Claimants are often cut off from benefits at this period by insurers despite a continued disability.

 Surveilled while on long-term disability

I’ve noticed in the past couple of weeks someone is following me with a camera while I do errands. Should I change my habits because of possible surveillance? My doctors have encouraged me to try to find a routine.

• Surveillance by insurance adjuster: Insurance adjusters are within their rights to conduct surveillance on claimants. Surveillance can often be conducted with certain claims, such as mental health claims, due to the complex and invisible nature of many illnesses. It is important for individuals to continue to be honest with their disability adjusters, and follow advice from their treating doctors. Surveillance footage is rarely viewed in high regard by courts.

3 Fast Facts about Cancer and LTD

• Eligibility to apply for disability benefits: Individuals diagnosed with cancer who have been able to work for a period of time are still able to apply for disability benefits. Many claimants can no longer continue working due to the rigorous treatment plans they are put on.
• Pre-existing conditions: Some disability policies can consider cancer as a pre-existing condition. Pre-existing clauses were meant to deter individuals from “shopping” for better benefits coverage. This is despite the fact that this is a rare occurrence with most claimants. It is important for claimants to consider legal advice and take a close look at the pre-existing clause in their policies.
• Reason for denial of claim: Many cancer claims are denied as disability insurers believe individuals are able to work in a sedentary position. Adjusters often don’t take into consideration lingering symptoms, and secondary issues, such as mental illnesses, as a result of the initial diagnosis.

Medical condition deemed “work-related”

My brother was recently denied LTD and told his back issues were work-related. He was working as a mechanic and his doctor and physiotherapist think he may never be able to return to his job. Is he still entitled to benefits?

• Disability considered conditional: Claimants are often told by insurance adjusters that their conditions are “work-related” and do not exist outside of the workplace or are directly the result of a work environment. Despite the cause of a condition, claimants with ongoing debilitating symptoms and the support of a doctor should receive benefits. Claimants should ensure their doctor’s reports are detailed and specific to their limitations. Workplace-related conditions can mean claimants could pursue other benefit programs, such as Workers’ Compensation.

Claim denied due to insufficient medical documentation

It took some time for my sister to send her medical records to the insurer as her treating doctor was away. Her claim was then denied due to insufficient medical information.  Should she appeal this decision?

• Appealing a denial of benefits: The appeals process was created by the insurance company and is rarely successful. Appeals are not conducted by an objective third party and are often assessed by the initial adjuster that denied a claim. Rather than file an appeal, a legal claim is more beneficial. Claimants should ensure all relevant medical information is provided to the insurer.

PREVIOUS EPISODE: Disability Law Show S5 E25 – 3 Common myths about insurance adjusters