3 Important facts about the appeals process in LTD claims | Disability Law Show TV – S5 E09

Episode Summary

3 IMPORTANT FACTS ABOUT THE APPEALS PROCESS IN LTD CLAIMS on Season 5 Episode 09 of the Disability Law Show with national practice leader and disability lawyer and 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

A doctor denied mental health disability benefits

I worked as a doctor in the ER and as a result of COVID-19, have developed depression and anxiety. Despite support from treating doctors and psychiatrists, my private disability cut off my LTD benefits as they believe the pandemic crisis has passed.

• Mental illnesses as a result of the pandemic: Many individuals who have the support of their treating doctors are denied long-term disability benefits or had benefits cut off. In some situations, particularly with mental illnesses, a workplace can trigger an illness that becomes generalized. Insurance companies will often try and argue that the disability is in fact situational, and a workplace issue. Claimants that have been denied benefits and are still unable to work should contact a disability lawyer as soon as possible.

Doctor approval for a return to work

I have been on LTD for over a year under the care of a family doctor & psychiatrist. I was told by my insurance adjuster that they do not need my own doctor to sign off on a return to work. Is this true?

• Returning to work from LTD: Claimants that are on long-term disability must receive the support of their treating doctors and medical team before they attempt a return to work. In many cases. claimants that feel pressured to return to the workplace before they are ready, experience a regression in their recovery or a worsening of symptoms. Ultimately, insurers cannot force claimants to return to work before they are medically cleared to do so.

Three important facts about the appeals process in LTD claims

• Appeals are an internal process: Appeals are not arbitrated by an objective third party. Often, an appeal is conducted by the same adjusters and individuals at the insurance company who originally denied the long-term disability claim.
• The success rate of appeals: It is very rare for appeals to be successful. Insurance adjusters created the appeals process in order to ensure the influence and power in the relationship with claimants, remain with them.
• Frustrated clients and wasted time: In some cases, claimants file multiple unsuccessful appeals and as time passes, believe the process to be futile. Appeals can waste valuable time for claimants as they have up to two years after the date of denial to file a legal claim.

Attending an IME for a second opinion

I have a serious heart condition that came on years ago. My cardiologist instructed me to stop working as any sort of stress gets my heart going. Despite this, my insurer has requested I attend an examination for a second opinion.

• Attending an IME: Most disability policies include a provision that permits insurance adjusters to request a claimant attend an independent medical examination. Claimants are required to attend an IME but can prepare for the assessment. The examinations are not typically independent as the doctors that assess claimants have been selected and paid for by the insurance company. Claimants should ensure all aspects of the assessment are documented and ensure their own treating doctors are given the reports from the IME.

Mental illness triggered at work

After ongoing harassment at the office, my mental health took a serious negative turn. Repeated panic attacks lead to an inability to work. As these mental health concerns were triggered by my work environment, will I still qualify for disability benefits?

• Generalized vs situational LTD: It is not uncommon for claimants with mental illnesses to face questions regarding whether or not their disability is situational specific or has become a general illness. Individuals that are unable to work in any workplace as a result of their mental illness, despite the fact it was triggered at work, are entitled to disability benefits.
• Employment issues and long-term disability: In many cases, employment and disability issues can overlap. It is important to seek legal advice from a lawyer that is aware of the complexity of their claim.

PREVIOUS EPISODE: Disability Law Show S5 E08 – The difference between a denial of LTD and a cut-off of benefits