3 Key facts to remember if denied LTD | Disability Law Show TV – S4 E22

Episode Summary

3 KEY FACTS TO REMEMBER IF DENIED LTD on Season 4 Episode 22 of the Disability Law Show with disability lawyer and national practice leader, James Fireman.

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

Cut off of LTD due to social media post

I made a post early in the pandemic on Facebook about how difficult my life is and the “jobs” I’ve had to take on as a result of my kids being at home due to COVID-19. My insurance adjuster saw this post and decided to cut off my benefits. How is this possible?

• Behaviour leads to the end of benefits: In many cases, insurance companies will give vague reasons as to why a claimant is cut off from their disability benefits. Once a legal claim has begun, a disability lawyer is able to access all files and documentation from the insurance company to determine the real reason benefits were denied or cut off. Claimants who are open and honest with both their insurance company and treating doctors have nothing to fear in terms of posting on social media. Claimants who are worried about their social media posts being taken out of context should keep in mind their privacy settings and who has access to their posts.
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    Surveillance on long-term disability benefits

Denied LTD and told to appeal despite hearing loss

My doctor told me to apply for long-term disability benefits because I am suffering from substantial hearing loss. I applied for long-term disability benefits but was denied and told to appeal.

• The appeals process: Claimants are often unaware of the fact that the appeals process was created by insurance companies. Appeals are rarely effective and generally waste a claimant’s time. During the appeals process, the claim that was initially denied is not reviewed by an external third party and is often inspected by the same party which initially denied benefits. Appealing an LTD denial keeps the power with the insurance company and keeps claimants at a disadvantage.

3 Key facts to remember if denied LTD

• Appealing a denial may be ineffective: Appeals give power to the insurance company and claimants should instead consider filing a legal claim. The appeals process is not a formal process as there is no law that outlines how an appeal should be conducted. Each insurance company decides how they wish to proceed with an appeal.
• You have two years to take action against the insurance company: From the date of an initial denial, claimants have up to two years to pursue a legal claim. The limitation period can often be affected by a claimant who has brought forth several appeals.
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• Talk to a disability lawyer to find out what your options are: In order to regain their own influence and power, claimants are within their rights to seek legal advice to determine their own privileges. Most disability lawyers work on a contingency basis and so there are no additional financial burdens for clients.

Diagnosed with a progressive disease but denied LTD benefits

My mother is on dialysis due to an extremely rare kidney disease, resulting in extreme fatigue. When she applied for long-term disability benefits, she was denied. Was the insurance company’s decision fair?

• Progressive condition and disability benefits: Insurance adjusters generally do not like to pay out long-term disability benefits for claimants when their primary symptom is fatigue. Exhaustion as well as chronic pain, are considered to be subjective despite the fact that they can influence an employee’s ability to work. Claimants who have their doctor’s support, as well as a diagnosis, should have a strong claim for disability benefits. Rather than assuming the insurance company is right, claimants should speak to a disability lawyer to determine what their next steps could be.

Resign from employment while on long-term disability

Can I quit my job while I’m using long-term disability benefits?

• Employment issues and LTD: While employees are within their rights to resign from their position while on long-term disability it is not advisable to do so. Most claimants on long-term disability are working to recover and ideally be able to return to work. Claimants are typically also receiving group benefits while employed and by resigning could lose many other rights and privileges. Employees who are let go from their position while on disability benefits will still continue to receive their disability benefits as long as they continue to be disabled.

Constant updates are required by insurance adjuster

I have had difficulty moving my left foot ever since I had knee replacement surgery. The surgeon said it may take some time before I regain full use of the limb. My insurance adjuster has started asking me a growing list of questions. I feel like he may try to cut off my payments soon. What should I do?

• Communicating with the insurer: Claimants should be wary if an insurance adjuster is asking for constant updates in increasing frequency. Claimants should ensure that all communications with their insurance adjuster are recorded, preferably in writing. Claimants can summarize all communications with the insurance adjuster in order to ensure their version of events is documented. Claimants should also ensure that all up-to-date medical records are given to the insurance company, including a prognosis and likelihood of recovery. It is critical for claimants to put themselves in the best position possible if their benefits have been cut off to challenge the denial or end of benefits.

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Previous Episode: Disability Law Show S4 E21 – Common misconceptions of beginning an LTD legal claim