3 Key questions about appealing an LTD denial | Disability Law Show TV – S6 E06

Episode Summary

3 KEY QUESTIONS ABOUT APPEALING AN LTD DENIAL on Season 6 Episode 06 of the Disability Law Show with disability lawyer and Partner Tamar Agopian.

Watch above to discover the steps you must take when the insurance company cuts off or denies your long-term disability claim anywhere in Canada, on the only disability law show on TV and radio in the country.

Episode Notes

Earning other income while on LTD

I was on LTD leave due to a wrist injury from my dental hygienist position. In a conversation with my insurer, I mentioned I started making soaps as a hobby. My insurer then informed me my benefits would be paused pending an investigation. What can I do here?

•  Terms of disability policy: Some individuals have taken on hobbies that have eventually led to supplementary income or as a source of mental health support. Claimants need to look closely at the terms of their disability policy to determine if there are stipulations that will end ongoing disability benefits. Claimants should expect insurers to probe after a potential business venture is mentioned.
  

Disability benefits and severance

I’ve been on LTD for a while now. If I’m let go by my company while on disability leave, will the insurer automatically consider my severance pay as income and deduct it from my LTD payments?

• Severance and income while on LTD: Claimants need to seek legal advice from a disability lawyer aware of potential employment issues and how they could affect a disability claim. While continued employment is not necessary to receive disability benefits, a severance package can affect ongoing disability benefits. Insurers might receive a credit as a result of severance payments.
• Human rights violation: Employees cannot be terminated due to an illness or disability and might need to pursue legal action. Terminated claimants should speak to an employment lawyer to ensure their rights have not been violated.
  

3 Key questions about appealing an LTD denial

• Defining an appeal: An appeal is a process conceived of by the insurance company for claimants to pursue their benefits if they have been denied or cut off. This process is not included in the disability policy and there is no oversight and is largely driven by the insurer. Appeals are typically conducted by the insurers themselves and are not observed by an objective third party.
• When to file an appeal: Claimants can consider filing an appeal if there is new updated medical information for their claim. Generally, filing an appeal can waste valuable time for claimants who wish to pursue legal action.
• What to do if the insurance company rejects your appeal: In the event an appeal is denied, claimants should seek advice from a disability lawyer and file a legal claim. Legal claims are more beneficial and ensure claimants can focus on their health and recovery.

Unemployed and disability leave

I’ve been on LTD for nearly two years due to a serious heart condition. Recently, a co-worker mentioned that our company might be facing significant financial troubles. If the business shuts down and I lose my job, will my benefits be affected?

• Employment issues and disability benefits: Claimants can receive disability benefits if they were employed once disability benefits commenced. Disability benefits should not be impacted if a company shuts down. A group insurance plan can have other benefits other than simply disability benefits. Unemployment can lead to a loss of vital health benefits and a loss of treatment for claimants.
  

Anxiety due to talking to the disability insurer

Speaking to my insurance adjuster seems to increase my anxiety and stress. Is it possible to ask for less frequent updates from them? I’m worried that by avoiding communication, my LTD benefits will be cut off.

• Communicating with the insurance adjuster: Insurers are obligated to ensure that benefits are dispensed regularly. This leads to communication between an adjuster and claimant to ensure an updated disability and medical status. Claimants are within their rights to speak to their treating doctor if communications are causing ongoing health concerns. Claimants can then provide their insurer with medical documentation asking for less frequent communications.

NEXT EPISODE: Disability Law Show S6 E07 – 3 Misconceptions about Independent Medical Evaluations

PREVIOUS EPISODE: Disability Law Show S6 E05 – What to know if your disability is due to a workplace injury