3 Key things to know about the appeals process and LTD | Disability Law Show TV – S4 E09

Episode Summary

3 KEY THINGS TO KNOW ABOUT THE APPEALS PROCESS AND LTD on Season 4 Episode 09 of the Disability Law Show with disability lawyer Partner, 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

Can union members hire a disability lawyer if their claim is denied?

I’m a teacher and a union member and was denied disability benefits a year ago. I appealed the denial but was unsuccessful. Can I still speak to an external disability lawyer for help with my claim?

• Disability rights for union members: It is important to remember that union members who are unsure of their rights regarding long-term disability can inquire from a disability lawyer if they are able to help them. Disability lawyers would simply have to look at the collective bargaining agreement to determine whether or not they can provide legal counsel regarding a denied or cut-off disability benefits claim. Most unions are not set up to provide assistance to its remembers with disability benefit disputes.

Unable to access therapy needed due to COVID-19 while on LTD

I suffered a breakdown earlier this year due to the death of my mom. My doctor advised that I take time off work. I haven’t been able to access the psychotherapy I need, but my insurer constantly asks me to provide more information. I’m worried my benefits will be cut off.

• Seeking treatment while on LTD: Claimants that are receiving LTD are required to seek and pursue reason efforts of therapy and treatment. In some situations, it can be difficult for claimants to seek treatment, particularly during the pandemic. Issues such as availability or financial difficulties can cause problems for claimants. Claimants should do whatever is reasonable to try and seek treatment to the best of their efforts, such as free or virtual treatment options.
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3 Key things to know about the appeals process and LTD claims

• Insurance companies created the appeal process: The LTD appeal process is not a formal process in which the insurance company follows rigid rules. The appeals process ensures that claimants are kept under the insurance company’s control. For many claimants, they are not told the reason their disability benefits were denied or cut off and without the reason for the denial, it is impossible to argue a case for approval.
• Appeals are an internal process within insurance companies: Claimants are in most cases, asking the same insurance adjuster who initially denied their claim, to come to a different conclusion regarding their disability benefits. The insurance adjuster is also typically not given any new information from a claimant’s doctor to reassess as they already have all the relevant and necessary medical records.
• Appeals are rarely successful: The purpose of the appeals process serves the insurance adjuster’s needs rather than the claimants as they do not want claimants to begin a legal claim. Claimants have up to two years to begin a legal claim after the initial denial date.

Told to do sedentary work by the insurance adjuster

My long-term disability benefits were denied even though I am undergoing treatment for breast cancer. The insurance company believes I can still do sedentary work and tells me to look for another position. Can they do this?

• Cancer and disability claims: In the first two years of long-term disability benefits, claimants have to prove they are unable to perform the basic tasks of their own occupation due to their disability. Claimants who are unable to do their own job and are denied long-term disability benefits should speak to a disability lawyer as soon as possible. Only a treating doctor can determine whether or not a claimant is able to do work.
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Denied LTD benefits after a failed attempt to return to work

I’ve been on a withdrawal management program through LTD for the past 3 years. After a failed return to work, I tried to restart my insurance benefits but was denied. The adjuster told me that it was due to insufficient medical documentation. I don’t know how this is possible, what can I do?

• Attempting a return to work: Claimants who are receiving benefits and believe they are ready to return to work do have a recurrence clause in their disability coverage. Claimants who are unsuccessful at their return to work should be able to resume their disability benefits immediately. In practice, however, insurance adjusters do not resume benefits for claimants as they have already resumed working. Claimants should speak to their doctors before attempting a return to work and request specific accommodations and restrictions.

Click Here For More Information About COVID-19 and Your Rights

Previous Episode: Disability Law Show S4 E08 – 5 Things about LTD claims that everyone should know