3 Myths about “Total Disability” in LTD Claims | Disability Law Show TV – S4 E01

Episode Summary

3 MYTHS ABOUT TOTAL DISABILITY IN LTD CLAIMS on Season 4 Episode 01 of the Disability Law Show with disability lawyer and co-founding 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 Ontario, British Columbia, or Alberta, on the only disability law show on TV and radio in Canada.

Episode Notes

Denied benefits due to insufficient medical documentation

I’m a mechanical engineer and have chronic back pain and was eventually diagnosed with fibromyalgia and chronic pain. This has led to depression and I am no longer able to work. I was denied disability benefits as there is insufficient medical documentation. Should I appeal?

• Reasons for an LTD denial: Sivan explains that appeals are rarely effective and are an internal process created by insurance. It is important to contact a disability lawyer as soon as possible particularly if all medical support and documentation are in order. Disability lawyers can ensure that claimants reclaim their power and force the insurance company to pay benefits to those that are no longer able to work.
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    Fibromyalgia and LTD Claims

Harassment at work leads to deepening depression

My sister has been harassed at work and it got so bad that she had to go on leave because of depression. The insurance company denied her LTD application. Her family doctor and psychologist both wrote letters saying that she needs time off to heal. Should she try to return if she’s not ready?

• Denied LTD despite support from a doctor: Claimants should not return to work until their treating doctors have determined they are able to do so efficiently. Returning to work before a claimant is ready can further harm the claimant and ensure their treatment regresses. Only treating doctors can decide that a claimant is able to work as well as necessary accommodations and restrictions required in order for a claimant to return safely.

3 Myths about “Total Disability” in LTD Claims

• “Total Disability” means that you are catastrophically disabled: The term “total disability” does not mean claimants are completely disabled but simply that claimants are totally disabled from being to perform the basic duties of their own occupation for the first two years. This phrase was developed by the insurance company and often misleads the public regarding the true definition.
• Only the insurance company can decide if you are “totally disabled”: Sivan explains that the claimant and the treating doctor determine whether or not the claimant is disabled from working. Insurance adjusters would like claimants to believe that they are the only deciding factor in determining if an individual can no longer work.
• Told you are not “totally disabled” then you can’t get LTD: Claimants should not take the insurance company’s denial as the final determinate factor in pursuing their benefits. Claimants who are denied or had their benefits cut off can pursue legal action and speak with a disability lawyer to find out their next steps. As long as a claimant has their doctor’s support, they should be able to receive long-term disability benefits.

Disability benefits denied due to company shutdown

I have been on long-term disability for a year-and-a-half and in another six months the language changes to “capable of doing any occupation”. Unfortunately, my company closed a year ago. Will insurance cut me off if I have no job to return to or do they have to retrain me for a different career?

• Employment and disability issues: A company closing down should not affect whether or not a claimant is able to receive long-term disability benefits. Benefits are only cut off if a claimant is no longer disabled or if they have reached a certain age and their policy discontinues their benefits. Claimants after two years will have to prove they are unable to work in any comparable position, not just their previous role. It is not uncommon for claimants to be cut off at the two-year mark of long-term disability.

Transitioning from short-term to long-term disability benefits

I started having seizures last year and it would often happen at work. The doctors I’m seeing still don’t know what is causing them. After applying for LTD, I was told my transition claim from short to long-term disability was denied. What should I do?

• Short to long-term disability: Claimants in this situation should speak to a disability lawyer as soon as possible. Often, the test for short-term disability and long-term disability is the same although employers typically pay short-term disability and the insurer takes over the long-term disability benefits. Claimants in this situation should not appeal the denial but instead, consider their legal options and begin a legal claim.

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Next Episode: Disability Law Show S4 E02 – 3 Vital Things COVID-19 Long-haulers Should Know About LTD Claims

Previous Episode: Disability Law Show S3 E34 – Chronic Pain and Disability Claims