3 Questions people have when cut off from LTD | Disability Law Show TV – S5 E10

Episode Summary

3  QUESTIONS PEOPLE HAVE WHEN CUT OFF FROM LTD on Season 5 Episode 10 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

Private disability policy differences

I was on LTD through a private policy for almost 2 years for mental health reasons. My policy does not have an ‘own occupation’ period yet my benefits were still cut off. What can I do?

• Any and own occupation rider in a policy: Many disability policies implemented through group insurance programs typically have a change in the definition of disability after the first two years. Claimants have to prove after the first two years on long-term disability, that they are disabled from working in any occupation. In private policies, however, individuals are able to select an option that removes the ‘own occupation’ provision. Many adjusters still mistakenly cut off benefits for claimants on a private policy who do not have a change in definition after the first two years.

Forced to return to work

I tried going back to work after only a few months on LTD, but the stress caused me to end up in the ER. Now, months later after a small bit of improvement, my insurer is trying to rush me back to my job. Do I have a right to push back?

• Returning to work from LTD: Claimants should first ensure that they have the approval from their treating doctors and medical team before they attempt a return to work. Insurance companies often insist and pressure claimants to return to work before they are ready to do so. Individuals that return to work before they are medically cleared to do so, could experience a regression in recovery.

Three questions people have when they are cut off from LTD

• Applying for CPPD: Many disability policies will stipulate that insurers are able to claim credit from claimants if they receive benefits from other sources and programs like CPPD. It is beneficial for claimants to apply for CPPD as additional benefits will protect them if LTD ends or is prematurely cut off. The test in order to qualify for CPPD is also much more difficult than that of LTD. An approval of CPPD can only benefit claimants.
• The support of treating physicians: It is vital to have the support of a treating doctor and medical team. Doctors provide the information necessary to qualify for long-term disability and continue to receive benefits. Treating professional reports ensures evidence for claimants filing a legal claim.
• Accept a cut-off of LTD: Claimants do not have to accept a denial or cut-off of benefits from their insurers if they continue to receive the support of their doctors. Claimants can and should seek legal advice from a disability lawyer in order to determine their next steps.

Lack of medical records leads to cut-off from LTD

I’d been receiving LTD payments for just under 2 years when they suddenly stopped. I was told they had not received any updated medical records from my doctor, and that I can appeal the decision. Is that my best option?

• The appeals process and disability benefits: Most claimants are unaware that the appeals process is not objective or conducted by a third party. Often appeals are overseen by the same individual that initially denied a claim. Appeals are rarely successful and generally waste a claimant’s valuable time. By filing an appeal, claimants ensure that the power and influence remain with the insurance company.

The claimant’s company closes while on LTD

I’ve been on disability benefits for almost a year while on a waitlist to see a specialist. A colleague recently mentioned that the owners of the company might be shutting down the shop. If I lose my job, does that put my LTD claim in jeopardy?

• Employment issues and long-term disability: Disability claimants should note that a loss of employment while on long-term disability leave should not affect their benefits. Claimants should continue to receive benefits if they were employed at the time they were considered disabled. Claimants who are unsure of their rights if an issue has arisen that could affect their job, should speak to a disability lawyer aware of the entire situation.

An aggressive and unsympathetic insurance adjuster

At the start of the second year of my claim, I have a new adjuster who is aggressive and unsympathetic. It feels like they don’t believe me and are slowly working to get me off benefits. How should I push back?

• Communicating with an insurance adjuster: Insurance adjusters are obligated, under terms of the disability policy, to operate in good faith with their claimants. Individuals who feel that communications with their adjuster are inappropriate should ensure all communications are documented in writing. Claimants should also speak to their doctors about their concerns in communicating with their insurers.

PREVIOUS EPISODE: Disability Law Show S5 E09 – 3 Important facts about the appeals process in LTD claims