3 Reasons to avoid an LTD appeal | Disability Law Show TV – S3 E20

Episode Summary

THREE REASONS TO AVOID AN LTD APPEAL on Season 3 Episode 20 of the Disability Law Show with disability lawyer and partner James K. 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

COVID-19 Long-Haulers

COVID-19 long-haulers are individuals who no longer have COVID-19 but are still feeling the lingering effects of the virus and are unable to work, despite not having a diagnosis.

In order to be approved for long-term disability benefits, a diagnosis is not necessary despite what many insurers claim. Symptoms that prevent an individual from being able to do their job, as well as the support of a doctor, are the only requirements.

Segment starts at 0:55

Denied LTD after refusing to see claimant’s psych records

I applied for disability benefits late last year based on physical issues as well as anxiety. While they were considering my claim, I asked my adjuster if she needed my psychologist’s records, but she told me no – they had enough medical documents already. Last week they made their decision and denied my claim based on the opinion of their psychiatric medical consultant. Is this fair?

This is an example of bad faith exhibited by the insurer, and the process has to be fair. In this situation, the decision will be biased against the claimant. Medical consultants presumably are not doctors and hired by the insurance company who have some sort of medical experience or knowledge.

Segment starts at 4:30

3 Reasons to avoid an LTD Appeal

1️⃣ An appeal through the insurance company rarely works.

James explains that the appeal process is not sent to an independent third party in order to validate the claim. The motivation behind the appeal process is to ensure that the insurance company ultimately makes a profit.

Segment starts at 9:20

2️⃣ Appeals are designed to keep the power in the hands of insurance companies.

The appeal process does not require the insurance company to follow any legal specifics, unlike a legal claim that could lead to a decision given by a judge.

Segment starts at 12:48

3️⃣ You could miss the deadline to file a legal claim for compensation.

Applying for disability benefits requires a 90-day deadline to apply for the benefits, but in many cases, the insurer will still be required to review the claim. In order to file a legal claim if you have been denied benefits or cut off, there is a 2-year deadline from the initial denial in order to file.

Segment starts at 15:02

Cut off from LTD despite PTSD and doctor’s support

My cousin received a denial letter in the mail from his long-term disability insurer that said that they don’t consider him “totally disabled”. He’s been off work for over a year because of severe depression and hallucinations as a result of being the victim of a violent crime outside his apartment. His doctors have all said that he is unable to work and he takes numerous medications. Is there anything you can do to help?

Long-term disability insurers often use the term “totally disabled” but it does not mean that an individual is completely incapacitated, merely that they are unable to do their job. Insurance policies often define what the term means but it is used typically to confuse individuals.

Segment starts at 16:00

Terminated while on LTD

What happens if I am fired while on long-term disability? Would my benefits continue through the insurance company? My boss may be letting me go because I haven’t been able to work for the past 6 months.

If an individual is covered by insurance on the date that they become disabled, they will still be entitled to receive benefits as long as they are disabled from work. Disability benefits will not stop even if an individual is no longer employed.

Segment starts at 23:52

Denied LTD despite approval for short-term disability

I was on short-term disability for 6 months but when I applied for LTD they denied me. I suffer from seizures and a degenerative neurological condition that was just recently diagnosed. My LTD insurer is the same insurer that paid me STD, and my doctor confirmed that I can’t work. I appealed and I was denied. Can you help me?

By approving short-term disability benefits, the insurer clearly believed the individual was disabled initially. In most cases, the definition for what is considered disabled for short-term and long-term benefits is the same, with very few exceptions.

Segment starts at 25:25

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

Next Episode: Disability Law Show S3 E21 – 5 Common questions about LTD and CPP Disability

Previous Episode: Disability Law Show S3 E19 – 3 Tips for COVID-19 Long-haulers and LTD claims