3 Things in your doctor’s report that strengthen your LTD claim | Disability Law Show TV – S3 E28

Episode Summary

3 THINGS IN YOUR DOCTOR’S REPORT THAT STRENGTHEN YOUR LTD CLAIM on Season 3 Episode 28 of the Disability Law Show with disability lawyer and 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

My employer pays out insurance benefits

I’ve worked for my boss for more than 25 years but became disabled and I’ve been off for a while. My employer relied on another company to oversee the disability claims but they pay the benefits. The external insurer cut off my benefits. What do I do?

• Employment and disability issues: James explains that it is important for claimants to communicate properly with their employers and disability insurers that they eventually hope to return to work. Typically an employer that pays out benefits for employees is often large corporations and there are usually no issues in paying disability benefits. It is also common for claims to be resolved in mediation.

Long-term disability denied as my condition is “not bad enough”

I have spinal stenosis and fibromyalgia. In the report from my family doctor, he said my condition is moderate to severe. I tried to put a claim through my work for disability. They didn’t approve of it. Then I appealed two more times and they turned it down.

• LTD benefits and no diagnosis: James explains that appeals are rarely effective as typically an appeal process is internally conducted within the insurance company. It is important to note that there is no requirement that a medical condition has to have a diagnosis in order for an individual to claim benefits. Insurance policies are concerned with the disability or symptoms that prevent an individual from doing their occupation.
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    Chronic Pain and LTD Denials

3 Things that must be in your doctor’s report to strengthen your LTD application and claim

• An explanation of your illness or injury and functional limitations: Claimants don’t specifically have to have a diagnosis in order to be able to claim benefits. The claimant’s doctor should specify how their disability prevents them from doing the basic functions of their job such as being able to sit for long periods of time, lift heavy materials, etc. Doctors are not necessarily vocational experts so it would be helpful to provide a physician with the basic requirements of your job.
• Confirmation that you are following prescribed treatments: James explains that claimants have to take reasonable steps and treatments suggested by their doctors to improve their disability or help with recovery. If surgery is recommended, as there is a significant amount of risk involved, a claimant cannot have their benefits cut off if they refuse to proceed with the procedure.
• Unable to work for the “foreseeable future”: While a prognosis is never certain and can change over time, it is important for a doctor to communicate the timeline they foresee for claimants as well as necessary referrals and tests.

Relapse of health condition with an early return to work

Eighteen months into a disability claim for chronic anxiety and depression, my caseworker is stressing me out about a program for a return to work. A contract position did come up for 6 months with very minimal requirements compared to my previous job. What will happen to my benefits if I relapse?

• Returning to work from LTD: James explains that claimants can refuse to try programs for a gradual return to work that is recommended by the insurance company. Claimants that relapse or are unsuccessful in returning to work, can invoke a recurrence provision. Recurrence provisions ensure that claimants do not have to wait for an elimination period in order to receive their benefits. Ultimately, individuals should not return to work without the approval of their doctors.

Surveillance from insurance while on disability benefits

I have just filed a claim for long-term disability. I am well aware that the insurance company may put me under surveillance to find a way to deny my claim. Do they actually have a right to invade my privacy? I have nothing to hide, but I also don’t want them to infringe upon my rights and add to my stress.

• Surveillance and disability benefits: While insurance companies are within their rights to implement surveillance, it is rarely of value to the insurer. If a claimant has a legitimate disability and is unable to work, surveillance cannot be used as evidence to cut off or deny benefits. Many claimants fear they will be surveilled but it is typically not used often by adjusters.

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Next Episode: Disability Law Show S3 E29 – Dealing with difficult employers while on LTD

Previous Episode: Disability Law Show S3 E27 – 3 Things LTD claimants must know before a return to work