3 Things our lawyers do after you hire us to fight your LTD insurer | Disability Law Show TV – S3 E25

Episode Summary

3 THINGS OUR LAWYERS DO FOR YOU IMMEDIATELY AFTER YOU HIRE US TO FIGHT YOUR LTD INSURER on Season 3 Episode 25 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

Returned to work as LTD benefits were denied

I started a legal claim and returned to work as I was denied LTD benefits. I did not return to work full-time but part-time instead. Should I pursue a legal claim?

• Part-time work while on LTD: James explains that claims can vary depending on how claimants are earning income. Most policies encourage claimants to return to work so that they can earn more compensation overall. Claimants should only return to work with the approval of their doctor.

Denied LTD as the condition is considered a workplace issue

My brother injured his back a few years ago. He was able to work for a while but in a limited capacity. When he became depressed, his doctor told him to take a sick leave. He was put on short-term disability, but was denied long-term disability, as the insurance company said it was a “workplace issue”. Can we appeal?

• Workplace issues and LTD claim: Appeals are internal processes within the insurance company and are rarely effective. The test for short-term disability benefits is relatively similar to the test in order to qualify for long-term disability benefits. If a claimant is not able to do their job due to their condition at any job location, they are still considered disabled and the condition cannot be labelled a “workplace issue“.

3 Things our lawyers do for you immediately after you hire us to fight your LTD insurer

• We take over all communications with the insurer: As soon as Samfiru Tumarkin LLP is retained, all communications are handled through the disability law firm and the claimant does not have to communicate directly with the adjuster. The claimant is freed to focus on their own treatment and recovery.
• We ask for the insurer’s complete file: James explains that experienced disability lawyers can access the insurance company’s entire file in order to determine the information the insurance company has and how they are arriving at their conclusion.
• We start a legal claim: It is critical to begin a legal claim as there is a significant shift in power between the claimant and insurance adjuster. A legal claim flips the power imbalance and ensures the insurance company abides by the legal system.

Disability benefits were cut off and no reason was given

My husband hasn’t been the same since he was in a bad car accident years ago. He used to work as an executive at a large communications company. He was on long-term disability benefits but was cut off and we never found out why. Is it too late to start a legal claim?

• No reason for disability denial: Claimants have two years to pursue a legal claim from the initial date that benefits have been denied or cut off. If a claim is not brought forward within two years, claimants will have no other recourse. Insurance companies are obligated to notify claimants when the claim is denied.

Do claimants have a choice in attending an independent medical assessment?

I went off work due to workplace harassment. With my psychiatrist’s and psychologist’s support, I was eventually approved for LTD. I am now almost at the 2-year mark of my leave. The insurance company is now requesting that I go through an assessment. Do I have a choice in attending the assessment?

• A toxic workplace and disability benefits: Insurance companies are legally permitted to request claimants to attend an independent medical assessment. If a claimant refuses to attend, their benefits will likely be cut off. Insurance companies cannot force a claimant to return to work without the approval of the claimant’s doctor.

Do I have to follow the insurer’s recommended treatments?

I have recently been placed on LTD. I was diagnosed with generalized anxiety order and OCD. My insurance company is now asking that I see one of their psychiatrists and start a new treatment plan. Do I have to follow the insurance psychiatrist’s treatment instead?

• Following the insurer’s recommendations: Typically a psychiatrist’s opinion will be valued over a family doctor’s opinion by a court. However, the claimant is not required to follow treatments from the insurance company’s recommended doctor or psychiatrist.

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Next Episode: Disability Law Show S3 E26 – Top 3 BAD reasons why people decide not to challenge LTD denials

Previous Episode: Disability Law Show S3 E24 – Top 3 things that reduce anxiety when dealing with an LTD insure