3 Things that those with Fibromyalgia must know about LTD denials | Disability Law Show TV – S4 E27

Episode Summary

3 THINGS THAT INDIVIDUALS WITH FIBROMYALGIA MUST KNOW ABOUT LTD DENIALS on Season 4 Episode 27 of the Disability Law Show with disability lawyer and national co-managing 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

Obligated to continue treatments referred by the insurer

I suffer from cardiomyopathy and I’ve been approved for LTD. My insurer sent me for treatments at a clinic that does not specialize in heart problems. After switching clinics, I was told I was not cooperating with the insurance company. Am I obligated to continue treatments at the previous clinic?

• Complying with the insurer: While individuals on long-term disability benefits have an obligation to seek and undergo treatment in order to progress their health, they should listen to the advice given by their own treating medical team. Despite the insurance company’s insistence, they cannot force a claimant to seek treatment from their own doctors and specialists if it is against their own doctor’s advice. Claimants are able to ask their treating medical team to give them treatment specifications.

Information is taken out of context and used to end LTD benefits

After a call with my case manager, my disability payments were cut off. I am worried that they took the information I gave them about my daily habits and activities out of context to justify ending my benefits. What should I do now?

• Communicating with an insurer: It is very common for insurance adjusters to take communication with a claimant out of context in order to justify ending benefits. It is important for individuals to document all forms of communication with the adjuster in writing. Keeping an ongoing report of all communications ensures there is a thorough record for a legal team, later on, to use for a legal claim. In some cases, adjusters could owe claimants additional punitive damages for not behaving in good faith.

3 Things that individuals with fibromyalgia must know about LTD denials:

• Fibromyalgia is often looked on skeptically by insurance companies: The diagnosis of Fibromyalgia in some situations unfortunately is seen as controversial. It can be difficult to diagnose and in some cases, doctors disagree on the symptoms and condition. Claimants who are suffering from any ailment should speak to the right medical specialist in order to receive adequate treatment. Claimants are within their rights to ask for a referral to a specialist from their regular general practitioners.
• Appropriate medical treatments for Fibromyalgia are extremely important: Being engaged in reasonable treatments is vital for claimants in order to continue to receive benefits as most disability policies contain provisions that stipulate treatment must be sought out and undergone. Claimants who do not seek treatment are compromising their own legal rights.
• Proper medical documentation and reports are critical: At times, a claim is denied or cut off as the insurance adjuster will claim there is insufficient medical information in order to justify benefits. Claimants must have a doctor’s report that outlines how they are disabled specifically from their own position and later on in any position. It is important for doctors to be specific to a claimant’s situation. In some cases, doctors are unaware of the legal context of the information they are providing in their reports to the insurance adjuster.

Health concerns triggered by a toxic workplace

The culture and environment at work have led me to experience debilitating anxiety. My doctor has instructed me to apply for LTD, but I’m worried I’ll be denied as my health concerns were triggered by the workplace. What should I do?

• Generalized mental health conditions: Claimants should apply for long-term disability if they are encouraged to do so by their doctor. In some cases, adjusters deny long-term disability benefits due to the fact that the illness is workplace-related. Adjusters in these circumstances believe that a claimant would be able to work in another work environment and it is no longer a disability or health issue, but an employment concern. It is important to note that simply because a mental illness is triggered by a toxic workplace, does not mean it does not become a generalized condition and prevents a claimant from working in any environment.

Told to return to work after denial of CPPD

I have just been denied CPPD after being on LTD for two years. After the denial, I received a letter from my insurer proposing a return-to-work plan that will begin in the next few months. Is this due to the CPPD denial? While I am continuing to undergo treatment, my doctors believe I am still unable to work.

• Applying for CPPD: Insurance companies will often cut off disability benefits around the two-year mark as the test in order to qualify for disability changes from an inability to work in a claimant’s own occupation, to any occupation. Claimants that are still disabled from working should not have their disability benefits cut off despite a denial from CPP Disability. CPP Disability is a separate program from long-term disability.

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Previous Episode: Disability Law Show S4 E26 – 3 Things you need to Know about addiction and LTD