3 Things to remember about your LTD adjuster | Disability Law Show TV – S5 E14

Episode Summary

3 IMPORTANT THINGS TO REMEMBER ABOUT YOUR LTD ADJUSTER on Season 5 Episode 14 of the Disability Law Show with disability lawyer and co-founding Partner, Sivan Tumarkin and national practice leader, 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 provinces across Canada, excluding Quebec, on the only disability law show on TV and radio in the country.

Episode Notes

Travel restrictions and LTD

I’m on long-term disability and am unsure about travelling in the next few months. Will my benefits be cut off if I travel out of the country?

• Long-term disability policy provision: Many long-term disability policies contain a provision that prohibits or limits claimants from travelling. The restrictions can limit the geographic locations of claimants, as well as the time frame. Claimants unsure about their rights can request a copy of their LTD policy from their insurers in order to ensure they are following policy provisions. Support from a treating doctor regarding travel should be confirmed.

 LTD claim denied despite doctor’s support

I’ve been off work due to an ongoing low-back problem. After several tests, including x-rays and MRIs, my healthcare provider says I’m not ready to return to work. Despite this, my LTD claim was denied.

• Diagnosis and LTD: In order to be approved for long-term disability, claimants should continue to receive the support of their doctors. A diagnosis of a medical condition is not required in order to receive approval for LTD. Claimants that are disabled from performing the essential tasks of their own occupation should seek legal advice if they have been denied LTD.
• Returning to work from LTD: Often, employment and disability issues can meld together. Claimants should continue to ensure that their relationship with their employer remains positive and they are updated about the situation. Claimants should not feel pressured to return to work unless they are cleared to do so by their treating doctor.

3 Important things to remember about your LTD adjuster

• Insurance assumptions about claimants: Often insurance adjusters make assumptions based on the information provided to them by their own consultants. It is important to remember that the professionals employed by the insurance company that often conduct independent medical examinations have the insurer’s best interests in mind. An IME is requested in the hope that the reports detailed will ensure a claimant’s benefits can end.
• Missing information in a file: Insurance adjusters often have a large number of case files. There is also an incentive for adjusters to miss relevant information included in a claimant’s file. Insurance adjusters might also lack experience and training and lack understanding of certain medical knowledge.
• Insurance adjuster behaviour: Insurers are obligated to operate in good faith with their claimants. Insurers that fail to conduct themselves in a fair and appropriate manner have also failed to uphold the disability contract in place. In some cases, if an adjuster has behaved in a manner which resulted in further pain and suffering for claimants, additional punitive damages can occur.

Lump sum buy-out offered from the insurer

My husband is on LTD and CPP after undergoing treatment for cancer. The insurance company informed us that we can take a lump sum or continue to receive payments for six months at which point he will be cut off.

• A settlement offered by the insurer: In the event of a buy-out, it is important to remember that this is offered in the best interest of the insurance company. Claimants should consider how much they are offered in the lump sum and compare it to the benefits they would receive in the future.
• Cancer and LTD: Claimants will have to consider how likely treatment and recovery are if on LTD and diagnosed with cancer when contemplating a settlement.

PREVIOUS EPISODE: Disability Law Show S5 E13 – 3 Key questions about surveillance and LTD