3 Things you need to know about addiction and LTD | Disability Law Show TV – S4 E26

Episode Summary

3 THINGS YOU NEED TO KNOW ABOUT ADDICTION AND LTD on Season 4 Episode 26 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

Worried LTD benefits will end and loss of employment

I’m in my early 40s, work in IT and am suffering from severe depression due to several deaths in the family as a result of COVID-19. I was approved for LTD but after 6 months I had a new adjuster. My new adjuster is very aggressive and I’m concerned my benefits will be cut off and I might be losing my job.

• Mental health claims and workplace issues: It is important for individuals on long-term disability to remember that if a company shuts down or a claimant loses their job, and severance pay is given out, the insurance company is entitled to a credit. Claimants also do not have to accept bad behaviour from their insurance adjuster. Insurers are obligated to operate in good faith with claimants. Claimants are able to request a new adjuster and are within their rights to complain to their treating medical team that the adjuster is causing stress. Adjusters who behave in an inappropriate manner with claimants could be forced to pay punitive damages to a claimant.
  • LEARN MORE ABOUT EMPLOYMENT AND LTD
    Employment issues while on long-term disability leave?

Benefits cut off after not attending rehab sessions

My disability benefits were cut off as I didn’t attend two rehab sessions that were set up for me. I rescheduled the appointments right away but the insurance company is refusing to communicate with me. My employer is now asking when I’ll return to work as my benefits have ended.

• Complying with disability policy terms: Many insurance companies take the opportunity to deny or cut off long-term disability benefits when an individual was not able to attend treatment. This reasoning has occurred more frequently during the pandemic as many clinics were shut down or public health restrictions prevented individuals from accessing certain treatments. Most disability policies contain provisions that stipulate that in order for claimants to receive benefits, appropriate treatment must be undergone with doctor recommendations. It is unreasonable to cut off benefits for a claimant to have benefits cut off for a few missed appointments. Employers are not permitted to inquire about specifics about a claimant’s disability and must provide necessary accommodations.

3 Things you need to Know about Addiction and LTD

• Addiction is generally considered to be an illness: Human rights legislation, as well as disability policies, consider addiction and substance abuse as an illness. Many employers and insurance companies, however, despite the policies in place, misunderstand this illness.
• Continue to seek and comply with recommended treatment: While it is important for claimants to consider undergoing rehabilitation treatment for their illness, many insurance companies exploit this caveat in disability policies. Some individuals with addiction do experience relapses and can go through periods in which treatment is not possible. Relapses are considered part of the treatment regimen for many individuals experiencing substance abuse. It is important to consider that claimants should continue to receive benefits as long as they continue to seek out treatment.
• Denied on the basis that there is a lack of medical documentation: Unfortunately, many disability insurers treat those experiencing addiction in the same manner as individuals with a mental illness. Insurance adjusters often do not believe that a claimant is truly disabled as a result of their addiction and is able to continue working. Ultimately it does not matter what an insurance adjuster personally believes but the opinion of a treating doctor is relevant. Claimants experiencing addiction who have had their benefits denied should not give up but seek legal advice from a disability lawyer.

Told to attend an independent assessment for ongoing depression while on LTD

I am getting regular treatment from my doctor, counsellor and psychiatrist for severe depression and anxiety. I was assigned a new case manager last month and he told me I must attend an assessment with one of their doctors. Why are they doing this, and do I have to go?

• Request for an assessment: It is not unusual for insurance companies to request a claimant attend an independent medical assessment. Most disability policies contain provisions that allow insurers to request an IME from claimants. Individuals are obligated to attend an assessment however the rationale behind this request is usually to justify ending long-term disability benefits. Claimants should remember that ultimately, the opinion of their own treating doctors and medical team will carry more weight than that of the insurer’s consultant or own assessing doctor. Assessments are frequently requested after a claimant has been on LTD for almost two years as the test in order to qualify for LTD changes from an inability to work at their own occupation to any occupation.

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

Previous Episode: Disability Law Show S4 E25 – Key things to know about CPP Disability and LTD