3 Things you should do when dealing with your insurance adjuster | Disability Law Show TV – S4 E28

Episode Summary

3 THINGS YOU SHOULD ALWAYS DO WHEN DEALING WITH YOUR INSURANCE ADJUSTER on Season 4 Episode 28 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

Insurer advising a return to work after a medical assessment

I worked in an automotive manufacturing plant and I’m going through cancer treatments for breast cancer. I’ve been on LTD for almost 2 years and was recently informed after an assessment that I should be able to return to work. How is this possible?

• Requested to attend an assessment: Many claimants are subjected to independent medical assessments requested by the insurance company. It is important for claimants to remember that assessments are often conducted by general practitioners or consultants, and not specialists. In most cases, a claimant’s own treating medical team and their own opinions and recommendations carry more weight.
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    Cancer and long-term disability claims

Denied long-term disability mental health claim due to the sedentary job

I’ve been struggling with depression since my son died last year of cancer. I also had a heart attack 6 months ago and haven’t worked as an account executive since. The insurance company initially denied my LTD claim because they said my job was sedentary, and I could still work. Should I appeal?

• Mental health claims: While the insurance industry has slowly changed its opinions regarding mental illnesses, many claimants with invisible and not physical illnesses are denied long-term disability benefits. It is important to remember that the appeals process is rarely effective and it is a process created by insurance companies. Appeals are conducted internally and can at times be investigated by the same adjuster who initially denied a claim.

3 Things you should ALWAYS do when dealing with your insurance adjuster:

• Ask for a copy of your LTD policy and go through it: Most claimants are wary of combing through a long-term disability policy however they have a right to receive a copy of their disability policy. Insurers cannot refuse a request by claimants. It is important for claimants to be able to reference provisions in their policy if they are denied benefits.
• Ask the adjuster to explain anything you do not understand: Disability policies should contain specific payment information and how benefits are calculated. Claimants have the right to ask questions regarding the policy and about any information they are unclear about. Insurance contracts must clearly state any exceptions and must be clear in their intent.
• Confirm all conversations with your adjuster in writing: On many occasions, insurance adjusters take verbal communication out of context and can use a claimant’s response against them. It is important to have documentation and records of communication between the insurance adjuster and the claimant in the event of an eventual legal claim. Adjusters are instructed to save money for the company and will find any possible reason to cut off or deny benefits.

Given a return to work date by the insurance adjuster

I’ve been on LTD for almost two years but was recently given a return-to-work date. My doctors don’t believe I am ready and that I need extensive physiotherapy before I am able to function properly. What should I do?

• Returning to work: It is very common for insurance companies to give claimants a work-hardening or return-to-work plan. Insurance adjusters are mostly concerned with profit and in order to do so focus on pushing claimants to return to work. Claimants should rely solely on the opinion of their treating doctors and medical team on when they are ready to return to work as well as possible accommodations. Claimants have strengthened their case by securing a report from the doctor stating a return-to-work plan is inadvisable. Insurance companies are obligated to operate in good faith with claimants.

Asking the insurance adjuster if surveillance is being conducted

Do I have the right to ask my insurance company if they are surveilling me?

• Surveillance while on LTD: Insurance companies do conduct surveillance however most of the surveillance is useless unless a claimant is lying about their disability. Claimants have the right to ask if they have been surveilled but are often refused to be informed by insurers. Claimants should not be wary of surveillance if their claim is legitimate.

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Previous Episode: Disability Law Show S4 E27 – 3 Things those with fibromyalgia must know about LTD denials