3 Things you should know before filing an LTD claim | Disability Law Show TV – S4 E11

Episode Summary

3 THINGS YOU SHOULD KNOW BEFORE YOU FILE AN LTD CLAIM on Season 4 Episode 11 of the Disability Law Show with disability lawyer and 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

Denied disability benefits as disability is considered situational

I’m an architect and I’ve worked at my company for over 15 years. I’ve been experiencing issues at work with new management and was diagnosed with PTSD. I was denied LTD as my disability arose due to workplace issues. What can I do?

• Generalized vs situational disability: Insurance adjusters often deny mental health disability claims that originally began at a workplace. Claimants that have developed generalized conditions as a result of incidents that began at a workplace are entitled to long-term disability benefits and should speak to a disability lawyer. Claimants who only have symptoms when in a specific workplace do not have a generalized disorder and will not be entitled to benefits. In situations such as these, claimants not only have a disability claim for benefits but there is also some overlap with employment issues.
  • WATCH TO LEARN MORE
    Disability Law Show – Generalized vs. Situational Disorders and LTD Claims

Disability benefits cut off as a result of refusing medication

I was approved for LTD when my fibromyalgia began flaring up. The insurance company eventually sent me for an assessment with a doctor they recommended. When they told me to take a new medication, my doctors disagreed. My benefits are now being cut off as I’m “not compliant”. Can they force me to take medication?

• Complying with treatment: Claimants are not obligated to listen to medical advice that is not given by their treating medical team. Claimants should listen to the advice of their own treating doctors and follow their recommended treatment. It is important for claimants to comply with the insurance company’s suggestion but they should not be forced to take advice that is in direct conflict with their own doctors. Listening to treating doctors cannot be considered a breach of a disability policy.
  • LEARN MORE
    Fibromyalgia and Long-term Disability Benefits

3 Things to know before you file an LTD claim

• You need your doctor’s support: It is important for claimants to have their doctor’s support when they are unable to work. The insurance company will not take a claimant’s word that they are unable to continue working. The necessary documentation from treating medical professionals is necessary and must be as detailed as possible.
• Denied claims despite medical support: Insurance adjusters often cherry-pick the information given to them by a claimant’s treating doctor and claimants should be prepared for the possibility of a denial. Insurance companies profit from collecting premiums and refusing claims. Claimants who have been denied LTD should contact a disability lawyer as soon as possible to determine their next steps.
• Following the insurance company’s advice to appeal:The appeals process is often a waste of time and ineffective. Appeals were created by the insurance company and are not reviewed by a third-party external arbitrator. Claims are reviewed typically by the same people who initially denied a claimant their benefits. Before appealing the denial of a claim, claimants are within their rights to speak to a disability lawyer and determine their best options.

Insurance adjuster pressuring claimant to return to work

The adjuster working on my husband’s LTD claim has been harassing him about why he can’t go back to work. My husband is an engineer and has worked for the same company for more than 20 years but became depressed after recent deaths in the family. What should he do?

• Pressured to return to work: Claimants should not bow down to pressure from the insurance company as they should only return to work if they are cleared to do so by their treating doctors. Claimants who return to work before they are ready could regress and cause more damage to their health. Claimants who believe they have no choice should speak to a disability lawyer and their doctor to determine their rights and next steps. A report written by a treating doctor can be provided to the insurance adjuster on why a claimant is unable to return to work. Individuals who are cleared to return to work should provide recommendations by their doctors in order to effectively return to work.

Suffering from depression but denied long-term disability benefits

My wife and I lost our baby due to complications and since then she has been diagnosed with depression. We’ve discussed hospitalization with her doctor. She applied for LTD, but the application was rejected because they say that she’s not “totally disabled” from working. What should we do?

• Disability law terminology: The phrase “total disability” refers to a claimant’s inability to perform the basic tasks of their own occupation or any occupation after two years. Claimants often incorrectly assume that “total disability” means they must be completely incapacitated in order to receive disability benefits. In some cases, insurance adjusters can also owe claimants punitive damages if they have not acted in good faith.

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

Previous Episode: Disability Law Show S4 E10 – 3 Key advantages of getting help from an LTD lawyer