3 Tips for COVID-19 Long-haulers and LTD claims | Disability Law Show TV – S3 E19

Episode Summary

THREE TIPS FOR COVID-19 LONG-HAULERS AND LTD CLAIMS on Season 3 Episode 19 of the Disability Law Show with disability lawyer and partner James K. 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 Ontario,  British Columbia,  or Alberta, on the only disability law show on TV and radio in Canada.

Episode Notes

Lack of diagnosis leads to disability benefits being cut off

I’m a car salesman and have been experiencing abdominal pain for two years. After tests, my doctors still can’t figure out what’s wrong. My LTD benefits were cut off as a result. What can I do?

By company policy, there is no requirement for a diagnosis in order to be approved for disability benefits. Symptoms that prevent an employee from being able to work are the only requirements necessary to qualify for disability benefits.

Segment starts at 00:56

Case review by insurance medical consultant

I’ve been on LTD for almost 2.5 years now for severe sciatica pains and osteoarthritis. I get injections and treatment every week from my doctor. Recently a new claims adjuster took over my file and told me she reviewed my case with a medical consultant and they think that I should have gotten better and should be back to work already. She’s threatening to cut off my benefits if I don’t return. What should I do?

Individuals on long-term disability benefits should ultimately listen to their doctor’s advice on whether or not they are ready to return to work, not their insurance adjuster. After the two-year mark, the test for individuals to be approved for LTD benefits is more difficult. If approved after two years, unless there is an indication the condition has changed the insurer will have a difficult time justifying the cut-off of benefits.

Segment starts at 5:05

3 Tips for COVID-19 Long-haulers and LTD claims

1️⃣ If you can’t work because of the physical OR psychological effects of COVID-19, you can apply and should receive long-term disability benefits.

James explains that there are various claims possible regarding COVID-19 and long-term benefits. Most claimants who are considered COVID-19 long-haulers no longer have COVID-19 but instead lingering effects of the virus that limit their ability to work.

Segment starts at 11;30

2️⃣ Insurance companies may try to tell you that they don’t cover COVID-19 disabilities. That is not true unless the LTD policy specifically excludes coverage for Covid-19.

Insurance companies can only exclude or deny a claim the policy itself has to explicitly state what conditions are excluded. The vast majority of long-term disability policies were drafted before the pandemic and so couldn’t possibly include COVID-19.

Segment starts at 15:25

3️⃣ Contact us immediately if your long-term disability claim is denied and you can’t work because of Covid-19 or any other reason.

Insurance companies do not want COVID-19 related disability conditions and claims eventually leading to court as it would draw media attention and public commentary.

Segment starts at 16:48

Request for clinical notes from doctors to continue benefits

The insurance company has suggested that they will cut off my long-term disability benefits. Now they’re asking for clinical notes from all of my doctors. Do I have to provide them? Is this an infringement on my privacy?

Medical and clinical records can be requested from an insurance adjuster as it is part of the insurance policy. Individuals have to provide reports in order to qualify for benefits.

Segment starts at 20:35

Denied LTD benefits as the condition is a workplace issue

I’ve been diagnosed with a rare autoimmune condition that causes swelling throughout my body. Stress aggravates the condition and makes work impossible. My situation at work deteriorated to the point where I couldn’t get out of bed. My doctors have said that I can’t return to any work environment because the stress would cause me to regress significantly. I applied for LTD but my claim was denied because they said it was a “workplace issue”. Shouldn’t I be entitled to benefits?

James explains that ultimately if an individual has a disability that prevents them from working despite the environment, they should be approved for LTD benefits regardless of a mention of a “workplace issue”.

Segment starts at 22:52

Treatment for disability leading to further decline

I have struggled with chronic depression and went on LTD a couple of years ago. My depression and anxiety aren’t improving despite continuing therapy sessions. There is now a decline in my cognitive abilities. My question is at what point can treatment be causing more stress; I’m scared of being cut off if I don’t comply. Is there anything I can do?

The decision to return to work or change treatments is ultimately a medical condition and individuals on benefits should solely listen to their physician’s advice.

Segment starts at 25:44

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

Next Episode: Disability Law Show S3 E20 – 3 Reasons to avoid an LTD appeal

Previous Episode: Disability Law Show S3 E18 – 3 Things you can do if denied LTD