Disability Law Show

3 Tips on communicating with your insurance adjuster | Disability Law Show TV – S5 E04

Episode Summary

3 TIPS ON HOW TO COMMUNICATE WITH YOUR INSURANCE ADJUSTER on Season 5 Episode 04 of the Disability Law Show with disability lawyer and national co-managing Partner Sivan Tumarkin. and disability lawyer and Partner Tamar Agopian.

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

Repeated appeals and denied LTD

After repeated appeals, I was still denied long-term disability benefits. I eventually just gave up as this process has become stressful and debilitating. What else can I do?

  • Keeping control within the insurance company: The appeals process was created by insurance companies in order to ensure that the power remains with the insurer. Appeals are rarely successful and are typically not conducted by a third-party arbitrator, but usually by the same insurer that denied the claim initially. It is far more effective to file a legal claim and contact a disability lawyer in order to pursue rights and benefits.

Referred by the insurer to do an independent assessment

I’ve been on LTD for almost 2 years due to depression. After insurance recommended an assessment, an occupational therapist in the return-to-work department contacted me. Am I being pressured to return to work?

  • Return to work while on LTD: Insurance companies typically try and cut off benefits or influence a claimant to return to work as they do not want to continue paying disability benefits. It is not uncommon for claimants to be pressured to return to work despite the advice of a claimant’s doctor. Claimants should only return to work if they are cleared to do so by their own medical team.
  • Change in definition of disability: Often at the two-year mark, claimants can experience a cut-off from disability benefits. This is due to the fact that a change in the definition of disability occurs after two years. Claimants have to be able to prove that they are disabled from working in any occupation, as opposed to just their own.

3 Tips on how to communicate with your insurance adjuster

  • Asking for a copy of an LTD policy: Claimants are within their rights to ask for a copy of their long-term disability policy in order to determine which provisions might have led to a denial of benefits or cut-off. Insurers often invoke terminology that claimants are unaware of or do not understand.
  • Asking for clarification on terminology: Decline letters often do not include the specifics of the denial of a claim. Claimants should and can ask for clarification from the insurance adjuster.
  • Documenting communication in writing: While communication can occur over the phone or verbally, claimants should ensure all communications with an adjuster are documented in writing. This can also take the form of email communication. Recording all conversations, it ensures that in the event of a legal claim, the process runs smoothly.

Told to appeal an LTD denial while on a waitlist

I am currently on a waitlist for a treating psychiatrist. In the meantime, my request for LTD benefits was unexpectedly denied. I’ve been told to file an appeal with my insurer. Is this the best option for me now?

  • Waitlist for treating medical professionals: There is often a delay and backlog for treatment for mental health claims, particularly in the aftermath of the pandemic. Insurance companies typically do not like to wait however, the test in order to continue to receive benefits, is simply whether or not a claimant is disabled from working. A reasonable explanation should also be provided for a cut-off from benefits.

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