5 Common LTD terms and how they can impact your claim | Disability Law Show TV – S4 E13

Episode Summary

5 COMMON LTD TERMS AND HOW THEY CAN IMPACT YOUR CLAIM on Season 4 Episode 13 of the Disability Law Show with disability lawyer and Partner, James 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

Researching and hiring the right disability lawyer

I’d hired a disability lawyer and they reached out to my insurance company without setting up a mediation. The settlement offered was too low and not something I can agree to. What should I do?

• Legal advice from a disability lawyer: It is important for claimants to research the reputation of the law firm and the lawyer that is representing them before beginning the legal process against an insurance company. Some law firms are known for doing whatever they can in order to resolve a claimant’s case. When a file is moved from the claims department to the legal department, a value is placed on that file that controls how much money the insurer is prepared to pay out. Part of the analysis for this value is based on the reputation of the law firm.

Denied LTD due to no evidence to support a mental health claim

The insurance company said I am not eligible to receive LTD. The adjuster claims I don’t have enough evidence prior to my mental breakdown last year despite a long list of GP and psychiatrist appointments, as well as reports from specialists. How is that possible?

• Denying a mental health claim: It is possible that a detailed medical file still might not provide evidence to support that a claimant is disabled from working. Alternatively, a medical file and a doctor’s support can still lead to denials of disability benefits. Insurance companies will look through a file to find any justification to deny or cut off benefits, particularly with mental health claims. Mental health claims are still not treated in the same manner as a physical disability claim. Claimants can show that they’ve undergone necessary testing and treatments in order to strengthen their claim.

5 Common LTD terms and how they can impact your claim

• “Total Disability”: The term total disability is often incorrectly interpreted by claimants, as they view it as it is commonly used.  The term “total disability” in the disability law context is defined as an inability to perform the basic tasks and functions of a claimant’s job due to a disability. The definition for total disability can be found in the claimant’s disability policy.
• “Own Occupation” vs. “Any Occupation”: After two years on disability benefits, the test in order to qualify for benefits changes from a claimant’s inability to work in their own occupation, to any occupation. Claimants are often cut off from their disability benefits around the two-year mark.
• “Recurrence Clause”: A recurrence clause is found in a disability policy that allows claimants to return to work but if they are unsuccessful, resume their benefits. The recurrence clause allows claimants to forego the elimination period and can immediately resume benefits.
• “Pre-existing Condition”: There are very few specific circumstances that prevent claimants from being able to receive disability benefits due to a pre-existing condition. Most disability policies allow for claimants who have worked in their positions for over a year to claim disability benefits. in most cases, claimants who become disabled before the first year of employment could be considered to have a pre-existing condition.
• “Transferable Skills Analysis”: The transferable skills analysis is a tool that insurers will use in order to evaluate a claimant’s ability to work in a different job or position that is comparable to their previous employment. The skills analysis typically occurs around the two-year mark due to the change in the definition of disability. Often, the skills analysis results in insurance companies offering incomparable positions for claimants.

A claimant with young-onset Parkinson’s disease denied LTD

I’m a graphic designer who was recently diagnosed with young-onset Parkinson’s disease. I initially tried to continue to work but the tremors, and accompanying depression and anxiety, have made it impossible. My claim for LTD was denied because I was not “totally disabled”. What can I do?

• Progressive condition and disability benefits: Parkinson’s disease is considered to be a progressive disease and typically means claimants will get to a point at which they will no longer be able to work. Insurance companies are aware of the fact that claimants who are diagnosed with young-onset Parkinson’s will be on disability benefits for years and so will find any justification to deny a claim. Claimants who are denied their benefits should not give up and should contact a disability lawyer as soon as possible in order to pursue their rights as progressive diseases will only worsen over time.

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Previous Episode: Disability Law Show S4 E12 – What to know about transitioning from STD to LTD