5 Crucial things to do when your LTD benefits are cut off | Disability Law Show TV – S4 E24

Episode Summary

5 CRUCIAL THINGS TO DO WHEN YOUR LTD BENEFITS ARE CUT OFF on Season 4 Episode 24 of the Disability Law Show with disability lawyer and national practice leader 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

Employment issues after the LTD claim has been resolved

My claim has been resolved but now my employer is asking when I am ready to return to work or what is next for me after an inaccurate letter was sent by the insurer to my pension board. I am still unable to work. What do I do?

• Returning to work after LTD: It is important to remember that in many cases employment and disability issues can overlap. It is vital for claimants to seek the appropriate legal advice as issues can be complex or multilayered as many employment and disability elements can intersect.
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    Terminated due to an illness or injury?

Chronic migraines but denied LTD as not “totally disabled”

I was in an accident almost a year ago that resulted in a shoulder injury and ongoing migraines that prevented me from being able to work. I applied for LTD but was denied because I’m not “totally disabled”. My doctor believes I need to continue with ongoing treatments and that I am not yet able to return to my job. What are my options?

• Headache disorders and disability policy terms: Insurance companies will often inform claimants that they are able to appeal a disability benefits denial, however, appeals are rarely successful. Disability policies often contain language and terminology that refers to an individual who is “totally disabled”. This phrasing simply means a claimant is disabled from doing their own occupation, and not completely disabled in general. It is very important to remember the context of this terminology. This phrase is used to mislead claimants from pursuing their benefits.

5 crucial things you must do when your long-term disability benefits are cut off:

• Accept the insurance company’s decision at face value: Insurance companies spend a great deal of time and money trying to convince claimants that they have their best interests at heart, but ultimately they are a corporation. Claimants need to keep in mind that insurance companies have their own purpose and aim to make a profit. A treating doctor’s opinion should always carry more weight regarding whether or not an individual is able to work.
• Check your disability policy to determine if your benefits can continue: There can be situations where claimants should look closely at their disability policies to determine if there are technical elements that they were not aware of. In some cases, this can include a pre-existing condition denial of benefits or a relocation, etc. Terms that are not explicit in the policy cannot lead to a denial of benefits. Claimants are also within their rights to ask for a copy of their policy from their insurance company and to be directed to terms in the policy that are the basis for the denial.
• Apply for CPP Disability if you have not already done so: CPP Disability (CPPD) is a program run by the federal government and is applicable for claimants who have been paying into it. The test in order to qualify for CPPD is often more difficult than that for long-term disability. It is beneficial for claimants to apply and be approved for CPPD as it will be more difficult for insurance companies to deny or cut off their benefits. Even a denial of CPPD can be beneficial as the insurance company cannot take an estimate of benefits away from claimants.
• Confirm your doctor’s support in writing: Doctors’ reports should be detailed and specific to a claimant’s situation as to whether or not they are able to work, why they are not, and their potential prognosis. It is important for this report to be specific to a claimant’s functional limitations in relation to their job.
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    Treating doctor’s reports and long-term disability
• Speak to a disability lawyer as soon as possible: Claimants should not hesitate from contacting a disability lawyer as consultations are free and can be anonymous. A consultation ultimately should be about gathering information so that individuals can determine their next and best options.

COVID-19 long-hauler denied LTD due to lack of medical evidence

After contracting COVID-19 at the start of the pandemic, I began experiencing several symptoms associated with “Long Covid” that severely impacted my ability to function. I tried to get LTD benefits but was rejected over the lack of medical documentation. I have appealed twice.

• Appealing an LTD denial: The appeals process was created by insurance companies in order to maintain control over the process and they generally waste time. Many individuals are currently experiencing the symptoms of “long-haul COVID-19“. It is irrelevant what a claimant’s diagnosis is – but simply their functional abilities and the symptoms that they have that prevent them from working. An initial diagnosis of COVID-19 through testing could strengthen a claim however ultimately it is not necessary.

Updating insurance company with medical conditions

I was originally on LTD due to ongoing knee and back problems. After several surgeries, I was also diagnosed with severe neck stenosis. Am I required to inform the insurance company that I now have an additional condition?

• Multiple medical conditions: While it is not required for a claimant to update the insurance company of their ongoing additional conditions, they should keep their insurers informed. Keeping insurance adjusters updated with ongoing medical information can only strengthen a disability claim. Additional symptoms will further prevent a claimant from their basic functional abilities. Disabilities can change over time and at times, there might be psychological issues added to physical ones.

Disability benefits file reviewed by health management consultant

My insurance adjuster has informed me that my file will be reviewed by a “Health Management Consultant”. What does this mean? Do I have to follow this consultant’s recommendations?

• Insurance company policies: Insurance companies can hire a consultant however the consultant rarely specializes in the condition that the claimant has. This consultant is hired to offer a cursory opinion that in no way outweighs the opinion of a treating doctor or medical team.
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    Independent medical assessments and LTD

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

Previous Episode: Disability Law Show S4 E23 – How to get LTD payments if you suffer from mental health issues