5 Major facts about long-term disability benefits | Disability Law Show TV – S5 E02

Episode Summary

5 MAJOR FACTS ABOUT LONG-TERM DISABILITY BENEFITS on Season 5 Episode 02 of the Disability Law Show with disability lawyer and national co-managing Partner Sivan Tumarkin. and 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 provinces across Canada, excluding Quebec, on the only disability law show on TV and radio in Canada.

Episode Notes

Punitive damages for claimant after a legal claim is filed

A recent case in an Ontario court lead to punitive damages of over $1 million awarded to a claimant.

• Damages for claimant awarded: It is very rare that LTD cases go to court as insurers are aware of the disadvantages they face if a legal claim is decided upon by a judge. Punitive damages are typically awarded after a claimant’s insurance adjuster has behaved in bad faith with a claimant and caused additional stress.

A missed appointment could lead to cut off of LTD benefits

My wife has been on LTD recovering after eye surgery. She recently missed an appointment with her doctor but has since rescheduled it. Her insurer called to ask for an update and is now implying she’s in danger of losing her benefits. What should she do?

• Long-term disability policy provisions: Claimants are within their rights to request a copy of the long-term disability policy in order to determine if they are following all of the provisions included in their policy. In order to continue to receive benefits, claimants are expected to comply with ongoing treatment.
• Attending treatment appointments: Claimants should attend all treatment appointments and undergo the recommended treatments. Missed appointments should be rescheduled and an occasional missed appointment should not lead to a cut-off of benefits. Many individuals, particularly those who suffer from mental illness, or in some cases addiction, can lead to occasional regressions and cancelled or missed treatments. Claimants should communicate with their adjuster in writing the events that lead to their benefits being cut off.

5 Major facts about long-term disability benefits

• Benefits available for physical disabilities and mental illnesses: Often many individuals believe that a mental illness, as it is harder to physically prove, ensures that they are not able to receive approval for LTD. This belief is untrue and in reality, for individuals who are disabled from working in their own job as a result of a physical or mental illness or injury, an approval of LTD is possible with the support of a treating doctor.
• The term ‘totally disabled’: The term “totally disabled” in the context of long-term disability is often misinterpreted. In relation to LTD, “totally disabled” means a claimant is totally disabled from performing the basic duties and tasks of their own occupation as a result of a medical condition. The term is used often to confuse claimants
• Fighting an LTD denial with legal action: Claimants are within their rights to file a legal claim if their long-term disability benefits have been denied. Insurance companies would prefer claimants to walk away from a denial of benefits and give up. By filing a legal claim, the power imbalance between an insurer and a claimant is corrected.
• Time period to file a legal claim for disability benefits: After the initial date of denial is confirmed in writing, claimants have up to two years to file a legal claim and pursue their disability benefits. This time period is extremely important and claimants must abide by this time frame to file a claim.
• Appealing an LTD denial: The appeals process was created by insurance companies in order to waste time before a claimant can file a legal claim. Appeals are typically conducted by the same insurer that initially denied benefits and is not viewed by an external third party.

Benefits are potentially cut off due to a failure to comply

I’ve been on LTD for over a year due to an ongoing lung issue. My insurer recently informed me my benefits would end at the 2-year mark despite approval for CPPD.

• Cut off of long-term disability benefits at the two-year mark: Insurance adjusters and companies cut off benefits typically at the two-year mark as the change in the definition of disabled from working occurs. At the two-year mark, a claimant has to prove that they are disabled from working in any occupation as opposed to their own occupation.
  
• CPP Disability and its effect on LTD: The test in order to qualify for CPP Disability is typically more difficult than that for long-term disability. It is rare and unusual for a claimant who has CPPD approval to be denied LTD. Individuals should apply for CPPD as many disability policies assume that an application will occur and insurers will deduct a presumed credit.

PREVIOUS EPISODE: Disability Law Show S5 E01 – 3 Ways to make an LTD claim stronger