Disability Law Show

5 Ways to improve likelihood of a successful LTD application | Disability Law Show TV – S4 E14

Episode Summary

5 WAYS TO IMPROVE THE LIKELIHOOD OF A SUCCESSFUL LTD APPLICATION on Season 4 Episode 14 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

Surveilled by an investigator while on LTD

I reported to my doctor that I was unable to do much beyond resting in bed every day however, my insurance adjuster hired an investigator to follow me. I worry that the investigator has spotted me out and about. What are my options?

  • Daily activities and surveillance: Insurance companies often ensure that claimants fill out a daily log of activities and use surveillance to verify that the activities match up with what they are seeing. it is very important for claimants to be open and honest with both their treating doctors as well as the insurance adjusters as their credibility can be damaged. Claimants who have been found to be lying can have all other communication with their doctors called into question.

Attend a virtual assessment requested by an insurance adjuster

I have been on LTD for four years due to aggressive, high-risk Prostate cancer. My treatments have resulted in continued low energy, brain fog and memory issues. My doctors say I am not ready to return to work, but my insurance adjuster wants me to attend a virtual assessment. Do I have to agree to this?

  • Assessments and disability benefits: Insurers have a right to evaluate a claim and have claimants attend a reasonable amount of assessments with a qualified professional. Often, assessments are over-used by adjusters. The opinion of a claimant’s treating doctor and medical team will always carry more weight for a court and judge than that of an assessor that does not know a claimant’s medical history well.

5 Ways to Improve the Likelihood of a Successful LTD Application

  • Clear support from treatment providers: It is critical that whatever opinion is being provided by a doctor, is their own opinion. It is important to note that doctors can ask for advice from a disability lawyer on how best to explain a claimant’s medical condition and explain their inability to work.
  • Aggressively pursuing assessment of your disability: Claimants who are unaware of what is causing their symptoms should try their best to determine the condition. While it is not necessary for claimants to have a diagnosis in order to receive long-term disability benefits. it typically strengthens a claim. Insurance adjusters often deny benefits to claimants who do not have a diagnosis. Claimants if possible should seek out specialists.
  • Full compliance with treatment recommendation: The insurance company is entitled to cut off benefits if a claimant is not compliant with their disability policy. Claimants have an obligation to continue seeking treatment for their condition and actively work to improve their health. While there could be a dispute over what treatment is recommended, claimants should follow their own treating doctors’ recommendations.
  • The insurance company has all relevant medical records: Insurance companies should have records of all treating specialists as well as up-to-date claimant’s medical records and have complete access to a claimant’s file. Claimants should put in writing that they have sent in all updated files to an insurance adjuster and ensure that records have been sent.
  • Reduce all communication with the insurer to writing: Claimants are within their rights to request all communication with their insurer to be in writing. Some claims handlers will refuse to communicate solely in writing and insist on a phone conversation. Claimants can choose to document the phone conversations in writing and send them to the insurance adjuster to confirm the accuracy of the conversation.

On LTD being forced back to work despite waiting for surgery

I am waiting for surgery to help with my carpal tunnel. My surgeries have been delayed and pushed back and unfortunately, my doctors say I can’t return to work until I am healed. The insurance company wants me to try another job and says my benefits will end soon. What can I do?

  • Awaiting surgery while on LTD: It is important to distinguish whether or not a claimant is in the first two years of long-term disability benefits or beyond the own occupation period. After two years of benefits, claimants will have to be able to prove that they are not able to work in any occupation comparable to their previous employment. Claimants should remember that awaiting treatment and particularly surgery, are objective procedures that claimants do not have control over.

Denied LTD as claimant worked prior to applying

The insurance company said they denied my LTD claim because I worked prior to applying. They didn’t care about my reason for the application. I was barely able to function properly due to severe pain. The denial occurred despite the reams of documents from my doctors. Should I appeal?

  • Reasons for an LTD denial: The appeals process was created by the insurance company in order to maintain control over the claims process. Appeals are rarely successful and are not an objective process conducted by a third-party arbitrator. Appeals generally waste a claimant’s time and are best avoided. Claimants who are denied their benefits should speak to a disability lawyer as soon as possible in order to determine what they are entitled to.

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

Previous Episode: Disability Law Show S4 E13 – 5 Common LTD terms and how they can impact your claim

Lost Your Job?
Disability Claim Denied?

Our team has years of experience helping tens of thousands of Canadians. Get the advice you need, the compensation you deserve.

Get help now

Advice You Need. Compensation You Deserve.

Consult with Samfiru Tumarkin LLP. We are one of Canada's most experienced and trusted employment, labour and disability law firms. Take advantage of our years of experience and success in the courtroom and at the negotiating table.

Get help now