Applying for LTD because of fibromyalgia | Disability Law Show TV – S5 E21

Episode Summary

APPLYING FOR LTD BECAUSE OF FIBROMYALGIA on Season 5 Episode 21 of the Disability Law Show with disability lawyer and co-managing Partner Sivan Tumarkin.

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

A years-long disability claim

My client’s claim has been ongoing for seven years and off work for various reasons. After the initial approval of LTD, their benefits were cut off despite approval for CPPD. What can I do?

• Hiring the right disability lawyer: It is very uncommon for a disability claim to take years to resolve. Often, legal claims do not lead to court and are settled in a matter of months, and up to a maximum of one year. Claimants that have ongoing claims and are unsure of their benefits should consider a second opinion from a reputable disability lawyer.
• Approval for CPPD: Most disability policies stipulate that a claimant must apply for CPPD. Individuals that have not applied for CPPD can assume that their insurer will still deduct a credit based on the likelihood of additional CPPD benefits. Approval for CPPD can strengthen a long-term disability claim due to the difficulty in order to receive approval.

Automatic approval for LTD after STD

I’ve been receiving short-term disability for ongoing depression and panic attacks. My doctors believe I’m not ready to return to work after several months. If I apply for LTD, is approval automatic?

• Transitioning from STD to LTD: An approval for short-term disability does not ensure automatic approval for long-term disability. Insurance companies might not understand medical documentation for a variety of other reasons. Claimants should hope for the best and strengthen their disability claims. A denial of disability benefits does not mean claimants do not have other options and should speak to a disabilty lawyer.

Applying for LTD because of fibromyalgia

• Difficulty to diagnose and insurance skepticism: Many conditions, like fibromyalgia, are difficult to diagnose as they can be confused with other conditions. Fibromyalgia is based on symptoms that can debilitate claimants and prevent them from working. Ultimately, claimants should receive disability benefits despite a lack of a diagnosis.
• Seeking appropriate treatment: Most disability policies stipulate that in order to qualify for benefits, claimants should continue to seek and undergo treatment. Following medical recommendations is an obligation for claimants.
• Reasons for denying a claim: Due to the nature of fibromyalgia, and other conditions like chronic pain, it can be difficult to diagnose and articulate. Insurance adjusters will often deny claims based on a lack of sufficient medical documentation. Medical reports must be detailed and outline why a claimant is unable to work due to their symptoms. A referral to a specialist can be beneficial for claimants with fibromyalgia.

Non-compliance while on LTD

I suffer from rheumatoid arthritis and was approved for LTD last year. I was recently sent for an assessment and their doctor recommended a different treatment regimen. This new regimen could cause serious side effects. What should I do?

• Independent medical assessments: Claimants are obligated to attend independent medical assessments if requested by their insurer. Claimants ultimately should follow the medical advice from their own treating doctors. It is important for claimants to be careful with their refusal of recommended treatments and instead provide clarification from their own doctors.

Appealing an LTD denial

I have been off work for a year after a back injury. I originally applied for LTD but was denied by the insurance company. I just sent in my second appeal, but I’m worried I will be denied again.

• Repeated appeals and denials: The appeals process was created by insurance companies in order to ensure the power remains with the insurer. Appeals are rarely successful and are not conducted by an objective third party. Rather than appealing a disability benefits denial, a legal claim can be filed. Disability legal claims rarely lead to court and are typically settled quickly.

PREVIOUS EPISODE: Disability Law Show S5 E20 – What to know about mental illnesses and LTD