Common LTD insurance tactics | Disability Law Show TV – S4 E29

Episode Summary

WHAT YOU NEED TO KNOW ABOUT COMMON LTD INSURANCE TACTICS on Season 4 Episode 29 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

Legal claim process and mediation for LTD

My benefits were cut off despite the fact that my doctors supported my inability to work. Before my mediation process could begin, the insurance adjuster asked to begin an assessment. Is this normal?

• Duty for insurance adjusters to behave in good faith: All insurance adjusters are obligated to operate in good faith with claimants. Adjusters who fail to conduct themselves in an appropriate manner could incur additional punitive damages as well as the standard benefits that should be paid out.
• Mediation process for LTD: In most jurisdictions, mediation is not considered mandatory however it is in some regions in Ontario.

LEARN MORE ABOUT ASSESSMENTS
Independent Medical Examinations for LTD claimants

Given a return to work date by the insurance company

After being on long-term disability for almost two years, I was told by my insurer it is time to return to work. My doctors believe I’m not ready and need more physiotherapy. What can I do?

• Change of definition time period: After two years the change in the definition of what is considered disabled from working in a claimant’s own occupation to any occupation. Many claimants have their LTD benefits cut off after the initial two years.
• Return to work after long-term disability: It is potentially detrimental to a claimant’s own health and recovery if they ignore the advice of their doctor. Only a claimant’s treating medical team can condone a return to work and possible accommodations required. The decision of returning to work is a medical decision and not an insurance or employment choice.

What you need to know about common LTD insurance tactics

• Insurers refer and prescribe claimants to seek treatment from their own providers: Insurance companies are typically concerned with making a profit and ultimately will hire professionals and prescribe treatments for claimants that will give them a favourable outcome.  Claimants should get a referral to a treatment provider that they can trust.
  
• Adjusters will often take information out of context to justify ending benefits: Insurance companies are in constant contact with claimants early on in the claims process in which they take notes and summarize the communication. Adjusters often take verbal communication out of context or cherry-pick certain phrases to justify cutting off benefits. It is important to remember that insurance adjusters’ objective is to cut off benefits to help their employer.
• All or most communication will be conducted over the phone by adjusters: Early on claimants should ensure that all communications with adjusters are documented in writing and a request is made. Adjusters could refuse this request however claimants are able to take notes on their own of the conversations with the handler.
• Frequent vague references to the future and return to work plans: Adjusters often mention a return to work plan in order to provoke claimants into stating things that could be taken out of context. Adjusters could also introduce a return to work plan in order to make the claimants assume that returning to work is inevitable despite the medical condition of a claimant.

Different long-term disability policies

I was on LTD years ago at a different employer. After a successful return to work now appear to be experiencing debilitating migraines. Are there different kinds of disability policies?

• Long-term disability policies: Most disability policies are similar and follow a standard group disability policy. Claimants who are unsure of what their policy contains can request to obtain a copy of their LTD policy to determine the test in order to qualify for disability benefits. There can be pre-existing inclusion variances depending on the policy.

LEARN MORE
MIgraines and Long-term disability benefits

PREVIOUS EPISODE: Disability Law Show S4 E28 – 3 Things you should do when dealing with your insurance adjuster