Common Questions about LTD Cut-offs | Disability Law Show TV – S3 E30

Episode Summary

COMMON QUESTIONS ABOUT LTD CUT-OFFS on Season 3 Episode 30 of the Disability Law Show with disability lawyer and co-founding 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 Ontario, British Columbia, or Alberta, on the only disability law show on TV and radio in Canada.

Episode Notes

Insurance company ignoring claimant’s doctor’s prognosis

My daughter has a history of depression and anxiety and due to COVID-19 things have gotten worse. She was cut off from her long-term disability benefits as the insurer didn’t agree with her doctor. She appealed twice. What should she do?

• Doctor’s opinion of claimant’s condition: Sivan explains that many insurance companies deny long-term disability claims regarding mental health illnesses. It is important for claimants to remember that the appeal process is internal at an insurance company, and is rarely effective. Contacting a disability lawyer after a disability claim denial is vital in pursuing benefits and should be done as soon as possible.
  • Learn More
    Invisible Illness and Long-term Disability Claims

Long-term disability benefits ended but unable to work

My brother worked for a large international insurer for 11 years when he had a bad fall and was hospitalized. He first went on short-term and then long-term disability. After nearly 2 years on LTD, they have decided to end his benefits and income replacement., but he is still unable to work.

• Benefits cut off: Insurance companies often cut off benefits after two years of disability benefits. Claimants should remember that in most disability policies, there is a change in definition after two years; after two years the test for disability benefits applies to a claimant who is unable to perform the basic duties for any occupation, not just their own. Claimants who are unable to perform in a position that is comparable or in which they are suited, are still eligible for disability benefits.

Common Questions about LTD Cut-offs

• Cut off LTD while they are still disabled from working: Claimants can be cut off of long-term disability benefits by the insurer, however, the insurance company is not always correct in cutting off benefits. Claimants who are still unable to work can still pursue their benefits by contacting a disability lawyer.
• Wait until they are cut off to get legal help: Sivan explains that claimants can seek legal help as soon as they are made aware that their benefits will be cut off.  Waiting for benefits to be cut off can cause more difficulties for individuals as there could be months in which they have no financial income.
• Can anything be done to change the insurance company’s mind: Insurance companies want claimants to appeal a denial or cut-off of benefits as the appeal process is internal and often ineffective. By appealing a decision, a claimant is wasting valuable time.

Denied LTD as no significant change in medical condition

I was diagnosed with a degenerative disease 10 years ago and have undergone treatment and medication. As an account executive, my job requires me to deal with customers on a regular basis. My claim for LTD was denied as there hasn’t been any significant change in my condition. I appealed twice.

• Appealing an LTD denial: Sivan explains that insurance companies often operate in bad faith and can be liable for punitive damages. Claimants that are disabled and have their doctor’s support should contact a disability lawyer. Doctors should provide claimants with updated records and information regarding their medical condition and prognosis in order to strengthen a claimant’s file.
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Benefits cut off due to regression in addiction

I have a friend who is on long-term disability and was in a car accident and had very serious back and neck injuries. She is waiting on surgery to repair her spine. At the same time, she is struggling with depression and alcoholism. The insurer is suggesting if she is unable to get sober, her benefits could stop. Is this true?

• Addiction and long-term disability benefits: Most disability benefit policies view addiction as a disability and medical condition and so are unable to deny benefits due to substance abuse addictions. In some situations, such as car accidents, there are multiple disability and insurance claims converging. Due to this, it is important to contact a legal firm that is well-versed in multiple areas of the law, such as disability and personal injury law.

Denied or cut off benefits after an independent medical assessment

My son is currently on LTD but went to an independent medical examination upon request by the insurer. We have made attempts to contact the insurance company after the examination and have heard nothing in response. We’re worried that his benefits are going to be cut off. What should we do?

• Independent medical exams: Most independent medical assessments are not independent as they are arranged and paid for by the insurance company.  Claimants are however obligated to attend an IME but should ask for a report and communicate with their own doctor of the assessment in order to inspect inaccuracies or potential falsehoods.
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    Independent Medical Assessment: Tips from a Lawyer

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Next Episode: Disability Law Show S3 E31 – Invisible Illness and Disability Claims

Previous Episode: Disability Law Show S3 E29 – Dealing with difficult employers while on LTD