Diagnosed with an invisible illness & applying for LTD | Disability Law Show TV – S6 E19

Episode Summary

WHAT TO KNOW IF DIAGNOSED WITH AN INVISIBLE ILLNESS & APPLYING FOR LTD on Season 6 Episode 19 of the Disability Law Show with disability lawyer and Partner Tamar Agopian.

Watch above to discover the steps you must take when the insurance company cuts off or denies your long-term disability claim anywhere in Canada, on the only disability law show on TV and radio in the country.

Episode Notes

On leave while applying for disability benefits

I’d been working for a company as a project coordinator for many years and while transitioning to working back in the workplace I was diagnosed with cancer. My boss advised me to take time off before applying for disability benefits. I was denied by the insurer as I was not “actively employed” at the time of application.

• Applying for disability benefits: To qualify for disability benefits, a claimant has to be actively employed at the time of application. In many disability policies, there is a minimum required number of hours employees must meet. Individuals who have followed their employer’s advice should not be penalized by their insurer and ultimately should rely on their treating doctors’ support.

Request for medical updates from the insurer

My husband was diagnosed with schizophrenia and has been on LTD for almost 2 years. Our insurer keeps asking for medical updates from his GP. We’ve asked them to speak directly to his psychiatrist instead. Does the insurer’s lack of awareness mean his benefits will be cut off?

• Medical updates while on a claim: Insurance adjusters are not always aware of the nature of a medical condition, thus also unaware of who to speak to about a claimant’s treatment and prognosis. Claimants with complicated mental health conditions should ensure their insurer is kept informed by the appropriate treating professionals.

What to know if you’re diagnosed with an invisible illness and applying for LTD

•  A lack of objective medical evidence: Invisible illnesses can be difficult to diagnose due to a lack of objective medical evidence. It is a common misconception that a diagnosis is required to receive long-term disabilty benefits. Disability law supports that claimants must only prove their symptoms prevent them from working.
  
• Insurers often deny LTD claims: Claimants are often denied disability benefits based on insufficient medical evidence. With many invisible illnesses, providing imaging or test results indicating an illness is difficult. Claimants must provide all necessary information to their insurance providers, such as reports from treating professionals.
  
• Support of a treating doctor or specialists: Claimants need to have the support of treating doctors to receive approval for disability benefits. Courts typically defer to a claimant’s regular practitioners rather than those recommended by an insurer.

Non-compliance with insurer while on LTD

With the support of my doctor and physiotherapist, I had to stop working after shoulder replacement surgery a year ago. My case manager has told me to change to another physiotherapist and specialist they recommend. Do I have to follow these suggestions?

• Terms of a long-term disability policy: Insurance adjusters should be questioned by claimants who insist on a specific treatment plan, particularly if there is conflict with the claimant’s own doctors and treatment providers. Ultimately, claimants should follow the advice of their medical team and ask for clarity from their insurers.

Impact of CPP Disability on LTD

I’ve been on LTD for almost two years and was approved for CPP disability. In a call with my disability insurer, I was told they are reviewing my case again to decide if coverage should continue. If CPP disability has approved me for the long-term, can the insurer still decide to cut me off?

• Other disability programs: The test to qualify for CPP Disability is much more difficult than that of LTD. Unfortunately, despite approval for CPPD many LTD insurers still cut off disability benefits. A CPP Disability approval can be used as leverage against an insurer who insists on ending or denying a claim.

PREVIOUS EPISODE: Disability Law Show S6 E18 – What to know about LTD benefits and chronic pain