Disability Law Show: Alberta & BC – S1 E28

Episode Summary

When can an insurer reduce or deduct LTD payments? Disability lawyer Martin Willemse at Samfiru Tumarkin LLP answers this question and more on the Disability Law Show on 980 CKNW in Vancouver, 770 CHQR in Calgary and 630 CHED in Edmonton.

Listen below to discover important information about your rights and a guide through the proper steps to take when your insurance provider cuts off your long-term disability or denies your insurance claim.

Whether you need a BC disability lawyer or disability lawyers in Alberta, Sivan and his team can get you the advice you need, and the compensation you deserve.

Listen to the Episode

Show Notes

• LTD claim denied as insurer says claimant was not responsive: Claimants have an obligation to comply with the terms outlined in a long-term disability policy, which includes updates and communication as well as providing updated medical records. A refusal to comply is not an uncommon reason insurance adjusters use to deny or cut off claims. In some cases, a failure to communicate with an adjuster can occur as a result of a medical condition. Claimants should try their best to communicate with an adjuster and continue to receive treatment. It is important to have a complete record of communication with an adjuster in the event a legal claim is necessary.
• Insurance-recommended doctor not providing adequate treatment: In many cases, a claimant is sent for a medical examination or assessment by an insurance-recommended provider. Claimants are within their rights to seek a second opinion if they believe they are not receiving proper treatment. Long-term disability policies stipulate that claimants need to seek treatment in order to qualify and receive LTD benefits however most do not require an individual to seek treatment from a referred treatment provider.
• Disability benefit deductions due to another source of income: Insurance adjusters can only do what the terms of a long-term disability policy allow. For claimants who are awarded damages or income through a separate lawsuit, such as an injury sustained in a car accident, some disability policies state that the insurer receives credit as a result of the other benefits. The language and terminology included in a disability policy are very important in determining the next steps for a claimant.
• Missed deadline to apply for LTD but unable to work: In order to receive coverage and apply for LTD, a claimant has to be employed at the time of the application. Claimants have to be able to prove that they stopped working due to a disability. There could be many reasons why a deadline was missed by an application; this is typically referred to as ‘relief from forfeiture‘. Claimants should still try and apply for LTD regardless of a missed deadline.