Disability Law Show Bell Radio – S3 E27

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 3 Episode 27 of the Disability Law Show on Newstalk 1010 in Toronto.

Listen below to James Fireman and  Tamar Agopian, Disability lawyers at Samfiru Tumarkin LLP, as they guide you through the proper steps to take when your insurance provider cuts off your long-term disability or denies your insurance claim.

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Episode Notes

I work in childcare and I have a disability. My employer told me to take time off work but I was denied LTD. After appealing, I’m not sure what to do next.

Insurance companies have a mandate to be rid of as many claims as possible. A legal claim is sent instead to the legal department and there is a new claims specialist. It is important to start a legal claim with a disability lawyer as soon as possible as appeals are rarely successful.

I have been on LTD for 3 years and my insurer pays me 70% of my pre-disability income. Why aren’t my benefits calculated off what I currently earn and not my salary from 3 years ago?

Disability benefits are calculated based on what a claimant earned at the time of their illness and not the current change in income level. Claimants do not earn 100% of their salary when on disability benefits.

Can a union employee sue the company’s disability insurer?

In most situations, a unionized employee is able to sue the insurance company however in some cases the collective bargaining agreement prevents them from being able to do so. Unionized employees who have been denied disability benefits can reach out to a disability lawyer in order to bring forth a legal claim.

I’m on LTD benefits because of depression and anxiety. The insurer is looking to send me to a therapist of their choosing in addition to me doing therapy on my own. Can they force me to use their therapist?

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Anxiety Disorders and Long-term Disability

There are different protocols for treating depression and anxiety and in some cases, the insurance company might believe that the claimant’s therapist is not treating all illnesses. The claimant does not have to accept the insurance company’s recommendation if the requested therapy is not reasonable. It is important to determine whether the suggested rehabilitation is helpful or harmful to the claimant.

If LTD paid for an IME and a specific therapy is recommended, are they responsible for funding the therapy?

An independent medical assessment must be attended if requested by the insurance company. Treatments that are recommended at an assessment are not necessarily paid for by the insurer. Claimants often are expected by the adjuster to undergo recommended treatments on their own and use their benefits to do so. Claimants with the advice of their own doctor can decide whether or not they will undergo treatments.

I’ve been on LTD for 11 years and my benefits have never increased. Does that mean there is no cost of living index on my policy?

Benefits that have not increased likely mean that the insurance policy does not include a cost of living index. It is important for claimants to look closely at their insurance policies and determine how their benefits are being calculated.

My job is very physical and the insurer is attempting to push me back to work when both my doctor and I think it is too early. What options are best for me?

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Termination of Employment due to Illness

Claimants should remember that only their treating physicians decide whether or not they are ready to return to work and their recommended return to work program. Employers have a duty to accommodate employees who have a medical condition.