Disability Law Show Bell Radio – S3 E28

Episode Summary

COVID-19 long-haulers, disability claims and cancer diagnosis, mental health and more on Season 3 Episode 28 of the Disability Law Show on Newstalk 580 CFRA in Ottawa.

Listen below as Disability Lawyer Tamar Agopian, Senior Associate at Samfiru Tumarkin LLP, guides you through the proper steps to take when the insurance company cuts off or denies your long-term disability claim. Get the advice you need and the compensation you deserve.

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Episode Notes

The U.S has passed legislation that includes COVID-19 long-haulers as eligible for disability benefits.

There is currently no equivalent legislation or policy in Canada that is comparable to the American legislation. There are many Canadians currently struggling with long-term symptoms of COVID-19 that are at times invisible, such as fatigue, headaches, depression, etc. Many of these symptoms prevent Canadians from being able to function and work and yet they are often denied disability benefits.

I’ve been on LTD due to breast cancer.  Although surgeries are now over, I’m not well. Can the insurance company force me back to work if I don’t feel well enough?

Individuals who are still experiencing symptoms after cancer treatment and surgery should not return to work until their doctor has deemed them able to. Insurance companies cannot force claimants back to work before they are ready. Claimants who return to work before they are ready, the attempt might not be successful and they can suffer regression in their condition.

If a person wants to hire you to start a legal claim for disability benefits, does this mean they have to go after their employer too?

A claimant who is challenging their disability insurer for benefits does not mean they are also pursuing legal action against their employer. Claims against insurance and claims against an employer are generally separate. In some situations, such as when a claimant is on short-term disability benefits before their LTD begins, there is a third-party administrator that asks an employer for benefits.

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Employment Issues and Long-term Disability

Why aren’t my benefits calculated off my current salary and not the salary from 3 years ago when I began LTD?

Disability benefits are set on the time frame for when a claimant initially becomes ill and is unable to work. Disability benefits can only increase over time if there is a cost of a living provision included in the insurance policy that accounts for inflation.

Is there an easy way for someone to figure out how much disability benefits they are entitled to?

Claimants should ask for a clear and concise explanation from the insurance company on how their benefits are calculated. Claimants should also always make sure they have a copy of their insurance policy and understand all the terms and provisions included.

When I requested a copy of the disability contract from my insurer, I was refused and told to talk to my employer. My employer said it’s not for employees. What do I do?

Employers are obligated to provide an employee with a copy of their disability contract if requested by an employee, along with all information regarding an employee’s benefits. If an employer is unable to provide a copy, claimants are able to request and should be provided with the policy from their insurer. Insurers are not permitted to refuse claimants a copy of their insurance policy.

If a person returns to work after being off on disability, can they apply for disability benefits again if they need to?

Claimants are generally able to start disability benefits again after an unsuccessful return to work due to a recurrence clause in the insurance policy. Most policies include a provision that allows claimants to resume their benefits without the initial waiting period if their symptoms return or worsen as a result of returning to work.

I suffered a breakdown this year and I have a history of depression and anxiety. My doctor advised that I take some time off work.  My insurer and employer are making things worse by constantly asking me to provide more medical information. Should I just keep appealing?

Mental health providers and doctors should provide all the necessary information to the insurance company in order to help their patients be approved for disability claims. Claimants can be refused benefits on the basis of a lack of documentation. It is important for claimants to remember that appeals are rarely successful and are often a waste of time. If denied benefits, claimants should contact a disability lawyer as soon as possible.

What is the process of settling a disability claim like for your clients?

Once a disability lawyer is hired, a claimant no longer has to have direct communication with the insurance company. Mediations are handled by the disabilty and prepared in-depth by the lawyer. The process should have an open dialogue between all parties.