Disability Law Show Bell Radio – S3 E34

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 3 Episode 34 of the Disability Law Show on Newstalk 1010 in Toronto.

Listen below to James Fireman and Tamar Agopian, Toronto 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. Find out how a disability lawyer in Ontario can help you secure proper compensation.

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Episode Notes

I developed a mental health condition as a result of harassment at work and eventually lost my job. I applied for LTD after my termination but was denied. What can I do?

Often times mental illnesses can progress and it is important for claimants to seek treatment and put in an application for disability benefits as soon as possible. Insurers in this situation seem to be preoccupied with the fact that the claimant lost her job before her application was processed. This often happens despite the fact that a claim should only be considered on its medical merits. Claimants who have their treating doctor’s support should be approved for disability benefits. Denying a claim as a result of non-medical reasons typically does not result in favourable results for the insurance company.

I have a condition called lymphedema that makes it impossible for me to move. I worked as a forklift operator before this condition worsened. I was on LTD for 2 years but then my benefits were cut off. What are my options?

After two years on long-term disability, the test is in order to be approved for LTD changes. Claimants after two years have to be considered unable to do any occupation and not simply their own. Insurers often cut off disability benefits at the two-year mark and suggest possible job opportunities that are often not comparable or suitable for claimants.

I suffered a breakdown earlier this year due to the sudden death of my mom. I have a history of depression and anxiety, and things just got worse for me. I thought I’d be back to work by now, but I haven’t been able to access the psychotherapy that I need. Should I just keep appealing?

The appeals process was created by insurance companies and are rarely effective in changing a denial of benefits. It is an internal process within the insurance company and is not sent to an external arbitrator. Treating doctors should provide as much information to the insurance company as possible in order to limit the possible reasons for the denial of a claim. Adjusters that deny benefits after being provided with all of the necessary information will likely face legal action once a legal claim is filed.

LEARN MORE
Anxiety Disorders and LTD Claims
Depression and Long-term Disability Benefits

What is the mediation process like for clients who have filed a claim for disability benefits?

Mediation is the first and in the vast majority of cases, the only time a claimant is involved in the litigation process of a long-term disability claim. Claimants who sign a retainer do not have to communicate with the insurance adjuster as the disability lawyer takes over communication with the adjuster. This is often a relief for clients as they can focus on their treatment and health. Before the mediation, a disability lawyer should detail how the mediation should go with the claimant and what they can expect. At the mediation, clients do not have to do anything other than attend.

I took a less stressful job doing admin work, in the hopes I could continue working and manage my chronic pain.  My doctor put me off work 2 years ago and I’ve been getting LTD benefits under a private plan until recently. The insurer is denying benefits because they say I can go back to the admin work I was doing and because I’m not seeing my pain specialist anymore.  Does that make sense?

It is not uncommon to see slightly different terms and conditions to private plans, such as no change in the definition of disability. If there are other terms and conditions in the policy, it is important to have a copy of the disability policy. Insurance adjusters should be open and provide clarity on the reasons for the denial of benefits.  A failure to be clear with claimants is considered to be operating in bad faith.

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

Claimants who have brought a claim forth and have hired a disability lawyer, at the end of that process claimants will not be able to apply for benefits again. However, in most situations, claimants who have tried to return to work but were unsuccessful should be able to resume disability benefits due to the recurrence clause without an elimination period. If a claimant has returned to work for a longer period of time than specified in the policy and can no longer work, they are able to start a new claim for disability benefits.