Disability Law Show Bell Radio – S3 E38

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 3 Episode 38 of the Disability Law Show on Newstalk 1010 in Toronto.

Listen below to James Fireman, a Toronto disability lawyer at Samfiru Tumarkin LLP, as he guides 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 am working on a contract that is renewed every year. To get LTD from my insurance company, I have to get STD first. Will I be able to apply and receive the LTD benefits if my contract expires while I am on STD?

Claimants that are on short-term disability awaiting approval for long-term disability benefits should be able to receive benefits despite the contract expiring. Ultimately, the employee’s status of employment only matters if they are employed when they are deemed unable to continue working.

Can an employer put an employee on short-term disability?

In most cases, short-term disability policies are funded by the employer and insurance companies are hired to provide the adjudication. Employers in all situations reinforce the decision of the insurer but they are able to make their own decision.

I’ve been on LTD for 18 months for mental health illnesses. I was approved up until any occupation period but I’m now diagnosed with cancer. Can this diagnosis require a new claim?

The insurance adjuster and company should consider this claim as one continuous claim and claimants should not have to reapply for long-term disability benefits. In most cases, appealing a long-term disability denial is ineffective however in some situations in which there is new information it can be effective. This claim will be considered continuous as the diagnosis itself does not determine whether or not a claimant is able to work but that symptoms are ongoing that prevent an individual from working.

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Invisible Illnesses and Long-term Disability

I was injured at work but denied WSIB because they said my injury was due to a pre-existing back condition. I was approved for LTD benefits for two years when the insurance company cut me off. They asked if I was “totally disabled” and my doctor said I wasn’t. What can I do now?

The phrase “totally disabled” often is not clear to treating doctors as it has a different meaning in relation to insurance and disability context. Claimants in this situation can look to a specialist and also explain what the term “totally disabled” means in a disability policy. Reports from treating surgeons and doctors should focus on limitations that can be assessed. Ultimately, a claimant who has medical evidence that they are unable to work should be receiving long-term disability benefits.

If someone is on LTD, what is their obligation to the insurance company in regards to telephone interviews? Are they required to comply?

It is best for claimants to comply with requests from their insurance company in regards to communication and updates on their condition. Claimants should expect to hear from insurance adjusters more frequently if on a return to work plan. Claimants who feel their insurance adjuster is calling too frequently and invasive can ask their adjuster for the purpose of the interview.

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Dealing with difficult insurance Adjusters

I’ve been approved after the two-year mark for LTD. My adjuster said they would check in occasionally? What can I expect?

Claimants who have been approved of long-term disability benefits past the two-year mark should not expect to hear from insurance adjusters very frequently aside from a few administrative updates.

Can I babysit my granddaughter full time during the week if I am on a disability claim for mental illness?

In this situation, whether or not a claimant is able to babysit while on LTD will be dependent on the claimant’s occupation and if the occupation was similar to the task they are now undertaking.

Are long-term disability benefits taxable?

Long-term disability benefits will be taxable if a claimant has a personal policy that is outside of a group benefit. For claimants who have disability insurance through a group plan, benefits might not necessarily be taxed. Although benefits are taxed, if a claim is settled on a lump-sum basis and is paid for future benefits are not taxable.

How should I approach an out-of-province relocation request with my insurer, without jeopardizing my current LTD situation?

Claimants should look closely at their disability policy to determine if there are out-of-province restrictions. It could also be helpful for claimants to ask their insurance company who to communicate with regarding a relocation.

I have been on LTD for 2 years and they are cutting me off. They said there is not enough medical documentation to continue. Their letter says there is a 3-month appeal period. Do I have a case?

It is often uncommon and rarely effective for claimants to appeal a long-term disability benefits denial. The process of appeals is internal within an insurance company and is not looked at by an external arbitrator. Appealing a denial of benefits is typically a waste of time for claimants.