Disability Law Show Bell Radio – S3 E44

Episode Summary

COVID-19 long-haulers, reaching a successful disability settlement,  substance abuse and more on Season 3 Episode 44 of the Disability Law Show on Newstalk 580 CFRA in Ottawa.

Listen below as Tamar Agopian, Senior Associate at Samfiru Tumarkin LLP and Ottawa disability lawyer 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 from a disability lawyer in Ontario.

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Episode Notes

I was working from home as a result of the pandemic but have had a bad back and was attempting a return to work from LTD. I tried to reactivate my disability benefits but was denied. What can I do?

Most disability policies have a recurrence clause which allows for claimants who have tried to return to work but have been unsuccessful to resume their disability benefits. Claimants in this situation do not have to endure another waiting period for their benefits to resume. Insurance adjusters often do not initiate or approve recurrence benefits for claimants. Claimants who are denied their benefits should contact a disability lawyer to determine their next steps and be given more information as to why benefits were denied.

I’m getting disability benefits but the holidays are around the corner. How should I prepare?

It is a myth that many claimants who are on long-term disability benefits have to continue receiving benefits from their adjuster, and insurance companies will not deny claims during the holidays. A major component of disability policies stipulates that claimants can continue to receive benefits if they are in a certain location. Claimants that are planning extensive travel should look closely at their disability policies to determine if there are exclusions regarding coverage. It is also important for claimants to receive clearance from their doctors in terms of holiday plans.

I contracted COVID-19 last year and I’ve never really recovered.  I’m exhausted all the time and there’s no way I can go back to my job. I was denied LTD benefits. What happens if I get better before we finish the claim?

There are many individuals across Canada who contracted COVID-19 and have long-term symptoms despite recovering from the virus. Claimants who have their doctor’s support and have symptoms that prevent them from working should be approved for long-term disability benefits despite the novel nature of COVID-19. Ultimately, a diagnosis is not significant in the approval of LTD benefits. Claimants should not be discouraged from submitting a legal claim as the goal for many claimants is to eventually return to work but the legal process alleviates stress and financial burdens from claimants.

When you’re trying to resolve your client’s disability claim with the insurance company, what factors into reaching a successful settlement?

A successful settlement is typically a settlement in which there is give and take. An efficient disability lawyer will look closely at a client’s age, prognosis, deductions in play, such as CPPD, etc. to ask for as much compensation as possible for clients. The documentation is also vital in reaching a successful settlement as it outlines what the client is agreeing to in exchange for what the insurance adjuster expects.

LEARN MORE
CPP Disability and Long-term Disability

If my workplace caused my mental breakdown, am I still entitled to disability benefits?  My company has a third-party administrator who rejected my claim because of the performance issues I was having at work.

Claimants who have their doctor’s support and are unable to work do have a valid claim, regardless of whether the mental illnesses originated. It is important to determine whether or not a mental illness is situational or a general disorder. Claimants who are unable to work in another environment successfully do not have a situational disability.

WATCH TO LEARN MORE
Disability Law Show Season 3 Episode 2 – Situational v. Generalized Conditions

Once the insurance company approves a person’s disability claim, does someone new get assigned by the insurance company to deal with the claim?

Once a claimant is approved, they could see a change in insurance adjusters if they are transitioning from short-term disability to long-term. Internally the insurance company could have specific adjusters assigned to either long or short-term disability benefits. Claimants should prepare for a change in adjusters particularly if they have a mental illness.

My husband was put off work due to a heart condition, depression and self-medicating with alcohol. He would rather be working but hasn’t been able to. The insurer cut him off last year saying he could do another job. What can we do?

Some disability policies contain provisions that include terminology that restricts claimants who have substance abuse illnesses. It is generally considered an improper denial as long as claimants are seeking treatment. Insurance adjusters ask for repeated updates in order to wear down claimants and waste time so that a claimant does not continue to pursue their rights. Claimants who are denied disability benefits can speak to a disability lawyer particularly if there are complicated elements to their claim.