Disability Law Show Bell Radio – S4 E01

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 4 Episode 01 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, who 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

Does a lack of COVID-19 testing affect a future long-term disability claim?

Most disability policies and claims are not concerned with a diagnosis of an illness in order to qualify for long-term disability benefits. Claimants have to have symptoms that prevent them from being able to work, and their doctor’s support in order to qualify for long-term disability benefits. A diagnosis is not necessary and so proving a claimant’s COVID-19 positivity is irrelevant.

Can a lack of access to treatment lead to my benefits being cut off? It is more difficult for me to seek treatment due to COVID-19 and potential isolation due to lack of testing.

Claimants who are on long-term disability should speak to their doctors and treatment providers about their next steps regarding treatment. Unfortunately, some insurance companies have denied or cut off benefits as claimants are unable to receive treatment and are considered to be non-compliant. Claimants in this situation should speak to a disability lawyer as soon as possible as this behaviour can be considered to be bad faith and could result in punitive damages. Claimants should not be risking public health and safety.

I’ve been on LTD for a year now.  Why would my insurance company send someone from an outside company to my house for a house visit?  Should I be worried?

Insurance companies do not want to keep individuals on a claim and so will look for ways in order to cut off benefits. After two years of benefits, the definition of what qualifies a claimant to be disabled changes from disabled from an individual’s own occupation, to any occupation. Claimants are often reevaluated and cut off of benefits leading up to the two-year mark. Insurance companies will impose various assessments in order to have a basis to cut off benefits. Assessments are typically conducted to determine a claimant’s functional abilities on a daily basis.

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Surveillance and Long-term Disability

Is there a limit to how many assessments the insurance company can make you go to?

There is no specific limit to how many assessments an insurance company can make a claimant go to, however, the assessments have to be reasonable. Ultimately claimants should do whatever they can to extend the period of time in which they are able to receive benefits. At a certain point, continued assessments can cause additional stress and anxiety for claimants as well as provide more unnecessary information to the insurance company.

I was recently diagnosed with kidney disease.  At what point can I go on short-term disability?

Claimants who have a condition that prevents them from working, and have their doctor’s support, should apply for disability benefits. A diagnosis should not impact when a claimant is eligible to receive benefits.

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

There can be a high degree of turnover within the insurance company, and there can be several adjusters processing a single file. Claimants should expect a detailed conversation with their adjuster at the beginning of their claim application with the adjuster which who will be assigned to the file. Periodically, there will be check-ins with the adjuster throughout the process. Depending on the nature of the disability, there could be assessments that are not conducted by the adjuster as well as a potential third-party specialist that works between the insurer and the treatment providers.