Disability Law Show Bell Radio – S4 E03

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 4 Episode 03 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

I’m a teacher and have been on short-term disability leave for the second time in the last year. I did apply for LTD last time but my claim was rejected. I’m going to apply again. What should I do to prepare?

Claimants should ensure that they are in communication with their treating doctors, attend treatment and be proactive about their long-term disability application. While at times claimants do everything they should in order to be approved for LTD, there is no way to guarantee their claim will be approved by the insurance company. Mental health claims can also be treated with more skepticism than physical disabilities by insurers.

I’m a massage therapist and my workplace required certain PPE regulations which resulted in my having to take a medical leave. I was denied LTD despite having support from my doctor regarding my anxiety. What should I do?

Some conditions can be triggered by certain work environments however that does not mean claimants are not disabled from working. In many cases, the same insurer determines whether or not a claimant is able to receive short-term and long-term disability benefits. Insurance companies deny LTD as they have to pay the benefit, rather than the employer.

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Long-term Disability and Toxic Work Environments

Can you speak to catastrophic assessments and how that designation is made?

A catastrophic assessment is conducted after a motor vehicle accident occurs in Ontario. Individuals who have been a part of a car accident always have access to their own personal insurance. Individuals who have been in an accident and have severe injuries, as a result, can potentially access catastrophic benefits which can be significant. Certain things can occur that can lead to an automatic catastrophic assessment.

I’ve been on LTD for 2 years with PTSD and severe anxiety due to workplace harassment. I currently am under the care of a psychiatrist, as well as my GP and several specialists.  My insurer says I need to have a transferable skills analysis. Do they have a right to ask this of me?

In some cases, the insurance company typically makes an assessment around the two-year mark and before the “any occupation” period of the disability policy. The insurance company has to be able to show that a claimant is able to do another job and if this is not possible, a continuation of benefits has to be approved. Insurance companies undertake a transferable skills analysis and claimants have to co-operate with the insurer. This analysis becomes the basis for finding new opportunities however claimants should remember that the jobs offered might not be a reasonable fit. If a claim is very strong and has sufficient medical records to support it, it is very difficult to imagine a scenario in which the insurer is able to deny benefits after an analysis.

I’ve been on LTD for 3 years now with severe depression and anxiety.  Even though I am getting treatment I haven’t improved much. I have a new case manager assigned and he told me I have to have an assessment with one of their doctors.  Why are they doing this?

Claimants who have been on LTD for over 2 years have already passed the “any occupation” period and they are considered to be unable to do any occupation. Insurance companies in this situation are looking for a reason to cut off benefits. Claimants should comply with the insurance adjuster despite frustration as it is important not to give the adjuster a reason to deny benefits.

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Suffering from depression and applying for LTD

Is it two years from when LTD starts or when short-term benefits begin that the transferable skills analysis occurs?

It is not a forgone conclusion that a transferable skills analysis will take place. A skills analysis typically occurs after the first year of long-term disability benefits and before the two-year mark of benefits occurs. Insurance companies can at times conduct an analysis without notifying the claimant.

I’ve been offered a one-time lump sum amount on my disability claim. I’ve also been paying for my extended health plan. I will lose the extended health plan if I accept this offer but worry my LTD will be cut off if I don’t.

Often a lump-sump settlement offered by insurance companies is inadequate and much lower than what claimants deserve to be given over a long-term period. Claimants should speak to a disability lawyer in order to determine whether or not the settlement is adequate and if they should accept the offer. Claimants do not have to accept an offer from the insurance company and should note that the adjuster has already deemed their claim to have ongoing value.