Disability Law Show Bell Radio – S4 E04

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 4 Episode 04 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 was in an accident over a decade ago and had serious injuries. I recovered and could work up until a few years ago when my chronic pain and other health issues became too much. I was denied LTD and appealed several times. What can I do?

It is important to remember that the appeals process was created by insurance companies and appeals are not typically effective in restoring or approving long-term disability benefits. Insurance companies will often deny benefits if a claimant has been able to work for a period of time despite exhibiting symptoms. Claimants can have multiple health issues that can build and progress over time. There does not have to be a single triggering event that disabled a claimant from working.

My father passed away which triggered severe depression and anxiety. I was approved for LTD for over a year but then was told my benefits would end. My mom then passed away. Despite my doctor’s support, they are refusing to reinstate my benefits.

In some cases, despite changing circumstances insurance companies refuse to change their denial of benefits. Insurance adjusters would rather seek information to reinforce their choice to end or deny benefits than re-assess the situation. Mental health claims are often denied despite the recurring natures of many mental health illnesses. Claimants should not be detracted from pursuing their disability benefits and should contact a disability lawyer as soon as possible.

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

What does it mean when an Insurer says they are having your file reviewed by a “Health Management Consultant”. Do you have to follow their recommendations?

A health management consultant is an undefined term and is not a licensed profession. A health management consultant is typically an employee of the insurance company and is involved in the adjudication process, but not on a medical basis. Claimants should follow recommendations as long as the advice is reasonable however it is important to remember that consultants are not doctors.

My LTD claim was denied even though the insurer acknowledges my symptoms and illnesses. I was told my physician’s letter does not suffice. My doctor recommends 4-6 months of recovery before I return to work. Do I have a case?

Claimants who have their doctor’s support should continue to follow their medical advice. Only a treating doctor and medical team can determine when a claimant is ready to return to work, and the possible accommodations required. Some insurers will ask treating doctors to fill out detailed forms in order to be able to determine how often the claimant’s symptoms arise and the level of severity, however, doctors do not provide such detailed reports without prompting.

I receive LTD and am permanently disabled. I recently got arrested and charged with a criminal offence. Can the insurance company terminate my LTD as I have a criminal record?

The criminal record itself is not an issue in determining whether or not a claimant should receive or continue to receive long-term disability benefits. Claimants who have been injured or disabled while committing a criminal offence could be denied LTD as there are exclusions in disability policies. There is typically language in disability policies that allow insurance companies to stop disability benefits while a claimant is incarcerated.

I’m on LTD after having knee surgeries and cannot return to my daycare job. I was also diagnosed with severe neck stenosis and am in constant pain. Am I covered only under original injury?

Claimants can begin a disability claim regarding one particular health issue but can develop other health issues as time progresses. It is important for claimants to provide their insurance adjusters with ongoing health reports and medical information and be as open and honest as possible. Many individuals assume that disability insurance is there to provide for claimants if they have a diagnosed condition. Ultimately, whether or not a claimant should receive benefits is determined by their functionality regardless of a singular diagnosis.

Do I have any options if my LTD claim was denied due to being sent in past a deadline?

A limitation period differs from an application deadline regarding long-term disability. Disability policies often have an application deadline and deny benefits if a claimant misses a deadline. in reality, as long as a claimant’s application is not exceedingly late and the insurer is still able to review the claim, courts will allow a claimant to apply.