Disability Law Show Bell Radio – S4 E08

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 4 Episode 08 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 recently diagnosed with cancer and I’ve been told I need surgery. I was already struggling at work during COVID-19, and now with my cancer diagnosis, my family doctor thinks I should stop working and focus on my health. I’m worried I won’t be approved for LTD.

It is important for claimants to outline the symptoms they are experiencing with their doctor and treating medical team that is preventing them from being able to work. Claimants who have the support from their doctors that they are unable to work should apply for long-term disability benefits.  A diagnosis is ultimately not necessary in order to be approved for LTD. There are currently no cases that have gone to trial and had a verdict delivered regarding claimants and COVID-19 health concerns in relation to LTD. Insurance companies typically do not want cases to lead to trial as they do not want a precedent set.

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Cancer and Long-term Disability Benefits

Are there different kinds of disability insurance policies, or are they all basically the same?

Many disability policies contain the same definition to qualify for disability benefits and the approval process to qualify for LTD after two years. There are policy changes in regards to individual or group policies. Some individuals pay for disability policies themselves which contain different terms and provisions. There are also differences between short and long-term disability benefits. Short-term benefits begin first typically however not all employers have short-term coverage.

I submitted an LTD claim and found out because of my employment date that I’m subject to a pre-existing condition clause. Do I have to provide access to all my medical records?

The pre-existing condition clause exists in most disability policies and generally states employees who are sick within their first year of employment, an investigation will begin in order to determine if the condition existed before employment began. Claimants are required to provide all medical information in relation to this investigation. Disability policies can vary in regard to pre-existing condition clauses. It is important for claimants to cooperate with the insurance company and if still unsure of their rights, contact a disability lawyer.

What happens if I start a legal claim against my insurer and then I get better?  How long do I have to wait before I can return to work?

There is no reason for claimants not to be working if they are medically ready and deemed able to do so by a treating medical team. Claimants should not be deterred from filing a claim as, despite the process being initiated if they are able to return to work, they are still able to do so. Ultimately only a treating doctor can decide when a claimant is ready to return to work.

I was approved for LTD but recently I had a call with my adjuster, and he asked me whether I was pregnant or planning to get pregnant. Do I have to answer these questions?

Unless a disability claim is related to pregnancy, the insurance company might not have a legitimate reason to ask pregnancy-related questions. At times adjusters make assumptions that a claimant who is trying to start a family is also able to work and should not be considered disabled. It is not advisable for claimants to outright lie or hide information from their insurance adjusters.