Disability Law Show Bell Radio – S4 E09

Episode Summary

Discover your rights and the truth about insurance companies and long-term disability claims on Season 4 Episode 09 of the Disability Law Show on Newstalk 1010 in Toronto.

Listen below to Tamar Agopian, a Toronto disability lawyer at Samfiru Tumarkin LLP, who guides 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 sent periodic updates from the insurance adjuster about my daily activities. I later found out I was surveilled and my benefits were cut off. What can I do?

Claimants can be surveilled by insurance adjusters which can lead to disability benefits being cut off. While it is important for claimants to cooperate with the insurance company and be forthright with information, it is also important to note that surveillance information is taken out of context in order to justify cutting off long-term disability benefits. By beginning a legal claim, a copy of the file will be provided and it is easier to determine the reason the benefits were cut off.

My husband has struggled with mental health issues for years and his benefits were cut off in July 2020. We never got a letter telling us why. His doctors support that he cannot work.  Is it too late to start a legal claim for benefits?

Claimants have up to two years in a limitation period after their benefits are cut off or denied to file a legal claim pursuing their disability benefits. Most insurance companies will urge claimants to start an appeals process in order to resume benefits however this process wastes time and is generally ineffective. It is unusual for claimants not to receive a denial letter and the date of the denial is important to discover the limitation period and reason for denial. It is important to document all communications with the insurance company in writing.

Can you get disability benefits if you have depression?

Claimants with depression do qualify for long-term disability benefits as mental health issues are still qualified as illnesses or conditions. Depression, like a physical condition, can prevent a claimant from being able to work. Ultimately, if a doctor states an individual is unable to work due to a mental health condition, they should qualify for disability benefits.

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Invisible Illnesses and LTD

The long-term disability insurance company said that their doctor reviewed my claim and said because my job was sedentary I could work.  I suffer from depression and anxiety and was approved for short-term disability. Should I appeal?

Insurance companies should have a complete medical profile from claimants and individuals should ensure all relevant medical information is given to the insurer. Insurance companies that do not have all information might not have the full picture of a claimant’s health and deny LTD benefits on an incorrect assumption. It is important however to note that for insurers that have all relevant information and still deny benefits, an appeal will likely be unsuccessful. The appeals process is not investigated by an external entity and is often conducted by the same adjuster who initially denied benefits.

Do insurance companies wait for appeals or close files once benefits are denied?

In most cases, insurance companies will place a file in a temporary state in order to possibly await an appeal from a claimant. Claimants are often told, however, that their file has been closed by the insurance company and this statement often causes confusion.