Disability Law Show Global News Radio – S8 E13

Episode Summary

Discover your rights and the TRUTH about long-term disability and personal injury on S8 E13 of the Disability Law Show on Global News Radio in Toronto and Vancouver.

Listen below to Sivan Tumarkin co-founding Partner and disability lawyer at Samfiru Tumarkin LLP  as he joins co-host John Scholes and they guide you through the proper steps to take when your insurance provider cuts off your long-term disability or denies your insurance claim.

Listen to the Episode

Episode Notes

I’m scheduled to proceed to a mediation with my current disability lawyer. He’s refusing to show me the brief about my case because he says I’ll want to make too many changes. What can I do?

This is your case, not your lawyer’s case. This is about your disability, and your lawyer is accountable to you. Your lawyer has no right to ignore you or not explain the process to you. Your lawyer should be on your side. If a client ever came to me about lawyer at my firm who was not communicating with them, they would receive a warning. The mediation process serves the purpose of helping to resolve your claim. When you go to a mediation anything could happen, because no two mediations are the same. But I explain to my clients the pros and cons of any offers we receive, and I explain any alternatives. I would outline my legal advice and my practical advice. When you hire a law firm you need to be careful, and make sure you get the right person in your corner.

Recently I was put back on LTD. Can my insurance company do an audit of my bank account and financial situation?

Your insurance disability provider cannot get access to your back account. Are they asking if you own your home? They can’t ask these kinds of questions. However, every LTD policy that I have seen has a provision that allows them to get an offset if you earn money or other income (a pension, severance, side work). The insurance company is always interested in minimizing what they must pay you. Another way for them to do this is for you to tell them if you have income from another source. If you don’t tell the truth in this respect, you may get hit with a demand for you to repay them. So, they are not entitled to get into your bank account, but they are allowed to know if you have any other money coming in. If ever the insurance company is asking you for information that you’re uncomfortable with it, you can ask your adjuster to show you where in your LTD policy it gives them the right to ask for that information.

I’m presently off work on WSIB, they’ve approved my claim and I’ve been off now for 8 months getting treatment for my injury. I recently found out that my employer has terminated my employment and cut off my health benefits, and I can’t get my medications. Can they do this?

There is human rights legislation in Canada that says you cannot fire a person who is disabled and on disability. If a person is deemed to be disabled and an employer fires them, then the employer opens themselves up to human rights damages, to a human rights claim, in addition to a potential claim for wrongful dismissal. If you’re in that situation, please reach out to me and I will put you in touch with someone on my team who can help you.

Is it standard procedure for an insurance company to request that I apply for CPP disability benefits? I am 47 and have been on disability for a year. Will I be penalized down the road in my retirement years if I comply with this request? If I don’t comply, can the insurance company close my claim?

If you are on LTD, it is standard for insurance companies to ask you to apply for CPP disability benefits. The reason they do this is that if you apply and are approved, the insurance company gets a credit for that. You’re not going to get your full LTD payments, plus CPP disability. The insurance company gets a credit for whatever amount CPP ends of paying you. My understanding is that if you access CPP disability, that will not make your CPP payments down the road any less. The advantages to getting CPP now include that if you get it, it means that the government deems you disabled, which means the insurance company will have a tougher time at some point later saying that you’re not disabled. Also, if your insurance company cuts you off, you’ll still have CPP disability and money coming in. Could they close your claim if you get CPP? They could, but if you don’t comply, they could end up estimating what you would be getting from CPP and deduct that from your monthly disability payments.

My brother is on LTD, and recently married a woman from France. Now he’s planning on spending 6 months of the year in France. What punitive measures can the LTD insurer take should they find this out? Can they demand whatever money they paid him be paid back? Or could they cancel his claim? What options does the insurance company have?

Almost every LTD policy I’ve seen contains a provision that limits you to the geographic location you reside, it’s a geographical restriction. You can’t move to France, China, or Russia, and expect the LTD payments to continue non-stop. Get a copy of the LTD policy and look and see if there is a geographical restriction provision. If there is one, you must be very careful, because then if the insurance company finds out they can cut off your claim and ask for a repayment of whatever they paid you while you were not here.  If, for example, you want to travel somewhere for therapeutic reasons, speak to your doctor and get them to put down on paper that they recommend the travel, and then have a discussion with your adjuster. Make sure everything is above board. You don’t want to do something the insurance company is not aware of and give them an excuse to cut you off. But if they do cut you off, we can help you.

I’ve been on LTD for 19 months, and my insurance company wants me to go to a place called “Lifemark” for an assessment. Is this normal, or are they trying to rope me into something that I shouldn’t do?

We’ve spoken about this idea before, where an insurance company at some point during the claims process while they’re paying you LTD wants you to be seen by one of their assessors. The reason an insurance company is doing that is that they want to figure out if they can get an opinion from one of these assessors that tells them that perhaps you’re not as disabled as your doctors are saying you are, that perhaps you’re ready to go back to work, and that maybe you can do some other type of work. When an insurance company wants to send you to an assessment, that is normal. Under a lot of policy’s that I’ve seen, they have a right to do so. If you are told to go to one of these assessments, you must go. If you don’t go, you could be found to be in breach of your LTD policy, and that could be a reason for your insurance company to cut you off. Don’t freak out. Prepare yourself. Email your adjustor and ask your adjustor to please send you a copy of whatever report is generated by the assessment. Go over the report and make sure you note the inaccuracies in the report and send your adjuster the list of the inaccuracies within the report so it’s on record. Then, give the report from the insurance assessors to your doctor. Have your doctor do a rebuttal and provide a counter opinion and give that to your adjustor. That’s how you protect yourself.