Disability Law Show Global News Radio – S8 E19

Episode Summary

Mental health disability claims, appeals, insurance contracts, and more on S8 E19 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 joins co-host John Scholes and guides 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

Do disability insurance policies include conditions regarding treatment for mental illnesses?

Many insurance policies stipulate that individuals who have a mental health condition seek treatment from a medical professional. A failure to seek and participate in treatment can result in a denial of benefits. Mental health professionals however are scarce which poses problems for claimants. Claimants who cannot access therapy or a psychologist should still seek treatment where possible.

I have depression and PTSD and my doctor says I am unable to work. My insurer says my LTD benefits will continue after I attend an IME. I’m worried I will be cut off. What do I do?

Insurance companies do not have the right to stop LTD benefits until a claimant has attended an independent medical assessment. Individuals who have their doctor’s support should continue to receive benefits. Claimants should attend an IME and request a copy of the medical report for their own physician to look over.

I was in a car accident which resulted in serious injuries. I received short-term disability but was denied LTD. I’m having difficulty making payments to my disability lawyer. What should I do?

The vast majority of disability lawyers operate on a contingency basis in order to help claimants meet their financial responsibilities. Claimants should try and resolve their concerns with the legal time before seeking a second opinion.

I’m a unionized employee and was denied LTD. I have already appealed once. Is there anything else I can do?

Appeals are rarely effective and are an internal process within the same insurer that initially denied the disability claim. Appeals were created as a tactic by insurance companies that waste a significant amount of time for the claimant.

Watch to Learn More
3 Reasons to Avoid an LTD Appeal

My insurer has already initiated a change in disability classification. I asked for a copy of the contract in order to determine how classification is met and was refused. Is this right?

Claimants are entitled to a copy of their insurance policy. Insurance companies cannot withhold the policy from claimants. Under most LTD policies, after two years in order to remain on disability benefits, a claimant has to prove they are unable to perform essential tasks in any occupation.

My disability insurer told me I would be starting a return to work plan and that if I called into work sick at all, my benefits would stop. Can they do this?

Claimants on LTD who try to return to work should remember that most insurance policies contain a recurrence clause. The clause stipulates that if a claimant tries to return to work and is unsuccessful, the claimant’s benefits will resume with their doctor’s support. There is no elimination period. Insurance adjusters are obligated to operate in good faith and cannot harass claimants.

Learn More
3 Things claimants must know before a return to work