Disability Law Show Global News Radio – S8 E25

Episode Summary

CPP disability denials, having your benefits cut off, and the top 5 red flags you might spot from an insurance company, and more on S8 E25 of the Disability Law Show on Global News Radio in Toronto and Vancouver.

Listen below to Sivan Tumarkin co-founding Partner and Albert Klein, disability lawyers at Samfiru Tumarkin LLP as they join co-host John Scholes and 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 currently receiving LTD. I applied for CPP disability was denied. My insurance company says I have to appeal. Do I have to?

The insurance company wants you to appeal the denial because if you start receiving money from CPP disability, that reduces what they have to pay you. But if you want to appeal the CPP disability decision, you have to stop receiving regular CPP payments. My view is they cannot force you to appeal the denial. It is very rare that there would be a provision in an LTD policy that says you must appeal a CPP disability denial. If the insurance company is asking you to do something that could actually hurt you financially, you have to ask questions, and you can reach out to us, you can talk to myself, or someone else on the team.

LEARN MORE
• CPP Disability and Long-term Disability FAQ

I was receiving LTD and my insurance company cut off my benefits and said because I received treatments that they didn’t have to cover me. Is that true?

When you have a disability related issue, it’s important to contact a lawyer who specifically practices in disability law and has experience in that field. Unfortunately, since this occurred more than two years ago, there is nothing that you can do now. There is a time limit of two years to start a legal claim against an insurance company. If you have concerns that your disability lawyer isn’t pleading the correct things in the legal claim, contact us. We’ll answer your questions.

I have been on LTD and have 10 years left before my policy ends. Is there a possibility to apply for a lump sum payout?

You can  approach your insurance company and ask for a lump sum payout. But the general rule is that you have to be careful, because by asking for a lump sum from the insurance company you may attract unwanted attention and unwanted scrutiny. You need to be very, very careful if you do that.

Top 5 Red Flags from an Insurance Company

RED FLAG #1: The insurance company says they want you to be seen by one of our doctors

The mere fact that the insurance company wants you to be seen by one of their doctors as opposed to your doctors tells you that clearly they’re not buying what your doctors are selling or they are trying to figure out how to stop your benefits by sending you to one of their doctors and hopefully getting a different opinion from one of them. As soon as they tell you that they want you to be seen by one of their doctors or assessors you need to be on guard. If you go to our website LTDFAQ.com, there’s actually a memo on that in terms of how to prepare for that kind of an assessment, what to do, and what to watch out for.

LEARN MORE
Independent Medical Examinations (IME) and Long-term Disability FAQ

RED FLAG #2: They start asking you for your resume and work history

When they start talking to you about potentially doing work other than what you know you did before you became disabled, that’s a red flag. That usually coincides with the two-year mark of being on LTD, because under most policies, to get LTD from your insurance company for the first two years you have to be disabled from performing the essential tasks of your own occupation. Beyond the two-year mark the test changes so that you have to be disabled from performing the essential tasks of any occupation for which you are suited for by training, education or experience.

RED FLAG #3: They start hinting that they disagree with what your doctors are saying

They may even suggest that you should be undergoing some other types of treatments. They may not tell you that your benefits will end, but they may start hinting that they have these disagreements, in their opinion, with your doctors. You have to be on guard for that. You have to talk to your doctors about that.

RED FLAG #4: They start asking you to do a gradual return to work

If they start asking you to do a gradual return to work or they’re trying to get a sense of whether or not you can maybe take on a few hours here or there, or if they ask you to volunteer. Usually those are signs that they’re trying to establish if you are functional in some capacity, even if it’s only for an hour or two a day.  Because then they want to make the argument that the one hour or two a day could easily become four or five or even eight.

Learn More
Return to Work and Long-term Disability FAQ

RED FLAG #5: They use the word ‘noncompliance’

If they use the word noncompliance, that’s often a good sign that they may be trying to cut you off on this basis. Noncompliance is basically if the insurance company is telling you that they prescribed a certain medication or they want you to undergo some treatment without talking to your doctor about it, and you decline. But your doctor’s wishes and recommendations are more important than some adjuster who doesn’t have a medical background, and who is not treating you.

Conclusion:

Don’t assume that because you’re seeing any of these warning signs that you have no recourse. You can learn how to hit back, and it’s really important to make sure that once you identify a warning sign, you know what you can do to protect yourself. You can reach out to us, and we’ll advise you of the best options on how to proceed.

Learn More
When Should You Consult an Insurance Lawyer? Top 5 Red Flags

I’ve been asked to provide my municipal pension plan statement to my insurer. Do I have to share this with them?

The reason why they want you to provide it to them is because under many LTD policies there are provisions that entitle an insurance company to a deduction or credit for any pension that may be available to you. So, examine your policy if an insurance company’s adjuster asks you for other pension plans you may have access to. Because the reason is they’re doing that is they are looking to reduce how much they have to pay you. And sometimes those pensions eliminate the LTD insurers obligation to pay you anything.

After an LTD request has been denied by an insurance company, should you appeal?

No, we do not recommend whatsoever that you proceed with an appeal. It’s just going to delay the process and that’s what the insurance company wants. By starting a legal claim, you take control, and it’s done on your time. When you’re appealing, you’re just delaying. You can call us anytime or check out the free anonymous resource mydisabilityquestions.com to ask your questions and get them answered.

I’m a career electrician and I had a heart attack three weeks ago. I lost my job and have decided to return to school. Is LTD an option for me?

If you became disabled while you were covered, or while you were still employed, it doesn’t matter that you’re now without a job now. You should be applying for long-term disability, and you certainly should be receiving LTD. If there’s an issue there with that, you should be contacting us and we can help you.