Disability Law Show Global News Radio – S8 E32

Episode Summary

LTD benefits cut off, employers canceling employee premiums, and more on S8 E32 of the Disability Law Show on Global News Radio in Toronto and Vancouver.

Listen below to Sivan Tumarkin and Albert Klein, Toronto disability lawyers and partners at Samfiru Tumarkin LLP, as they guide you through the proper steps to take when your insurance provider cuts off your long-term disability or denies your insurance claim. Learn how to get the compensation you deserve, from leading Ontario long-term disability lawyers.

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Episode Notes

I had knee replacement surgery in February 2019. I had numerous operations and my surgeon determined that returning full-time at this time was not recommended. At the two-year mark, my LTD was cut off. What recourse do I have?

Clearly, the insurance company should not have cut off your benefits. They should not have stopped payments, especially since you’re unable to return to work at a full-time capacity. You can appeal if you want, but here’s what happens: if you waste your time with those appeals, not only could you potentially make a mistake by making an appeal in terms of the documentation, but also you are just prolonging the process. Meaning the timeframe between when your payments end and when we can actually get a resolution for you.

LEARN MORE
• Appeals and Long-term Disability FAQ

I’ve been on LTD for mental illness for the last two months. I recently found out I’m 13 weeks pregnant. Can the insurance company use my pregnancy against me to further stop or deny my benefits going forward?  Can they force me to apply for EI maternity/parental benefits at the time when my baby is born and then stop my LTD payments?

No, they cannot use your pregnancy against you. That’s not to say that they won’t try. This is very important to understand: insurance companies can do many things, but they try, or they think they can and that’s when we get involved. Without actually looking at your policy, it’s tough to say, but many of these policies today have a provision that mandates that you apply for EI/maternity benefits. However, one thing to consider is some of these policies actually state that while you’re on maternity leave, you cannot receive any long-term disability benefits. And then usually once you’re off that maternity leave, that’s when the long-term disability benefits will resume.

LEARN MORE
• Maternity leave rights in Ontario
• How long is Mat Leave in B.C.?

I’ve been on LTD since May 2021. I suffer from debilitating pain 24 hours a day. My GP says returning to work would be good for me, but my pain specialist supports me in staying off work. Who has the final say when it comes to my LTD?

If the pain doctor’s diagnosis is in line with what you’re feeling about your condition and your capacity to work, follow what your pain doctor is telling you. Some doctors are more attuned to their patients. The concern is that the insurer may decide to go with your GP’s opinion. Make sure that you get your pain doctor to provide a report that explains in detail why in his or her expertise and opinion, you are not ready to try to return. If the insurance company tries to cut off your benefits anyway, come talk to us.

I have been on LTD for over a year due to COVID-19. My employer instructed my insurance company to cancel my benefits. Even though my premiums are covered by a premium waiver in my policy. What recourse do I have?

First of all, the employer cannot do that. Second of all, when people hear about this waiver of premiums, what that means is that when you apply for long-term disability, you’re applying under a policy for which premiums were paid. When you become disabled, and you are approved by the insurance company for your disability, that triggers a waiver of premiums, meaning no premiums need to be paid going forward while you are on that policy. The employer should never ever interfere in the relationship between the insurance company and the individual. It’s possible that there is recourse here against the employer if any damage is in fact caused to the relationship between the insurance company and the individual.

LEARN MORE
• Employment Issues and Long-term Disability FAQ

I’ve been on LTD due to an illness since the beginning of 2021. My employer has put me in a job search program.  Am I going to be forced to work after the program, or will I still receive my LTD monthly payments?

Generally speaking, for the first two years under most standard policies, you’re supposed to be covered in the event that you cannot do the essential tasks of your own job. So really they can’t be forcing you to do other jobs prior to that two-year period ending. Since you’ve been on LTD since the beginning of 2021, technically speaking if you can’t do your job from 2021 to 2023, the insurance company should be covering you. If you don’t feel capable of returning to your job or a different job, even in spite of doing this job search program, you shouldn’t return. You might risk actually exacerbating your condition or making things worse. The insurance company should be maintaining your long-term disability payments.