Disability Law Show: Ontario – S4 E72

Episode Summary

Why do long-time claimants on LTD have their benefits cut off? Disability lawyer and Partner Tamar Agopian at Samfiru Tumarkin LLP answers this question and more on the Disability Law Show on 640 Toronto and Newstalk 580 CFRA.

Listen below to discover important information about your rights and a guide through the proper steps to take when your insurance provider cuts off your long-term disability or denies your insurance claim.

When you need a disability lawyer in Ontario, Tamar and her team can get you the advice you need, and the compensation you deserve.

Listen to the Episode

Show Notes

• Stress leave from work and long-term disability: Many insurers will take the position that employees are able to work in a different position and that mental health conditions as a result of a work setting should not qualify for LTD. Treatment is vital for claimants to be able to show insurers that they are in the process of recovery but at the moment, are unable to work. Details are very important as well as referrals for treatment from doctors.
• Treatment and medication are a struggle for a long-time claimant on LTD: Insurance companies ultimately seek out opportunities to close out claims and not pay out benefits to claimants for the long term. Claimants that have been on LTD past the change in definition have an advantage if a claim eventually leads to court. It is difficult for claimants to qualify for LTD for several years and insurance companies are responsible for proving that a cut-off of benefits is warranted after so many years.
• A failed return to work and resuming benefits: Claimants must first receive approval from their doctors to return to work at a gradual pace. It is very rare for claimants to return to work full-time immediately. It is important to take things slow for claimants, and see how their health progresses. There is generally an overlap period for claimants in which they are still receiving LTD benefits and some income. For individuals who attempt a return to work and are unfortunately not successful, benefits should resume due to a recurrence clause in their LTD policies. It is important for claimants to document in writing medical support that the return to work was unsuccessful due to a worsening of symptoms.
• Insurer asking for retroactive payments or will cut off benefits: In the event that an insurer asks a claimant to apply for CPP Disability, they typically believe that the claim will be long-term. Disability policies do state that the insurer will receive a credit for other benefits a claimant might receive, like CPPD. Insurers do have to be transparent in their communications with a claimant on how benefits will be reduced or credits if a CPPD approval occurs.