Disability Law Show: Ontario – S5 E06

Episode Summary

Why do disability insurers deny mental health claims? 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

• Mental health disability claims: Insurance adjusters often resist disability claims related to mental illnesses. Many disability policies stipulate that claimants have to seek appropriate care and treatment from a provider and do not typically go into specifics. Insurers in order to deny mental health claims, disability insurers will state that claimants are not seeking treatment from a psychiatrist. Depression and anxiety disorders, unlike many physical disabilities, are not linear and cannot be categorized by symptoms easily.
• Pre-existing medical conditions and an LTD denial: Disability policies contain an exclusionary provision that ensures an insurer can deny a claim if it arises in the first year of coverage. If no treatment was offered or a condition was not considered significant prior to filing a claim, it cannot be considered a pre-existing condition.
• Communicating with an insurance adjuster: In many cases, claimants can find communication with an insurance adjuster to be stressful. While an employer is entitled to know an employee is on disability leave and seeking treatment, they are not entitled to information regarding a diagnosis. Alternatively, a disability adjuster is entitled to know all up-to-date relevant medical information and possible limitations from a treating doctor.
• Sending medical records for a disability claim: It is important for disability adjusters to receive all relevant and up-to-date medical information from a claimant’s doctor. Claims can be denied on the basis of an insufficient amount of medical information. Claimants are not in control of how quickly reports are written by their treatment providers. Before appealing a denial of long-term disability benefits, claimants should instead speak to a disability lawyer.