Guide to disability benefit denials | Disability Law Show TV – S6 E16

Episode Summary

GUIDE TO DISABILITY BENEFIT DENIALS on Season 6 Episode 16 of the Disability Law Show with a disability lawyer, National practice leader and Partner James Fireman.

Watch above to discover the steps you must take when the insurance company cuts off or denies your long-term disability claim anywhere in Canada, on the only disability law show on TV and radio in the country.

Episode Notes

Expectations of retaining a disability lawyer

It has been three years since I retained a disability lawyer and I have no idea what’s going on with my claim. What can I do now?

• Pursuing legal advice: Individuals who are unsure about the status of their claim should seek specific details from their disability lawyer. Claimants should receive communications from their disability lawyers to ensure the legal process is conducted efficiently. Claimants can expect the process to take approximately ten to twelve months.

Deductions made regarding CPPD

I’m on LTD and struggling to return to work. My adjuster is asking me to apply for CPPD. Although I haven’t applied yet, the plan is to deduct an amount from my benefits. What can I do here?

• Terms included in a disability policy: The CPP disability program is a federal benefit that is provided to those who have paid into CPP. The test to qualify for CPPD is typically more difficult than long-term disability. An approval for CPPD can strengthen an LTD claim. Most disability policies contain a provision that allows insurers to estimate a CPPD benefit and deduct a credit based on the estimation.

Guide to disability benefit denials

• Doctor’s approval and support: Insurers often deny long-term disability claims despite the support of a treating physician or specialist. Insurers will find any reason to deny a claim.
  
• Insurance adjusters do not have the final say: Insurance adjusters do not have the final say regarding a disabilty claim. Appealing a denial is often unsuccessful and wastes valuable time for claimants.
  
• Seek legal advice from a disability lawyer: Denials sent from insurers are often vague and a rationale is not provided. Claimants who have been denied disability benefits are within their rights to pursue a legal claim and retain a disability lawyer.

A failure to return to work from LTD

I’ve been on disability for over a year due to a herniated disc and have been following my doctor’s advice. I’m considering returning to my construction job, but if it doesn’t work out, will I need to reapply for benefits?

• Failed attempt to return to work: Disability policies typically contain a recurrence clause. Individuals who return to work after being on disability leave but experience a regression in recovery and an inability to work can resume benefits without a waiting period. Despite a recurrence clause, insurers can still deny benefits.

Refusing treatment while on disability claim

After a year on disability benefits for severe depression, my insurer recommended a specific psychiatrist who is pressuring me to try a new anti-depressant. My doctor strongly advises against this medication. Can I refuse this treatment without risking my benefits?

• Complying with recommended treatment: Disability policies often contain terminology requiring claimants to comply with recommended treatment. A refusal to comply can risk a cut-off from benefits. Ultimately, claimants should listen to their own treating medical team regarding treatment. A treating doctor is in the best position to make recommendations.

Constant requests for medical updates from the insurer

I’ve been approved for LTD for two years after finally confirming a lupus diagnosis. Despite this, my insurer frequently asks for updates, causing me anxiety attacks and increased chronic pain. What options do I have in this situation?

• Communicating with the insurance adjuster: Claimants should continue to communicate regularly with their insurance adjuster and be open and honest. If requests for updates lead to negative health outcomes, claimants should inform their adjusters and doctors. Disability insurers are required to act in good faith with claimants and a failure to do so can lead to legal consequences.

PREVIOUS EPISODE: Disability Law Show S6 E15 – Returning to work successfully from disability leave