Guide to heart conditions and LTD | Disability Law Show TV – S7 E03

Episode Summary

GUIDE TO HEART CONDITIONS AND LTD on Season 7 Episode 03 of the Disability Law Show with disability lawyer and co-founding Partner Sivan Tumarkin.

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

Insurer causing added stress to a claimant on LTD

I’ve been on long-term disability for just over a year, due to ongoing heart issues as well as mental health. My case manager recently informed me they would be sending me to some of their psychologists in preparation for an eventual return to work. This has led to increased stress and anxiety. What can I do?

• Communicating with an insurer: For many claimants on long-term disability at some point, the insurance company will start insinuating that a return to work is inevitable. The two-year mark on long-term disability leave ensures a change in the definition of disability. Claimants must prove they are unable to work in any occupation, not just their own.

LTD denied despite the doctor’s recommendation

While on short-term disability recovering from surgery, my son tragically passed away, and I developed severe depression. Despite my doctor’s strong recommendation that I wasn’t ready to return to work, my application for LTD was denied, with the insurer claiming I should be able to work.

• Reasons for LTD denial: Insurance companies often deny disability claims despite the support of treating medical professionals. Ultimately, an inability to work and the support of a doctor should lead to the acceptance of the insurer. Insurance adjusters must behave in good faith. Failure to do so can lead to additional legal damages.

Guide to Heart Conditions and LTD

• Prevented from working a sedentary job: Individuals can be prevented from working even in sedentary jobs due to heart conditions. A heart condition can lead to a myriad of other health issues, such as chronic fatigue.
  
• Consistent treatment and monitoring: Most disability policies require claimants to pursue and comply with recommended treatment. Individuals must try and improve their medical condition. Insurers are within their rights to refuse benefits for those in breach of policy provisions.
  
• Record all tests and referrals: It is vital for those on long-term disability leave with a heart condition to document and record all tests and referrals by medical professionals. Insurers often deny claims based on “insufficient documentation”.

Non-compliance and disability benefits

I’ve been on LTD for two years due to mental health issues. Recently, a new case manager insisted I attend a clinic for a treatment plan. Reviews of the clinic suggest they push patients back to work prematurely. The case manager dismissed my worries and threatened to cut my benefits if I didn’t comply.

• Terms outlined in a disability policy: After two years on long-term disability leave the definition of disabled changes from an inability to work in one’s occupation, to any occupation. Insurers often cut off benefits during this period. Disability policies do not require claimants to receive treatment from their recommended specialists. Many insurer-recommended specialists work for the insurance company and do not have the claimant’s best interests in mind.
• The power imbalance between insurers and claimants: Courts are aware of the power imbalance between an insurance adjuster and the claimant. Insurers believed to have acted in bad faith can face additional punitive damages.

PREVIOUS EPISODE: Disability Law Show S7 E2 – Fast facts about anxiety disorders and disability claims