Guide to LTD benefits and employment | Disability Law Show TV – S6 E20

Episode Summary

GUIDE TO LTD BENEFITS AND EMPLOYMENT on Season 6 Episode 20 of the Disability Law Show with disability lawyer and Partner Tamar Agopian.

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

Parental leave and disability benefits

My long-term disability policy contains a provision that dismisses eligibility for benefits while on parental leave. Do I have any recourse if I am unable to work?

• Terms in a disability policy: Many disability policies contain terminology that prevents claimants from pursuing benefits while on parental leave. These exclusions were written as individuals entitled to another government-sponsored benefit but could not receive additional benefits. Disability insurers often presume that as an individual can care for their children, they are not disabled “enough” to receive benefits.

Repeated short-term disability benefit denials

I have used up all my short-term disability benefits. I was denied twice by the insurer for long-term disability benefits, being told I hadn’t provided sufficient medical information. I don’t see how that’s possible.

• Short-term disability benefits: Insurance adjusters deny benefits often based on a lack of medical information, particularly regarding mental health claims. Claimants need to provide detailed and sufficient medical documentation to their insurer. It is also beneficial for claimants to seek legal advice from a disability lawyer if a transition to long-term disability benefits from short-term has been denied.

Guide to long-term disability benefits and employment

• Claims that are triggered due to workplace events: Long-term disability claims that are triggered by a workplace event, such as bullying or harassment, are often denied. Insurers proclaim the resulting mental illness is specific to a workplace, and not a generalized condition.
  
• Returning to work after a cut-off: Claimants should listen to the advice of their own treating medical team regarding a return to work. It is vital for claimants not to be pressured into a premature return, as it can lead to a regression in recovery.
  
• Termination of employment: Disability benefits should continue despite a termination of employment. A loss of employment can result in some complications with benefits, however, if an individual is receiving severance payments. Often there can be an overlap between a wrongful dismissal suit, and a claim for disability benefits.

A transferable skills analysis while on LTD

My disability insurer wants me to do a transferable skill analysis. I told them I was willing to begin the rehabilitation program but did not consent to anything else. If I can return to work eventually, I want to return to my job, not a position that won’t pay close to what I am getting paid now. Do I have to consent to this?

• Transferable skills analysis: After the first two years of long-term disability a change in the definition of “disability” occurs. Claimants have to prove they are unable to work in any occupation, as opposed to just their own. A transferable skills analysis is often requested during this period. Claimants must cooperate with their insurer’s requests.

No long-COVID diagnosis despite symptoms

After contracting COVID-19, my wife has suffered from continuous brain fog, chronic fatigue, and debilitating chest pains. Despite rigorous testing, there is no official diagnosis. She was denied LTD and told she should be able to continue her receptionist position. We’ve been told we can appeal this decision. Do we have any other options?

• Appealing a denial of benefits: Disability insurers often typically deny long-term disability claims due to a lack of a diagnosis. A diagnosis is not necessary to receive disability benefits. Claimants should ensure they have the support of their treating doctors, and seek legal advice. The appeals process is rarely successful as it is not conducted by an objective third party.

PREVIOUS EPISODE: Disability Law Show S6 E19 – Diagnosed with an invisible illness & applying for LTD