How to protect yourself from an aggressive adjuster | Disability Law Show TV – S7 E08

Episode Summary

HOW TO PROTECT YOURSELF FROM AN AGGRESSIVE ADJUSTER on Season 7 Episode 08 of the Disability Law Show with Disability Lawyer 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

Support of a general practitioner for disability benefits

I worked as an office administrator, with a history of cardiac health issues. I was off work years ago as a result. Upon my return, unfortunately, my symptoms seemed to get worse. My GP, as well as my cardiologist, deemed me unable to work. After resuming disability leave, my GP retired. Will this influence my claim?

• Treating doctors and medical team: To continue to receive disability benefits, claimants must seek appropriate ongoing treatment. This can become difficult as many individuals struggle to find a family doctor. Claimants who have been receiving active treatment, and ongoing medical support, but cannot receive acute primary, are still entitled to disability benefits.
  

Pressured to return to work from LTD

I qualified for long-term disability benefits after an injury. After a few months, the insurer had my case assessed and deemed I was ready to return to work. My doctor believes I’m still not able to do so.

• Returning to work from disability leave: Often insurance companies offer long-term disability benefits for a certain period, before determining on their own, that benefits should end. This is typically despite ongoing support from treating doctors. Claimants should only return to work if they are approved to do so by treating doctors and specialists. Insurers can send claimants to be assessed by their consultants to justify a cut-off of benefits.

How to protect yourself from an aggressive adjuster

• Reviewing the long-term disability policy: It is always a good idea for claimants to request or obtain a copy of their long-term disability policy. Claimants can and should ask their insurers for a copy. Claimants can look at their policy to determine if what is being asked of them by their insurer is an included term.
  
• Recording forms of communication: Recording all communications with the insurance adjuster in writing is vital. By documenting all communication, the substance of each conversation is recorded. After a conversation concludes, claimants can send their detailed notes to the insurer for confirmation. Records of communication can solidify a legal claim if benefits are denied.
  
• Seeking legal advice: Typically consultations with a disability lawyer are free. Claimants do not necessarily have to retain legal representation but can determine their next steps and protect their rights. Once a legal claim has been filed, claimants do not have to worry about continued communication with an adjuster as the disability lawyer takes over this responsibility.

Employment ends while on LTD

My husband has leukemia and has been off work for almost 3 months. He’s currently receiving disability benefits through work. Although his doctors believe he may be able to return to work gradually in a few months, his boss doesn’t think this is feasible and wants to end his employment. How can we ensure the insurance company will continue paying his benefits?

• Frustration of contract: Claimants who are on medical or disability leave and their employment status changes do not have to worry about their disability benefits. Benefits should continue as long as at the time of approval, the claimant was employed, and they are still unable to work.
• Seeking the right legal help: If employment and disability issues overlap, claimants should seek legal advice from those well-versed in both areas of law. A potential employment law claim or suit can impact disability benefits.

Claimant with arthritis filing LTD appeal

I’ve been on LTD for 5 years now due to inflammatory arthritis. My benefits have been cut off. I’ve complied with requests for medical documentation and filed an initial appeal. I’ve tried contacting them multiple times but haven’t received a response. Is there anything more I can do?

• Change in the definition of disability: Claimants who have been on long-term disability for over two years should have a strong claim to benefits. After the initial two years of disability benefits, most policies require claimants to prove they are disabled in any occupation.
• Filing an appeal: The appeals process is often unsuccessful. Appeals are typically conducted by the adjuster who initially denied the claim. Claimants should remember that insurers are incentivized to make a profit; this often means a cut-off from benefits.

PREVIOUS EPISODE: Disability Law Show S7 E7 – Disability claims and addiction: Quick Q&A