How to transition from short-term to LTD benefits | Disability Law Show TV – S5 E06

Episode Summary

HOW TO TRANSITION FROM SHORT TO LONG-TERM DISABILITY BENEFITS on Season 5 Episode 06 of the Disability Law Show with disability lawyer and Partner Tamar Agopian.

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

Episode Notes

Returning to work with accommodations

After experiencing serious burnout at work, I had to apply for LTD. My insurer reached out to my employer about a return to work but it was not feasible. Despite this, my benefits were cut off. What are my options?

• Employment and disability issues: In many cases, disability concerns and employment issues can overlap. It is vital for claimants to seek legal advice from a firm that is aware of the complexity of their claim. Claimants that are still unable to return to work and have the support of their doctor, should not return before they are cleared to do so despite pressure from external sources.
• Insurer-provided treatment: In order to push for a return to work, insurance adjusters will often recommend claimants seek out their own preferred treatment providers. Insurer-recommended treatment is not independent and ultimately will seek out the interests of the insurer rather than the claimant.

Pressured to return to work by the insurer

I’ve been off work for the past year and am still receiving rehabilitation for an injury. My insurance adjuster recently mentioned sending me back to work. Since this news, I have been overwhelmed with anxiety as I don’t feel up to it yet.

• Returning to work from LTD: Ultimately, claimants that do not feel ready to return to work should listen to their own treating medical team before attempting a return to work. Resuming work before an individual is ready can lead to a regression in recovery and further deterioration of health. As soon as an individual returns to work, an obligation to continue benefits can end for the insurance company.

How to transition from short to long-term disability benefits

• Applying for long-term disability: It is important to apply for long-term disability benefits if, at the end of short-term disability, an individual is still not recovered or well enough to return to work. Short-term benefits could be provided by an employer, and many individuals assume the same insurer will provide long-term disability benefits. This is not always the case. Additional forms might be required in order to apply for LTD after short-term benefits.
• Follow recommended treatments: In order to qualify for long-term disability, most disability policies require that a claimant is continuing to seek treatment and have continued support from a treating doctor. Claimants should ensure that their disability insurer has all up-to-date medical reports and is aware of all treatment efforts.
• Long-term disability approval is not automatic: Sometimes short-term disability benefits are paid for by a different entity than long-term disability benefits. This means approval for LTD after short-term disability is not automatic. Insurance companies typically pay for LTD themselves as opposed to STD.

Without prejudice payment offered by the insurer

My partner applied for LTD a long time ago. She was recently issued a ‘without prejudice’ payment indicating that the process is taking time. Should we accept this?

• A payment offered by the insurer: There are no set time frames in which a disability insurer is supposed to respond to a long-term disability application. A ‘without prejudice payment’ is offered in the event an application is taking a long time to be reviewed. The insurer recognizes that claimants are without financial income and do not want to incur potential damages. This payment does not mean that a claim will be approved.
• Pre-existing condition clauses: A pre-existing condition investigation occurs as a result of a clause included in long-term disability policies. Claimants that might have had a health issue that occurred in the first year of coverage could be exempt from disability benefits as it is considered pre-existing.

PREVIOUS EPISODE: Disability Law Show S5 E05 – 3 Important ways your doctor can help your LTD claim