Invisible Illness and Disability Claims | Disability Law Show TV – S3 E31

Episode Summary

INVISIBLE ILLNESS AND DISABILITY CLAIMS on Season 3 Episode 31 of the Disability Law Show with disability lawyer and Partner, James K. Fireman.

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

Episode Notes

Denied benefits despite approval from insurer’s psychiatrist

I was sent for an independent medical assessment and despite the insurer’s hired psychiatrist’s recommendation that I am unable to work, my benefits were cut off. The insurer misinformed me. What do I do?

• Denied benefits with doctor approval: James explains that insurance companies have to operate in good faith with their claimants. Insurance companies that do not operate in good faith and cause additional stress for a claimant, can potentially be faced with additional punitive damages.

Awaiting treatment due to COVID-19 and not totally disabled

I’ve been receiving LTD since 2019 while waiting for surgery on my hip. Due to Covid, my surgery date keeps getting bumped. Recently, I received a letter from my insurance provider stating I’m not totally disabled and can return to work. If it were not for the pandemic I would have had my surgery already.

• Definition of disability: Insurance companies cannot deny or cut off benefits if a claimant is awaiting treatment and they are not responsible for delays. It is important for claimants to remember that after two years of benefits, there is a change in the definition of whether or not a claimant is disabled. Many claimants are cut off after two years or denied benefits as the test is now more difficult in order to qualify for LTD.

Invisible Illness and Disability Claims

• What are invisible illnesses: Invisible illnesses are not visible on any type of medical imaging and are common mental illnesses or at times cognitive issues. Some physical conditions are also potentially invisible on medical imaging.
• Why insurance companies deny claims for invisible illness: James explains that it is difficult to prove an invisible illness as it is not objectively provable. There have been many invisible illness cases that have led to court and typically judges have been concerned with symptoms and not diagnoses.
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    Invisible Illness and Long-term Disability Claims
• What should you do if a claim is denied or cut off: James explains that is important to contact a disability lawyer as soon as possible. Samfiru Tumarkin LLP offers free consultations for claimants who have had their benefits cut off or denied.
• Should you appeal when your claim is denied: Appeals are rarely effective as they are an internal process that is conducted within an insurance company and is not processed by an external entity. The opportunity to appeal is often offered as it is in the insurance company’s best interest.

Misunderstandings about the legal process

What is the biggest misunderstanding people have about the legal process and filing a claim against an insurance company after a long-term disability claim denial?

• The legal process for claimants: James explains that many individuals misunderstand that they will have to be heavily involved in the legal process. As soon as a legal claim is filed, there is no communication between the insurance company and the claimant.

How effective is the appeal process?

I fell last year and got a really bad concussion.  I can’t concentrate on anything for more than 10 minutes and I have severe migraines. My insurance company denied my long-term disability benefits claim. Should I gather my documents and start the appeal process?

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3 Reasons to avoid an LTD Appeal

• The appeals process: Claimants should provide the correct documents and as much medical information as possible to the insurance company. Insurance companies are justified in denying a claim if the proper documentation has not been received. Appeals are also rarely effective and will cause further stress for the claimant.

Click Here For More Information About COVID-19 and Your Rights

Next Episode: Disability Law Show S3 E32 – Surveillance and LTD Claims

Previous Episode: Disability Law Show S3 E30 – Common Questions about LTD Cut-offs