Long-term Disability Appeals – Fact or Fiction? | Disability Law Show TV – S7 E16

Episode Summary

LONG-TERM DISABILITY APPEALS – FACT OR FICTION? on Season 7 Episode 16 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

Complex medical condition, but disability benefits cut-off

I worked for over a decade before having an accident and injuring my ankle. I was eventually diagnosed with complex regional pain syndrome. After years on long-term disability, my insurer suggested another position I could work in, which seems the same as my current job. What can I do?

• Any occupation period: After two years on a long-term disability policy, the test to qualify for disability benefits changes. Claimants must prove they are unable to work in any occupation due to their ongoing symptoms, not just their own. Insurers typically cut off benefits at this point as they do not want to continue paying benefits for the foreseeable future.

Applying for LTD after short-term disability

I have been on short-term disability due to a visual impairment. While I’m continuing to undergo treatment, my doctor still believes I am unable to work and should apply for LTD. If the application process does not go well, and I return to work, what should I be aware of?

• Pushed to return to work: Claimants should speak to their treating doctors about whether or not they are ready to return to work. A return to work is a distinctly medical question, and should not be posed to a disability lawyer or insurer. It is in a claimant’s best interests to apply for long-term disability if encouraged to do so by their doctors.

Long-term Disability Appeals – Fact or Fiction?

• Appeal a denial through your insurance company: Insurers often suggest claimants should or must appeal before a claim is denied or benefits are cut off. Appeals through an insurance company are rarely successful or required.
• Filing multiple appeals: Filing multiple appeals can waste valuable time for claimants who have had their benefits denied or cut off. Appeals are often conducted by the same adjuster who initially denied the claim, and not by an objective third party.
  
• A time limit to take legal action: Claimants have up to two years after the initial denial of benefits. Claimants need to seek legal action as soon as this denial occurs.

Surveillance leads to a cutoff of disability benefits

I just found out my insurance company hired someone to spy on me. They sent a letter saying they have photos and video showing I’m more active than I claimed. I was just doing basic things, but now they’re saying I’m not disabled. Can they cut off my benefits over this?

• Surveillance by the disability insurer: Surveillance is not as common as many claimants believe it to be. Insurers do implement surveillance, but sparingly due to the cost. Claimants should continue to be open and honest and follow medical advice. Many adjusters use surveillance to fit their preconceived judgments, but it is typically not successful.

PREVIOUS EPISODE: Disability Law Show S7 E15 – Chronic Pain and LTD Denials: What you should know