Myths that LTD Insurers want you to believe are true | Disability Law Show TV – S3 E13

Episode Summary

MYTHS THAT LTD INSURERS WANT YOU TO BELIEVE ARE TRUE on 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 or British Columbia, on the only disability law show on TV and radio in Canada.

Episode Notes

Long-term disability cases and trials

James discusses a recent disability case that went to trial in Ontario; in this particular case, the judge confirmed that the opinion of the treating doctor is typically preferred in comparison to the opinion of the insurer’s doctor.

Segment starts at 1:40

Cut off due to pre-existing condition

I had just started a new job as a customer service rep when my gallstones got to be too much for me to work. After a year on LTD, I tried to go back to work but ended up in the hospital for emergency surgery. I was then diagnosed with fibromyalgia and went on LTD for a few more months, but was cut off because the insurer thought my condition was pre-existing. Are they right?

Pre-existing conditions do not exempt clients from being approved for long-term disability. Typically, pre-existing conditions are only an issue in the first year of being insured. Once a year passes, the condition does not matter.

Segment starts at 8:25

Myths that LTD Insurers want you to believe are true

1️⃣ You must appeal the denial of your disability or else you won’t get paid

The appeal process is not typically mentioned in policies. Insurers created appeals in order to maintain control over the process. There is no independent body that investigates appeals.

Segment starts at 13:28

2️⃣ You have to go back to work if the insurance company tells you to do so

Returning to work is a medical condition and not a legal condition and can only be approved of by a doctor and medical team.

Segment starts at 15:45

3️⃣ You have no choice but to get treatments from a clinic or doctor they approve

A client has to make sure they’re getting the best care and that they’re comfortable with the medical team treating them and ultimately the client chooses who will treat them.

Segment starts at 18:30

Change in definition of my condition

I am on LTD with complex inflammatory OA, affecting many joints, and am mentally exhausted. My employer said they can’t accommodate me in a different position (I’m a fitness instructor) or offer severance. My insurer has sent a letter informing me of a change in definition next year and wants me to list all of my work skills. What should I do?

Typically, requesting a list of skills and abilities is permitted and occurs around the two-year mark of long-term disability benefits. After two years in a standard LTD policy, the definition of what is considered disabled changes and the test becomes more difficult.

Segment starts at 23:15

Termination and loss of benefits

My 33-year-old brother suffered a brain aneurysm while playing basketball which led to a stroke. His doctors think that he’ll be left with permanent memory loss and struggle with concentration. He worked as a programmer at an IT company with good health benefits before this happened. His employer sent him a letter saying that they had to replace him and may not have a position for him if he gets better. If they let him go, can his long-term disability be cut off too?

If terminated, an individual does not lose their long-term benefits. If an individual has insurance coverage on the day they are considered disabled from work, that particular insurer has to provide benefits until that individual is no longer disabled or is 65 years of age. Even if a policy remains in effect, however, the insurer has an extra incentive to terminate that claim.

Segment starts at 26:04

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Next Episode: Disability Law Show S3 E14 – What to do if on LTD and fear your benefits will be cut off

Previous Episode: Disability Law Show S3 E12 – 3 Reasons individuals on LTD should apply for CPPD