Situational v. Generalized Conditions in Long Term Disability Claims | Disability Law Show S3 E2

Episode Summary

SITUATIONAL V. GENERALIZED CONDITIONS IN LONG TERM DISABILITY CLAIMS on the Disability Law Show with disability lawyer James K Fireman.

Watch above to discover your workplace rights and learn everything you need to know about disability law in Ontario and British Columbia on Season 3 Episode 2 of the only disability law show on TV.

Denied LTD claims based on mental health conditions

In most cases, the timeline for disability claims has shrunk despite COVID-19. Frequently as soon as the claim has been issued, not long after the representative from the insurance company calls to discuss an early settlement.

Segment begins at 1:20

Put on short term disability but denied LTD

I worked for about 2 years and asked for accommodation and was immediately put on STD. Denied long term, and given a position that I was unable to do and so was put on STD again. I was then denied LTD a second time and told I had to wait for my company to accommodate me.

Segment begins at 5:34

Situational v. Generalized conditions in LTD claims

1️⃣ Make sure you understand the difference between the two (situational v generalized)

A situational condition will only be present in certain circumstances. A generalized condition is one that is present no matter the situation.
Segment begins at 10:44

2️⃣ Situational doesn’t mean that you don’t have a case

This is a vague answer an insurer will usually give.
Segment beings at 11:27

3️⃣ You may have both an LTD case AND an employment case – you need a lawyer that understands both areas of law

Your employer has a duty to accommodate an employee’s situation.
Segment begins at 12:20

The insurer said the disability is situational

My wife has been denied LTD and I want to know what we should do. She works in a government office where the work culture is toxic. She went on medical leave last year because of harassment, and her psychologist has diagnosed her with general depressive disorder. The insurance company claims that her disability is “situational” and is not covered by the disability policy. Is that right?

Segment begins at 16:30

Missed deadline for application due to incapacitation

My 59-year-old father had a stroke last year. We found out recently that he had an LTD policy that he purchased privately. The insurer denied the application because they said that he applied too late but it was because he is incapacitated, and my brother and I just found out about his condition. Is there anything that can be done about this?

Segment begins at 19:45

Independent medical assessment request

 I went off work due to workplace harassment. With my psychologist’s support, I was eventually approved for LTD. I am now almost at the 2-year mark of my medical leave, and they want an independent medical assessment. I know from watching your show that it is never good when they ask for that! What are my options?

Segment begins 23:33

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Next Episode: Disability Law Show S3 E3 – FIVE COMMON QUESTIONS ASKED BY PEOPLE ON LTD

Previous Episode: Disability Law Show S3 E1 – 3 COMMON “EXCUSES INSURERS WILL USE TO DENY YOUR LTD CLAIM