The difference between a denial of LTD and a cut-off of benefits | Disability Law Show TV – S5 E08

Episode Summary

THE DIFFERENCE BETWEEN A DENIAL OF LTD AND A CUT OFF OF BENEFITS on Season 5 Episode 08 of the Disability Law Show with national practice leader and disability lawyer and Partner Sivan Tumarkin.

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

Nervous about appealing LTD denial

I have been off work due to mental health claims. I was denied LTD and decided to appeal. I’m nervous about a response. Is there anything else I can do?

• Advice from a disability lawyer: Many claimants contact a disability lawyer within the disabilty claim process. It is important for claimants to seek out advice from a disability lawyer before filing an appeal, as appeals often waste time. Claimants should be aware that they are within their rights to appeal an LTD denial but it will be more advantageous to seek out legal advice from a disability lawyer.

Short-term to long-term disability benefits

A good friend of mine received short-term disability benefits while undergoing chemotherapy. His treatments will have to continue for a few more years and he’s unsure what do to next.

• Transitioning from short to long-term disability: Individuals will have short-term disability either through work or through a government program. Many employers also have programs that allow employees to apply for long-term disability benefits. Individuals can also have private insurance coverage. Approval for long-term disability is not automatic despite approval for short-term disability. It is not uncommon for long-term disability to be denied despite a cancer diagnosis and support from a treating doctor. Claimants should seek out advice from a lawyer as soon as possible.

The difference between a denial of LTD and a cut-off of benefits and what you should do next

• Difference between LTD denial and cut-off: A denial of LTD occurs when a claimant applies for LTD but is outright denied benefits. A cut-off occurs when an initial approval for long-term disability benefits is given but eventually leads to the insurer deciding benefits must end.
• Doctor’s help with LTD denial: A treating doctor is crucial in order to continue to receive long-term disabilty benefits as well as for initial approval. A treating doctor must provide regular updates at intervals for the insurance company regarding their patient and the claimant’s ongoing treatment and prognosis.
• Contacting a disability lawyer: Upon denial of long-term disability, claimants should immediately contact a disability lawyer to determine their next steps. Claimants that have had their disability benefits cut off are given a specific reason and when the benefits will end. Claimants should not wait until their benefits end or believe that their insurer will change their decision in order to contact a disability lawyer.

Denied LTD due to daily activities

Continuous headaches lead to a diagnosis of a hematoma in my brain. My neurologist says I should stay off work until I see the neurosurgeon. I was denied LTD however, as I can still do some daily activities. Should I appeal this?

• Appealing an LTD denial: Most insurers will encourage claimants to appeal a denial of long-term disability benefits as it ensures that the power and influence remain with them. Appeals are rarely successful and are not arbitrated by an objective third-party.
• Considered not ‘totally disabled’: The term ‘totally disabled‘ does not mean that an individual is completely incapable of functioning in the context of long-term disability. In order to be totally disabled under an LTD policy, a claimant has to prove that they are unable to perform the essential tasks of their own occupation.

A failed attempt to return to work after LTD

After a failed return to work from disability, my benefits resumed through a recurrence claim, but only up until the two-year mark. What happens if I’m still not well enough to return after that?

• Returning to work from LTD: Claimants should only return to work when they are cleared to do so by their treating doctors and medical team. A return to work before an individual is medically ready to do so can lead to a regression in recovery. Due to a recurrence clause in most disability policies, disability benefits should resume if an attempt to work is not successful.
• Two-year mark of a long-term disability: At the two-year mark of long-term disability a change in definition occurs. After two years claimants have to prove that they are unable to work in any occupation due to their disability. Claimants often have their disability benefits cut off at the any occupation period.

PREVIOUS EPISODE: Disability Law Show S5 E07 – What you should and should not do if denied LTD