Top 3 reasons you should NOT fear your LTD adjuster | Disability Law Show TV – S3 E23

Episode Summary

TOP 3 REASONS YOU SHOULD NOT FEAR YOUR LTD ADJUSTER on Season 3 Episode 23 of the Disability Law Show with 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 Ontario,  British Columbia,  or Alberta, on the only disability law show on TV and radio in Canada.

Episode Notes

Denied LTD due to insufficient medical documentation

My brother had passed recently and due to grief and depression, I could not work. I was denied LTD due to insufficient medical documentation. Is this right?

If a claimant has their doctor’s support and advice that continuing to work is not possible, they should follow their doctor’s orders. It is important to contact a disability lawyer as appeals are rarely effective. A report from the claimant’s doctor or therapist is considered sufficient for disability benefits.

Segment starts at 1:02

Request for assessment by insurance company doctor

My mother has worked as a secretary at an accounting firm for the past 25 years. Last year, she broke her hip and three ribs in a slip and fall on ice outside her friend’s condo building. She has been off work and on LTD for the past 7 months. Recently her insurer asked her to be seen by one of their doctors and she wants to know if she has to go.

Sivan explains that claimants who are asked to seek an insurance company’s doctor have to agree to an assessment, not treatment. Assessments by insurance company doctors are ultimately requested in the hope that the report will be favourable for the insurer, not the claimant. It is important for claimants to be truthful and ask the adjuster for a copy of the assessment report.

Segment starts at 9:50

Top 3 reasons you should NOT fear your long-term disability adjuster

1️⃣ Your adjuster is an employee of your LTD insurer and must uphold the insurer’s good faith obligations towards you as an insured.

It is important for claimants to remember they have more power than the insurance adjuster would lead them to believe. Adjusters are bound by the obligations an insurance company has to claimants.

Segment starts at 15:40

2️⃣ Your adjuster can not force you to do things that harm your health, such as returning to work before you are ready or undergo treatments your doctors disagree with.

Individuals who are on disability leave must follow their own doctor’s advice and are not obligated to follow anything that opposes medical counsel.

Segment starts at 18:44

3️⃣ Any mistakes your adjuster makes on your file will give you more ammunition against the insurer if you are denied or cut off LTD benefits.

Adjusters are often dealing with many claims simultaneously and can often make mistakes. Once a legal claim has begun, any reports and documentation must be given to the disability lawyer and claimant.

Segment starts at 20:33

Denied LTD and told to do another job

I suffered a mental breakdown due to my work environment. I was getting LTD benefits as well as CPPD, but I recently got a letter stating that I don’t qualify for LTD benefits because I can do another job. I completed a work trial last month but suffered a huge setback with my health. My doctor is changing my medication and again says I can’t work. Should I try to apply for LTD again?

If a claimant has tried and failed to return to work, their previous LTD benefits should continue due to a recurrence provision in their insurance policy. This provision stipulates a claimant’s benefits begin immediately.

Segment starts at 24:58

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

Next Episode: Disability Law Show S3 E24 – Top 3 things that reduce anxiety when dealing with an LTD insurer

Previous Episode: Disability Law Show S3 E22 – 5 Fast Facts about Long-term Disability Claims