Top 5 Insurance Company Flaws | Disability Law Show TV – S4 E03

Episode Summary

TOP 5 INSURANCE COMPANY FLAWS on Season 4 Episode 03 of the Disability Law Show with disability lawyer and co-founding 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

Appealed LTD denial due to insufficient medical documentation

I’m a pharmacist and am 54 years old. I had a predisposition for several mental health illnesses and the pandemic has taken its toll on me. I applied for LTD and was denied as there was insufficient medical documentation. What can I do?

• Reasons for an LTD denial: Sivan explains that the appeal process is rarely successful and was created by insurance companies. The appeal process is internal and is not arbitrated by a third objective party. Claimants rather than appealing should speak to a disability lawyer as soon as possible in order to pursue their benefits. Beginning a legal claim alleviates pressure from claimants and allows them to focus on their health.
  • LEARN MORE
    • Pharmacist severance packages
    • Invisible Illness and Long-term Disability

My disability insurer told me not to apply for LTD

My brother was given short-term disability, although it was a struggle, and the insurer was not happy about it. Now insurance is telling him not to bother applying for long-term disability because he’ll never be approved for it. He just wants to give up.

• Short to long-term disability transition: Insurance adjusters rely on claimants not being aware of their rights and often can dissuade claimants from applying for benefits. Claimants should apply for benefits if they have the approval of their treating doctors. In some cases, insurance adjusters could owe claimants punitive damages for causing further stress and misinformation to claimants.
  • LEARN MORE
    Dealing with difficult adjusters

Top 5 Insurance Company Flaws

• Insurance adjusters are often overwhelmed: Many claimants who speak to adjusters often feel that the adjusters do not know the specific details of their files. This is often the case as adjusters have a large number of files to go through. Once a legal claim has begun, the insurance adjusters have to provide copies of all necessary documentation and files to the disability lawyer.
• Relying on claimants’ vulnerability and ignorance: Sivan explains that insurance adjusters often operate under the assumption that claimants are not aware of their rights and that they can be bullied as they are in a position of vulnerability. Disability lawyers and the legal process can rebalance the relationship between insurance adjusters and claimants.
• The primary focus for insurance companies is profit: Claimants should remember that insurance adjusters are preoccupied with making a profit and do not take into consideration their obligations to claimants. By not providing claimants with the conduct they deserve, adjusters provide disability lawyers and a legal team with the necessary information to ensure claimants receive their benefits.
• Adjusters often make mistakes: Sivan explains that in some cases claimants who have lost their job and received severance run into difficulties with insurance adjusters. Many adjusters do not look closely at long-term disability policies as policies can have different terms and provisions.
• Insurers are preoccupied with fraudulent claims: Insurance companies generalize and exaggerate the number of fraudulent claims and in many cases reject legitimate long-term disability claims.

Denied LTD due to no objective medical evidence

My husband injured his neck and shoulder in a bad car accident years ago. His doctors say that he is still experiencing pain and related migraines. His insurer has been paying him, but now they say that there is no objective medical evidence. What does this mean?

• Chronic health conditions: Sivan explains that there is no provision in most policies that require objective medical evidence in order to qualify for long-term disability benefits. Most policies are concerned with claimants who are unable to perform the tasks necessary for their job. Claimants who have previously been approved for LTD should question why they are no longer eligible and contact a disability lawyer. Insurance adjusters often cherry-pick information from the medical documentation that they are provided with.

Diagnosed with arthritis but denied LTD as can do sedentary work

I’ve worked as a manager at a popular fast-food restaurant chain for nearly 25 years. My doctor said I need to stop working due to pain from my rheumatoid arthritis. I tried to apply for LTD benefits but was denied because the insurer said that I could do another job. Should I appeal this decision?

• Told to do another position: Sivan explains that appeals are rarely successful and while claimants are free to appeal they are wasting their time. The test in order to qualify for the first two years of long-term disability is whether or not a claimant is able to do the necessary tasks of their own occupation and not any other position. Claimants who are unsure of their rights should contact a disability lawyer in order to determine their options.

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

Previous Episode: Disability Law Show S4 E02 – 3 Vital things COVID-19 long-haulers should know about LTD claims