Understanding insurance company surveillance | Disability Law Show TV – S7 E09

Episode Summary

UNDERSTANDING INSURANCE COMPANY SURVEILLANCE on Season 7 Episode 09 of the Disability Law Show with Disability Lawyer and National co-Managing Partner Sivan Tumarkin.

Watch above to discover the steps you must take when the insurance company cuts off or denies your long-term disability claim anywhere in Canada, on the only disability law show on TV and radio in the country.

Episode Notes

Slip and fall accident leads to long-term disability

I worked as an ultrasound imaging technician. I had a slip and fall and broke the arm that I use for work. I received treatment however I’ve developed a stiffness that limits my movement. After two years on LTD, my insurer believes I can do other work. What options do I have?

• Personal injury and LTD: After a slip and fall accident and ensuing injury, individuals should pursue personal injury entitlements. This can include pain and suffering damages, as well as income replacement. An initial injury can also lead to a need for disability leave and benefits if the individual cannot work for a longer period.
  
• Any occupation: Claimants are often cut off from disability benefits after two years of long-term disability despite a continued inability to work. This is due to the change in the definition of “disabled”.

Applying for CPP Disability while on LTD

I’m nearing the 2-year mark on LTD and have an upcoming surgery scheduled. My insurer hasn’t said whether they’ll continue my benefits but has told me to apply for CPP Disability. Do I have to?

• Support of CPP Disability: While an individual on long-term disability leave cannot be forced to apply for CPP Disability, they should. Approval of CPP Disability can strengthen an existing long-term disability claim as it is more difficult to receive assent. Most disability policies state that insurers can receive credit while a claimant is on CPP Disability.

Understanding Insurance Company Surveillance

• Reason for conducting surveillance: Insurers choose to conduct surveillance if they have suspicions that a disability claim is not legitimate or a claimant is lying and their limitations do not match their regular behaviour.
  
• How is information gathered: Surveillance is conducted through physical means, such as another party photographing and recording a claimant, or online. Online surveillance can include combing through a claimant’s social media profiles and public accounts.
  
• Rights under surveillance: Claimants must understand that is a natural course of many claims that the insurer will conduct surveillance. Claimants cannot be harassed by anyone conducting surveillance. As investigators act on behalf of the insurer, they must also behave in good faith.

Request to attend an IME

I’ve been on LTD due to multiple health conditions, including depression and arthritis. My insurer has asked me to undergo an Independent Medical Examination with a doctor they’ve chosen. My doctors agree that I can’t return to work and have thoroughly documented my limitations. Do I have a right to refuse this request?

• Independent medical evaluations: Claimants generally cannot refuse to attend an independent medical assessment. Most disability policies contain provisions that permit insurers to request evaluations. Independent assessments are not in reality independent as they are often used to deny or cut-off benefits. The professionals evaluating the claimants are typically employed by the insurer.

Injured and transitioning from short to long-term disability

I’m currently off work for an injury that is not healing quickly and may become permanent. With my short-term disability period ending soon, my doctors and physiotherapist have recommended applying for long-term disability. Will the transition be straightforward or will there be challenges getting approval?

• Short-term disability benefits: Claimants should have a straightforward transition from short to long-term disability benefits, however, it doesn’t always occur. Short and long-term disability benefits can be offered through different insurance companies.

PREVIOUS EPISODE: Disability Law Show S7 E8 – How to protect yourself from an aggressive adjuster