What to know about a disability lawyer’s role in LTD claims | Disability Law Show TV – S7 E05

Episode Summary

WHAT TO KNOW ABOUT A DISABILITY LAWYER’S ROLE IN LTD CLAIMS on Season 7 Episode 05 of the Disability Law Show with Disability Lawyer and Partner Tamar Agopian.

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

Disability insurer denies short-term claim

I had many unfortunate health issues resulting in trying to manage my diabetes. My job made it hard to have set times for eating, taking medication, etc. My disability insurer believed I could manage my condition. I applied for short-term disability benefits but was denied.

• Impact of denial of benefits on job: Transitioning from short to long-term disability can be difficult for many claimants. An initial denial of short-term benefits can lead to difficulties with an employer. Retaining an experienced lawyer to manage both a disability claim and a possible termination of employment is vital. Employment and disability issues can often overlap.

Insurer insisting on IME

I have long-term COVID and several other medical conditions. I’ve been on LTD for a year and a half but now my insurer is claiming, based on their doctors, that I have a mental illness. They’re insisting I undergo an IME for a psychiatric evaluation. Can the insurance company require this?

• Common reasons for denial of benefits: Many disability policies contain a provision that requires claimants to attend an independent medical evaluation if the insurer requests. A failure to attend could be considered non-compliance and lead to a cut-off from benefits. Claimants can request the report from an IME to be sent to their own treating doctors. The opinion of a claimant’s treating doctor carries the most weight.

What to know about a disability lawyer’s role in LTD claims

• Beneficial to hire or speak to a disability lawyer: There is often an imbalance of power between a claimant and the insurance adjuster. Seeking legal advice can ensure claimants are empowered and given the guidance they need, and can be conducted at any point. Claimants do not have to wait for a denial of benefits to speak to a disability lawyer.
  
• Assist in the application process: A disability lawyer can offer guidance throughout the application process. Claimants must seek legal advice if a denial of benefits occurs. Claimants have up to two years after a denial to file a legal claim.
  
• Cost to hire a disability lawyer: Many disability lawyers are retained on a contingency basis. This means claimants do not have to pay any fees unless their legal claim is successful. Consultations with a disability lawyer are often free.

Request to appeal from insurer

I’ve already provided my insurer with a letter from my rheumatologist confirming I have fibromyalgia, osteoarthritis, and lupus. Despite this, I was denied benefits.  After appealing their decision, the company responded by requesting additional information. Are there other options available to me?

• Appealing a denial of benefits: Insurance companies created the appeal process to prevent claimants from filing a legal claim. Appeals are conducted often by the same adjuster who initially denied the claim, and usually unsuccessful. Appeals waste valuable time for claimants to pursue their benefits.
• Denials to subjective claims: Many medical conditions, such as lupus or fibromyalgia, are considered to be subjective. It is difficult to obtain objective medical evidence, and as a result, insurers will use this reasoning to deny a claim.

Aggressive communication from disability insurer

I’ve been on LTD for 6 years now due to rheumatoid arthritis and was recently approved for CPP Disability. Despite this, the insurance company keeps asking me for constant updates about my condition. I’m limited in the medications I can take and I have surgery soon. Why does the insurer keep harassing me for more information?

• Communicating with an insurer: Some adjudicators are more aggressive as they need to have constant updated reports. Claimants who have approval for CPP Disability should remember that the test to qualify for CPPD is more difficult than LTD. A constant request for more paperwork alludes to an adjuster’s desire to cut off benefits. Adjusters must behave in good faith with claimants.

PREVIOUS EPISODE: Disability Law Show S7 E4 – 3 Common questions about IMEs