What to know about addiction and disability claims | Disability Law Show TV – S6 E10

Episode Summary

WHAT TO KNOW ABOUT ADDICTION AND DISABILITY CLAIMS on Season 6 Episode 10 of the Disability Law Show with disability lawyer, National practice leader and Partner James Fireman.

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

Benefits denied due to “pre-existing” clause

I had to take a medical leave from my position due to a mental health issue. As I’d been at this job for less than a year, the insurer informed me I was denied benefits as it was a “pre-existing” condition. What can I do here?

• Pre-existing exclusion clauses: Claimants need to look closely at the terms of their disability policy. In some cases, benefits can be denied due to a “pre-existing” clause in a disability policy. This applies to claimants who need disability benefits before a year of starting coverage. Claimants who have a long-term medical condition that is being managed, but are considering beginning a new job should consider this.
  

New LTD case manager

I’ve been on LTD for 3 years now. I recently got a new case manager who has suddenly been asking for more updates. I’m worried they’re getting ready to cut me off. Can they do that even though I have the support of my doctors and am still unable to work?

• Communicating with an insurer: Claimants should ensure all communications with their insurance adjuster are documented in writing. Often claimants are denied or experienced a cut off from benefits as they are assigned a new case manager. A request for more information does not always mean benefits will be denied, however, claimants should be wary but continue to cooperate.

What you should know about addiction and disability claims

• Considered under most disability policies: Under most disability policies, substance abuse and addiction are considered disabilities. Many individuals suffering from an addiction are unaware that they are entitled to disability benefits with the support of a doctor.
• Seek and undergo treatment: All claimants applying for disability benefits are required to seek and undergo the necessary treatment. Some disability policies state that for those with disabilities related to addiction, claimants must participate in an in-house facility.
• A relapse or regression: A relapse or regression can lead to a cut-off from benefits despite the nature of addiction. Claimants who have had their benefits cut off should contact a disability lawyer as soon as possible.

Mental illness deemed “situational”

My wife stopped working due to workplace harassment, leading to anxiety and PTSD, as advised by her doctor and psychiatrist. Despite this, the insurance company claims her condition is “situational” and suggests she can work elsewhere. Can she still qualify for LTD?

• Generalized vs situational mental health conditions: Insurance adjusters frequently deem mental health claims to be situational if they are triggered by a difficult workplace situation. Workplace harassment or a toxic work environment can cause a disability that is considered general. A generalized mental illness will affect a claimant’s ability to work under any employer.

Asked to attend an IME by the insurer

I’ve been battling debilitating long-term COVID symptoms since contracting it two years ago and was approved for LTD. Recently, my adjuster has been insisting on a psychiatrist assessment. My condition is not psychological and I’m not sure why they’re asking for this. Do I have to attend?

• Attending an independent medical examination: Most disability policies require claimants to attend an independent medical examination when requested by an insurer. Long COVID symptoms frequently lead to denials of benefits as it is hard to diagnose due to a lack of objective medical evidence. Claimants must attend IMEs but can ask for the corresponding report to provide to their own treating doctors.

PREVIOUS EPISODE: Disability Law Show S6 E09 – Common Questions about Disability Benefits