What to know about headache disorders and LTD | Disability Law Show TV – S5 E23

Episode Summary

WHAT TO KNOW ABOUT HEADACHE DISORDERS AND LTD on Season 5 Episode 23 of the Disability Law Show with disability lawyer and co-managing Partner Sivan Tumarkin and Partner and disability lawyer, Tamar Agopian.

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

Episode Notes

Long-duration disability claims

I’ve been on a disability claim for over 5 years due to both physical and mental health issues. After surveillance, my benefits were cut off. Why did this happen?

• Benefits cut off after any occupation period: After the first two years on long-term disability, the test in order to be considered disabled changes. Claimants have to prove they are disabled from working in any occupation, rather than just their own. Some claimants, who do not appear to be improving dramatically, are deemed to be on a claim for “long duration”. Insurance companies typically do not like long-duration claims, and will try and find a way to cut off benefits.

Disability claimant told can do another job

My brother has been on LTD for 2 years as he struggles with schizoaffective disorder and agoraphobia. He just found out from the insurer that his benefits are about to be cut off as they believe he can do another job. Why are they doing this?

• Change in definition period: Many claimants experience a cut-off from disability benefits after the two-year mark, due to the change in definition period. Insurance companies are profit-engineering entities that do not want claimants to remain on benefits for a long time. Insurers post-pandemic have presumed claimants are able to work from home despite their disabilities. Claimants should speak to a disability lawyer and their treating doctors for advice going forward.

What you need to know about headache disorders and LTD

• Definition of headache disorders: Many headache disorders are debilitating and can prevent individuals from performing the essential tasks of their job. Many disability insurers are resistant to headache disorder claims as the condition typically does not go away. Headache disorders, like migraines, can be managed but for many there is no cure.
• Diagnosing headache disorders: Headache disorders are often considered to be invisible illnesses as they are difficult to diagnose. Medical science currently has limits that can make it very difficult to prove certain conditions. Insurers will often deny claims on the basis of a lack of objective medical evidence. It is important to remember that a diagnosis is not necessary to receive disability benefits.
• Documentation and medical records: In order to strengthen an LTD claim it is vital to document all treatments and medical records. Details, such as restrictions and limitations, should be provided to the insurer from treating doctors.

Increased stress due to insurance adjuster

I’ve been on LTD for a mental health disability for over six years. After speaking to the insurer, my anxiety and stress increased tremendously. Should I consider negotiating a lump sum, so I no longer have to keep in contact with my adjuster?

• Relationship with the insurer: Insurance adjusters have a legal obligation to conduct themselves in good faith with claimants. Individuals who feel their adjusters are not being fair should speak to a disability lawyer. Approaching an adjuster for a lump sum payment can lead to red flags for the insurance company. All communication with an insurance adjuster should be documented in writing.

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