What to know about LTD if suffering from depression | Disability Law Show TV – S5 E15

Episode Summary

WHAT YOU NEED TO KNOW ABOUT LTD IF SUFFERING FROM DEPRESSION on Season 5 Episode 15 of the Disability Law Show with disability lawyer and national practice leader, James Fireman, and Tamar Agopian, disability lawyer and partner at Samfiru Tumarkin LLP.

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

Hidden motivations of insurance companies

I’ve been on disability leave for almost 2 years. Communicating with my insurance adjuster is now more difficult and I’ve been sent for an evaluation. Will my benefits be cut off?

• Change of definition period: Many claimants experience a change in the behaviour of their insurance adjuster around the two-year mark while on long-term disability. The motivations of the insurer change as the “change in definition” period occurs. After two years claimants have to prove they are disabled from working in any occupation, as opposed to just their own. During this period claimants are often sent for independent medical examinations or functional ability tests in order to justify a cut-off from benefits.

Approved for short-term disability but denied LTD

I have a compression fracture in my back that prevents me from working. The insurance company accepted my short-term disability claim but denied my LTD. I’ve appealed 2 times.

• Short to long-term disability: Many claimants are unaware that while short-term disability benefits are often through their employer, long-term disability benefits can require a separate application.  Approval for short-term disability benefits does not mean automatic approval for LTD. Insurers often resist the transition from short to long-term disability benefits despite the fact that the test in order to qualify is the same.
• Appeals process after a denial: Appealing an LTD denial is often unsuccessful and leads to a waste of a claimant’s time. It is far more beneficial for claimants to file a legal claim and pursue legal action with a disability lawyer.

What you must know about LTD if you’re suffering from depression

• Applying for LTD: Claimants should remember that they are paying for disability benefits and premiums through a group policy program. With the approval of their doctors, claimants that are depressed and unable to work should apply for long-term disabilty. Mental illnesses are considered real disabilities despite the behaviour and judgement of an insurer.
• Medical documentation and support from a doctor: Most disability policies stipulate that claimants should pursue and continue prescribed treatment in order to receive disability benefits. Claimants with depression must seek medical help and ensure that all clinical notes are detailed and document all relevant symptoms.
  
• Legal advice from a disability lawyer: Claimants who have been denied long-term disability have up to two years after the date of denial to pursue their legal rights. Consultations with disability lawyers are often free and can provide support and relief for claimants. By filing a disability claim, individuals are able to focus on their own health and recovery.

Misrepresented medical information

The insurer says I misrepresented my health history and now my disability coverage is void. I’m confident that the medical documentation I sent to my insurer is correct and up to date.

• Medical reports and documentation: Claimants that have disability benefits in a group policy will rarely face a denial on the basis of a misrepresentation of health history. In many private disability policies, claimants will have to submit a health questionnaire to the insurance company to determine their coverage. Individuals that have not intentionally misled insurers can seek legal advice from a disability lawyer.

PREVIOUS EPISODE: Disability Law Show S5 E14 – 3 Things to remember about your LTD adjuster