What to know if suffering from addiction and applying for LTD | Disability Law Show TV – S5 E18

Episode Summary

WHAT TO KNOW IF SUFFERING FROM ADDICTION AND APPLYING FOR LTD on Season 5 Episode 18 of the Disability Law Show with disability lawyer and co-managing Partner Sivan Tumarkin and national practice leader and disability lawyer, James Fireman.

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

A failed attempt to return to work

After years of LTD, a new treatment seemed to help lessen the pain. I was cleared for light duties at work but ultimately was not successful. As I attempted to return to work, my disability benefits were cut off.

• Resuming disability benefits: In some cases, after an attempted return to work, despite whether or not the attempt was successful, insurers will deny or cut off benefits. Claimants should be able to resume benefits due to a recurrence clause in most disability policies. Claimants should only attempt a return to work with medical clearance and employer accommodations.

On LTD for over a decade pressured to return to work

My husband has been on disability for 14 years. He has had a double lung transplant, and now the insurer is asking if he’s able to come back to work.

• Decades of disability benefits: After two years on long-term disability, the test in order to qualify for disability benefits changes. Claimants after two years on LTD have to prove that they are unable to work in any occupation. After over a decade of benefits, the insurance company appears to have designated a claimant is not able to work in any occupation. The responsibility for proving a claimant is able to work lies with the insurer, not the claimant.

What you should know if suffering from addiction and applying for LTD

• Addiction is considered a disability: In most disability policies, substance abuse and addiction are considered to be disabilities. In most human rights codes across Canada, addiction is considered a disabled condition. Despite this, addiction claims are often denied by insurance companies.
• Following recommended treatment: In most disability policies, it is required for claimants to continue to seek treatment. The law does not consider relapse to be non-compliance with treatment and recovery. Claimants that are trying to progress their recovery should continue to receive benefits.
• The complexity of addiction disability claims: Due to the nature of addiction, claimants can relapse or regress in their recovery. Insurance adjusters, however, typically do not take into account the fact that every claimant responds differently to addiction. There are also many secondary conditions that occur as a result of addiction.

Refusal to comply and a cut-off from disability benefits

My sister started seeing a doctor recommended by her insurer. She’s now on medications that have serious side effects. The insurer says if she refuses the treatment she’ll be cut off from her benefits.

• Cut off from disability benefits: Insurance companies can insert themselves into the doctor and patient relationship. Claimants should ultimately follow the treatment recommended by their own doctors and medical team. Regardless of the legal repercussions, claimants should continue to focus on their own health and recovery. In the event of a cut-off from disability benefits, claimants should seek legal advice from a disability lawyer.

PREVIOUS EPISODE: Disability Law Show S5 E17 – 3 Fast facts about chronic pain and LTD