What to know if your disability is due to a workplace injury | Disability Law Show TV – S6 E05

Episode Summary

WHAT TO KNOW IF YOUR DISABILITY IS DUE TO A WORKPLACE INJURY on Season 6 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

Recurrence clause in disability policies

I was working as a support worker in a nursing home. I’m in my 50s and this was a very physical job. My doctors advised me to stop working after years of accommodations due to nerve issues in my knees. I was denied LTD despite the approval of short-term benefits. How is this possible?

• Recurrence clauses: Claimants should only return to work when they are medically cleared to do so by their doctors. Most disability policies contain a provision that stipulates if a claimant returns to work but their medical condition prevents them from continuing to work, their benefits should resume without a waiting period. This is considered to be a recurrence provision.
  

Not considered “totally disabled” by insurer

My best friend just received a denial letter in the mail from his LTD insurer. They stated that they don’t consider him “totally disabled” and believe he can do sedentary work. He’s been off work for almost 8 months now because of severe back pain. Is there anything you can do to help?

• Disability insurance terminology: Disability insurance adjusters often implement terminology that confuses both claimants and medical professionals. The test for disability when first applying for benefits applies to a claimant’s occupation. To qualify for disability benefits, to be deemed “totally disabled” simply means unable to perform the basic tasks of their job. 
  

What to know if your disability is due to a workplace injury

• File a long-term disability claim with your insurance provider: Workers Compensation benefits exist in provinces across Canada. Most employees also have access to disability benefits through a plan with their employer. Claimants can apply and qualify for both benefit programs. Applications for both programs should be conducted as soon as possible with the support of a treating doctor.
• Health issues covered by LTD benefits: Workplace injuries can become prolonged and lead to coverage by long-term disability benefits. Claimants should speak to their medical team to determine their prognosis and when they will be able to return to work.
• Contact a disability lawyer: Claimants are within their rights and should speak to a disability lawyer if their benefits are denied. Claims that arise as a result of a workplace injury often lead to denials of disability benefits. Mental health claims triggered by a toxic work environment are also often denied.

Approval for LTD after short-term disability

If someone is approved for short-term disability benefits, does it mean they will automatically be approved for long-term disability benefits as well?

• Transitioning to long-term disability: There is no automatic approval or transition from short to long-term disability benefits. At times claimants might have to file a separate application entirely. Even though the test to qualify for long-term and short-term disability benefits is the same, short-term disability benefits are often paid by employers and not the insurance company.
  

Denied disability benefits despite a concussion

My brother was denied LTD despite a severe concussion. He already gave his insurer all medical records from a local brain injury clinic. The insurance company has invited him to appeal. Is that the best option?

• Appealing an LTD denial despite medical support:  It is important to ensure the insurance adjuster is provided with all necessary medical documentation. Brain injuries and concussions can take longer than initially believed to recover. Appeals are rarely successful if a disability claim is denied. It is far more beneficial for claimants to file a legal claim to pursue benefits.

Multiple assessment requests by the insurer

My physician provided a note to my insurer stating that I can’t attend another assessment, as it worsens my PTSD and anxiety. Despite this, my insurance provider has threatened to cut me off if I don’t go for another IME. What are my rights?

• Attending an independent medical examination: While claimants are expected to attend independent medical examinations made by the insurer, the requests must be reasonable. Claimants who feel they have been subjected to multiple IME requests can resist the assessment request. To protect their continued right to benefits, claimants should seek legal advice from a disability lawyer and review the terms outlined in their disability policy.
  

NEXT EPISODE: Disability Law Show S6 E06 – 3 Key questions about appealing an LTD denial

PREVIOUS EPISODE: Disability Law Show S6 E04 – 3 Important facts about your medical reports