What you need to know about Cancer and LTD Claims | Disability Law Show TV – S4 E06

Episode Summary

WHAT YOU NEED TO KNOW ABOUT CANCER AND LTD CLAIMS on Season 4 Episode 06 of the Disability Law Show with disability lawyer Partner, 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 Canada on the only disability law show on TV and radio in Canada.

Episode Notes

The disability adjuster cut off benefits but didn’t speak to a specialist

I was diagnosed with thyroid cancer and it had to be removed. My insurer relied on online medical guidelines and relied upon them in order to determine whether or not I should remain on LTD. The adjuster says I should have recovered by now. What can I do?

• Lack of contact with treating doctors: Claimants who have been diagnosed with cancer have to consider whether or not the symptoms of their diagnosis prevent them from doing the basic functions of their job. It is common, however, for claims handlers to rely on general guidelines as more than just a basis for understanding a condition but instead look to the guide for prognosis. Only a treating doctor and medical team can decide whether or not a claimant is ready to return to work.

The insurance adjuster pushing me to return to work

I had a serious knee injury and have been on LTD for over a year. My job is very physical, but the insurance company is attempting to push me to return even though I’m not quite 100%. My doctor has stated that the proposed return to work date is too early. What should I do?

• Returning to work after LTD: The return to work decision is a medical decision and not a legal or insurance adjuster’s decision. Claimants should not return to work before their treating doctor has approved a return. Insurance adjusters can often pressure claimants to return to work but claimants should make sure their proposed return to work plan is in writing and specific. The report and strategy for a return to work suggested by the adjuster can then be given to a claimant’s doctor. If a claimant’s condition worsens under the adjuster’s plan, they can be owed additional compensation.

What you need to know about cancer and LTD claims

• Individuals who have cancer and are unable to work: Cancer is a broad diagnosis and there are many different kinds. There are some individuals with cancer who are able to work for an extended period of time as well as those who are unable to work. Symptoms, not the diagnosis, are the most important factors in determining whether or not a claimant is able to work. Symptoms can be associated with the condition or treatment.
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    Cancer and Long-term Disability Claims
• Classifying cancer as a pre-existing condition: There are limits to what can be considered a pre-existing condition. In long-term disability, there are limited applications for pre-existing conditions as it only applies to conditions that claimants were treated for between 3 to 4 months before they were insured. Claimants who are unsure of their disability policy should contact a disability lawyer for clarification.
• Claimants should keep their insurer up to date: Claimants, no matter their condition, should ensure that their adjuster is kept up to date in order to prevent the disability adjuster’s justification to cut off benefits. Claims handlers typically try and find any reason to cut off long-term disability benefits. Claimants can ask their adjuster if there are any records they need in order to be kept up to date.
• Claimants are denied LTD due to assumptions: Claimants should make sure that their case is being adjudicated fairly and if unsure of their rights should contact a disability lawyer. Insurance adjusters are obligated to operate in good faith and understand their claimant’s case specifically.

Appeal denial of LTD after initial approval of short-term disability

I was approved for short-term disability after surgery but had to apply for long-term disability because recovery is taking longer than I expected. My claim was denied. Should I start the appeal process that my adjuster recommended to me?

• Short to long-term disability: The appeals process is typically ineffective and is an internal process conducted by the insurance company. Appeals are not included in a disability policy and were created by the insurance company in order to better control the situation. Instead of wasting more time, claimants should consider beginning a legal claim in order to pursue their benefits.

Insurance company requesting  attendance at a medical assessment

I’ve been receiving LTD benefits for just over 2 years. I had two surgeries for progressive disease, but they didn’t seem to help much. The insurance company is asking me to attend a medical assessment. Do I have to agree to it?

• Attending an assessment: Claimants are not obligated to seek treatment from the suggested providers by the insurance company if they are already receiving treatments. Claimants are obligated to attend assessments requested by the insurance company as it is important for the adjuster to understand the claimant’s condition and adjudicate a claim. Claimants who refuse to attend an assessment risk their disability benefits being cut off.

Previous Episode: Disability Law Show S4 E05 – What to Know about returning to Work from LTD