What you should and should not do if denied LTD | Disability Law Show TV – S5 E07

Episode Summary

WHAT YOU SHOULD AND SHOULD NOT DO IF DENIED LTD on Season 5 Episode 07 of the Disability Law Show with national practice leader and disability lawyer and Partner Sivan Tumarkin.

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

Mental illness is considered situational

I applied for long-term disability benefits but was told my mental illness was a result of my workplace and so I do not qualify. What does this mean?

• Generalized mental illness: In many mental health claims, insurance companies will deny the claim on the basis that the illness has arisen as a result of a toxic workplace. Insurers will recommend that claimants resolve their employment issues but insist the correlating illness, like anxiety or depression, is only applicable to the workplace. Claimants according to the insurance company, should be able to work in another workplace.
• The illness developed as a result of a toxic workplace: Many individuals develop mental illnesses as a result of a toxic workplace and is generalized and no longer specific to their workplace.

Surveillance while on LTD leave

Is it illegal for an insurance company to watch you using a private investigator while you are off work on long-term disability? I’m worried that they will misinterpret some of what they see.

• Surveillance and long-term disability claims: Insurance companies are allowed and often use private investigators in order to implement surveillance on long-term disability claimants. Investigators are not permitted to cause distress or further harm to claimants. In reality, while the investigator and insurer will try and come up with reasons to justify denial or cut off benefits, often surveillance does not produce anything of value. Claimants that feel that surveillance is being used in bad faith against them, should speak to a disability lawyer as soon as possible.

What you should and should not do if you are denied long-term disability

• Do not panic and seek legal advice: It is key for claimants not to panic if they are denied LTD or had their benefits cut off. It is a stressful situation however it is vital for claimants to contact a disability lawyer for a consultation in order to put their minds at ease. Disability lawyers will provide claimants with all of their possible options.
• Continue recommended treatment: In order to continue to qualify for long-term disability benefits, most disability policies require claimants to seek treatment for their disability. It is important to follow treatment recommendations from a doctor and inform the treating medical team of the situation and the denial.
• Appealing and LTD denial: The appeals process is rarely successful and often leads to a delay in pursuing a legal claim for individuals. Appeals were created by the insurance company in order to ensure the power and influence remain with them and not the claimant.

Attending an IME requested by an insurer

I’ve been on LTD and CPP Disability for over 2 years with fibromyalgia and migraines. My insurance provider is sending me to one of their doctors for a mandatory medical assessment. Do I have to attend?

• Independent Medical Examinations: Under most disability policies there is a requirement for claimants to attend an independent medical examination if requested by an insurance company. The policy that governs the relationship between the insurer and claimant is a contractual policy. Claimants can ask for all of the necessary information in order to prepare for the assessment and can request a report after it has been conducted to give to their own doctor.
• Own occupation and any occupation periods: After the first two years of long-term disability, under most policies claimants have to demonstrate that they cannot perform the essential tasks of any occupation. After the initial period of LTD, claimants are often sent for an IME.

PREVIOUS EPISODE: Disability Law Show S5 E06 – How to transition from short-term to LTD benefits