Confused by your Long Term Disability claim? You are not alone.

It’s hard enough dealing with the medical symptoms of illness or injury which are preventing you from working – the last thing you need is the added anxiety of facing an unclear insurance claims process.

The process can be so stressful for some claimants that they simply give up and therefore miss out on many of the benefits they are legally entitled to, including pension and benefits through the employer (which are often only in place if an employee is on an approved long term disability claim).

Many recipients of long-term disability (“LTD”) benefits with private insurance companies experience some or even all of the following issues while in receipt of, or when appealing, their LTD benefits.

Are you experiencing..?

• Confusing messaging regarding entitlement to benefits after the “change of definition date” from “own” to “any” occupation (usually at the 24-month mark)
• Seemingly arbitrary timelines for submitting medical information, or appeals that seem very short given the availability of medical advisors
• Different or changing reasons for denial such as when the insurer will deny for one reason, but if your doctor addresses that reason then they deny for a different reason
• Doctor fatigue or frustration – when you fear alienating your medical support team because they are so frustrated by repeated requests for medical information or having their opinion disregarded or rejected by the insurer
• A lack of clarity around the insurer’s entitlement to offset various other benefits such as:
  • • CPP Disability (gross amounts offset or net amount offset)
    • WorkSafe pensions (awarded from unrelated disabilities), passive income earned (from trading stocks, inheritance, or rental income)
• A lack of clarity around entitlement to “rehabilitation benefits” or “vocational benefits”
• Rejection of medical information because it is not “objective” or because “stress leave isn’t covered” or some other vague reason for which the insurer does not provide reference to any policy wordings
• Requests for further medical information after you have already provided what you thought was required, without any clear instruction as to why the initial information was rejected
• Fear around what your employer is saying to your insurer, and vice versa
• Vulnerability around the privacy of your information including a lack of clarity around who these “third parties” are that the insurer’s say they can share your information with
• The insurance companies’ rejection of your medically approved treatment plan in favour of their own idea for a treatment plan
• The insurance company implying they have the right to cut you off if you turn down certain investigations, such as receiving their rehabilitation representatives into your home (via zoom or in-person) to review your personal situation
• Insurance companies conducting surveillance without warning and in secret
• Insurance companies or employers stating that you must take a completely different job or an amended job with your employer (and then terminating your LTD benefits if you do not)
• Unexpected telephone calls from the insurance company who demand that you submit to lengthy telephone interviews – sometimes multiple times a month – which include questions like:
  • • what your hobbies are,
    • what trips you have taken,
    • what you watch on TV,
    • what you read,
    • details about your mental health and your personal relationships (even if your claim does not involve a mental health condition),
    • what kind of plants you have in your garden, or
    • whether your kids or parents live with you.

There is help!

You may wonder if the above conduct is legal. The answer is… sometimes yes and sometimes no. The language used by insurance companies can be unclear, and this is why claimants who have been denied benefits should consider seeking legal guidance from a third party with a deep understanding of the insurance industry claims process.

If your insurance company is demonstrating behaviours like those listed above, please contact us directly for a free consultation about your rights and entitlements. You do not have to navigate this complex process alone.

Sarah Hentschel is a lawyer in our Litigation and Dispute Resolution Group and has over fifteen years of experience dealing with insurance companies and helping insureds resolve their claims. She can be reached at shentschel@watsongoepel.com or at 604-642-5677.