If you have a claim for short or long term disability benefits from a private insurance company including Manulife, Sun Life, Desjardins, Empire Life, Pacific Blue Cross, RBC Insurance (or Paul Revere), SSQ, Great West Life, or your employer or union, you may have been told you are no longer entitled to disability benefits for one of more of the following reasons:
- You have reached the end of the “own occupation” period (usually 24 months) and you do not qualify under the “any occupation” definition of the policy because you could do some other type of work
- You have been approved for a graduated return to work
- Your claim of stress in the workplace is “not a disability”
- You should be on WorkSafe benefits
- You do not have any “objective” evidence to support your claim
- Any other reason you do not understand
Denial letters from insurance companies can be very confusing, however you should never assume that what you have been told in a denial letter is the final word. There is almost always an avenue to appeal a decision regardless of the timelines provided by the insurance company (although waiting too long to address issues could close some doors for your claim, so we advise you reach out to a lawyer to obtain assistance as soon as possible).
Regardless of how frustrated or hopeless you feel, don’t walk away from your benefits claim before you have first consulted a disability and benefits lawyer.
Alternatively, you may find yourself in a situation where you are not cut off from benefits entirely, but where you are feeling harassed or confused by any of the following:
- Applications for Canada Pension Plan Disability benefits (where the insurer insists they have a direct offset regardless of the taxability of the benefit)
- Settlements in motor vehicle or personal injury claims which the insurer claims they are entitled to
- Medical assessments and rehabilitation home visits and constant demands for more medical information
- Graduated return to work programs or “rehabilitation programs”
- Uncertainty around what the insurer is telling the employer and what the employer is telling the insurer
- Whether you can work, or study, or volunteer while on benefits
- All of the above, or some other confusing, frustrating, stressful issue
If you are feeling overwhelmed by letters, phone calls or emails you have received from your insurance company, please reach out to a disability and benefits lawyer for advice. At Watson Goepel we offer a free consultation to review your claim and assess your potential options for recourse.
After assessing your situation we will either provide you with tips for you to move your claim in the right direction on your own, or we may offer to represent you either on an hourly or contingency fee basis, depending on your circumstances. Regardless of your circumstances we will endeavor to help you find resolution to your claim.
Sarah Hentschel is a lawyer in our Litigation and Dispute Resolution Group and has fifteen years of experience dealing with insurance companies and helping insureds resolve their claims.