When you live with chronic pain –– physical or psychological –– even the simple act of getting out of bed can be a monumental challenge. Whether you’re battling cancer, depression, fibromyalgia or another serious illness, it impacts every area of your life –– work, social, financial, emotional and spiritual.
If you’re on leave from work and receiving disability insurance benefits, it’s important to take steps to help your recovery and ensure that your benefits continue while you do. In this column, I’ll provide some insights into the importance of following the recommendations of your treatment professionals, the potential consequences of not doing so and the challenges that sometimes prevent people from acting on those recommendations.
A strong advocate in your corner
In my practice, I frequently represent clients whose claims for disability insurance benefits have been cut off because they haven’t followed the protocols laid out in their insurance policies. For example, most policies have provisions that require the insured person to follow the recommendations of treating practitioners, such as taking prescribed medication or attending ongoing physiotherapy or counselling appointments. When those directives aren’t followed, insurers will often use that as the justification for discontinuing benefit payments.
Unfortunately, many individuals who genuinely suffer disabling symptoms are denied short-term and long-term disability benefits by their disability insurance company. Our firm takes our role as an advocate very seriously. We have extensive experience helping clients receive the disability compensation they deserve when their ability to work has been impacted by illness, injury or disease.
What the disability insurance company expects
It’s important to understand that when you’re receiving short-term disability (STD) or long-term disability (LTD) benefits, the insurance company can access your health records. If your family physician refers you to a psychiatrist for treatment of depression, but you don’t attend that appointment, the insurer may cut off your benefits. Likewise, if your orthopaedic surgeon recommends weekly physiotherapy to treat a back injury, but the records show you’ve only attended three sessions in the last six months, that could result in your benefits being cut off.
Even if your primary physician provides evidence of your ongoing inability to work, disability insurance companies will often ignore it, favouring their own internal reports that come from a practitioner who has never even met with you. Remember: the disability insurance company’s mandate is not to ensure your recovery; it’s to get you back to work.
Obstacles to recovery
For everyone who is struck by illness, the unfortunate reality is that some days will be very dark. In addition to the physical or psychological pain associated with the primary illness, some people also suffer from chronic fatigue and a sense of hopelessness.
Many clients I work with complain of a persistent lack of energy; they can’t get out of bed and don’t have the stamina to participate in active rehabilitation programs. This is especially true for psychological impairments such as anxiety disorder, depression or personality disorders. It becomes difficult to continue with therapy when you do not see immediate results. It can overwhelm people to the point of psychological paralysis, and unfortunately, many simply give up.
Most disability insurers recognize that a large number of claims are based on mental illness, but when they’re adjudicating claims, that same philosophy doesn’t apply.
Steps claimants can take
Receiving disability insurance benefits while you recover from an illness is an important component of the healing journey. In addition to dealing with a debilitating illness, those denied or cut off from benefits are forced to fight an additional battle on the financial front.
From the many cases our firm has successfully resolved, here’s some guidance for claimants:
- See your primary care physician regularly. Your doctor documents your complaints, and these records are disclosed to the disability insurance company to establish that you do, in fact, have ongoing difficulty. If you’re not seeing your doctor regularly, there will be little evidence to demonstrate your impairment.
2. Always tell the truth to your treatment practitioners and the insurance company. This can’t be underscored enough. I’ve worked with clients whose benefits have been cut off because they haven’t been completely honest with the insurance company. If your caseworker asks you when your last appointment with your doctor was and you tell them it was last week, but the doctor said two months ago, it won’t bode well for you.
3. Attend recommended treatment programs. If your primary care physician refers you to a psychiatrist for treatment of depression, anxiety or another mental health issue, it’s critical to show up at that appointment and follow the psychiatrist’s recommendations. Sometimes progress is very slow in terms of seeing results from medications or cognitive therapy. It’s easy to feel disheartened and stop doing the rehab. Disability insurance companies will take advantage of that and deny or terminate claims or terminate claims based on the person not following recommended treatment programs.
4. Keep a journal and document all of your medical and rehab appointments, as well as any conversations with the insurance company’s case manager. It’s also important to document your symptoms regularly. As weeks turn into months, it can be difficult to recollect what happened when, and this journal will allow you to refresh your memory of events.
5. Be aware that the insurance company may be conducting surveillance on you, both in person and in your online activities. It’s human nature to want to put your best foot forward on social media, but posting a photo that shows you having a good time at a birthday party could be misconstrued by the insurance company. That single photo doesn’t necessarily represent your life on the whole, but it’s important not to give the insurance company the ammunition they need to deny or cut off your claim.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
We understand that being denied short-term disability or long-term disability benefits can be devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a short- and long-term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.
Call your trusted long-term disability lawyers at 1-888-GOKOTAK or (416) 816-1500. Our consultation is free and we don’t get paid until you do. We represent disabled people throughout Ontario including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Fort Erie, Keswick, Kingston, Ottawa, Barrie, Timmins and other locations.