By Nainesh Kotak
Your long-term disability claims adjuster is not your friend.
It may sound like a harsh statement, but this self-protective mantra is one that many injured workers would benefit from repeating to themselves before getting too close to the insurance company representative in charge of their claim for long-term disability (LTD) benefits.
When a worker is forced off the job by a medical issue, the recovery period is often a lonely one, so I can understand why LTD claimants may feel a connection to their point person at the insurance company. On the surface, it looks like you share a common goal, but the underlying truth is that the claims adjuster’s ultimate duty is to their employer: the insurer.
All too often, the relationship deteriorates over time as the claim adjuster’s true allegiance reveals itself in the form of intimidating behaviour — a betrayal that cuts deeper for claimants who felt like they had established a rapport with their bully.
In almost three decades of legal practice advocating on behalf of injured workers, I have lost count of the number of clients who feel harassed by insurance company representatives asking the same questions — over and over again — about their ability to function or pressuring them into an inappropriately early return to work.
If you have encountered a bullying claims adjuster, feel free to contact a member of our LTD team for help. In the meantime, here are my top five tips for dealing with them.
1. Tell the truth
Honesty is always the best policy when dealing with insurance company representatives. As invasive as it may feel to answer questions about your medical history and day-to-day activities, claimants are always best served by straightforward, truthful answers.
In some cases, insurers hire investigators to follow claimants in an attempt to catch out those exaggerating. But even without the threat of surveillance, you don’t want any of your actions to be seen as misleading, since judges do not look kindly on parties who fail to be open or up-front if the matter ever makes it to court.
2. File a complaint
If a claims adjuster’s conduct is truly untoward, you should not have to put up with it. Do not be afraid to ask for their manager’s name or escalate your concerns further up the chain if necessary.
Alternatively, every LTD insurer has some form of ombudsman or complaints department where you can express your dissatisfaction with your treatment. At the very least, this will ensure that someone else at the company gets their eyes on your file so that you are not going one-on-one with the claims adjuster.
3. Keep records
Many insurers are already making a record of your conversations with their employees, but it’s a good idea to keep your own version, even if it’s just a few notes concerning what was discussed during the call.
In appropriate cases, courts have the ability to award punitive damages to punish bad-faith conduct in the handling of an injured person’s case. If you’re uncomfortable with a request that a claims adjuster makes of you on the phone or a persistent line of questioning, ask them to put it in writing.
If the person fails to follow up, you may want to email them yourself to ask for clarification or confirmation regarding your understanding of what was asked.
4. Tell your doctor
Unfortunately for many injured workers, inappropriate interactions with their LTD insurers exacerbate their health problems — particularly those dealing with psychological conditions such as anxiety, depression, post-traumatic stress disorder or obsessive-compulsive disorder.
Make sure your family physician and other medical specialists you are seeing know about any pressure insurance company representatives are exerting and how it has impacted you so that they can adjust your treatment accordingly.
This could also become relevant if you end up in litigation against your insurer since extra-contractual damages may be available to claimants who can show that the way their case was handled resulted in mental distress.
5. Get a lawyer
If your LTD claim is ultimately denied or your benefits are terminated, let your lawyer know about everything that went on during the claims-adjustment process so that your legal counsel can properly draft a claim to target any inappropriate behaviour, as well as make appropriate requests for records from both the insurer and your treating medical professionals.
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 (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). 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. We also serve clients throughout Alberta, including Calgary, Edmonton, Red Deer, Lethbridge, Medicine Hat, Fort McMurray, Grande Prairie, Airdrie, Spruce Grove, Lloydminster, St. Albert, Wetaskiwin, Camrose, Banff, Canmore, Jasper, Cochrane, Okotoks, High River, Sylvan Lake and others.