By Nainesh Kotak
Proactive and open communication with your long-term disability (LTD) insurer could help preserve your benefits or boost your case in court if they are ever terminated.
I can understand why injured workers may not like the idea of becoming well acquainted with their insurance company after they begin receiving LTD benefits, but approval is unfortunately just the first step of a process that requires ongoing correspondence with your provider.
It may help to think of these interactions as one of those times in life where cordial relations serve a greater purpose — just like the irritating neighbour you acknowledge to keep the peace or the dull family member you speak to more out of obligation than for pleasure.
Mind your obligations
In the case of LTD benefits, the obligation is one consistently recognized by courts, known as the common law duty to mitigate damages. The requirement for insureds to seek appropriate medical treatment and abide by the recommendations of their treating practitioners is usually also spelled out explicitly in contractual provisions that form part of their individual and group policies.
If your condition takes a turn for the worse or one of your health professionals recommends a new course of treatment, it’s important to pass on to your insurer the medical records and reports that set out those opinions or back up the assessments of specialists. You should also let your LTD insurance provider know when you begin seeing a new health practitioner and update them on progress after receiving any therapies or procedures, such as surgery.
In addition, it is usually advisable to give your insurer some warning about events that may impact your coverage. For example, if you are planning to travel abroad for a vacation, to visit sick relatives or for some other reason, it is better for them to learn that information from you ahead of time, rather than from some other source after the fact.
Honesty is the best policy — although it may not seem like any of your insurer’s business what you do with your own time, you don’t want any of your actions to be seen as misleading. And in the event the matter ends up in court, a judge will also often look kindly on a party who was open and up-front about their behaviour.
Pressure to return to work
Having said all this, I must add that in reality, claimants do not get many opportunities to be proactive with their LTD insurers, since few providers are willing to let their insureds get on with their recovery in peace.
In my experience, it’s far more likely that recipients of LTD benefits will find themselves on the receiving end of harassing correspondence from insurers pressuring them into a premature return to work or suggesting new — often inappropriate — avenues of treatment.
LTD claimants with psychological impairments are unfortunately among the most vulnerable to insurer pressure, which is frequently exerted via requests to attend rehabilitation programs, staffed and supervised by companies hired by the LTD insurance providers themselves. In these instances, an insurance company may take advantage of a person’s refusal to attend by claiming they are in non-compliance with the terms of their policy and terminate benefits.
But that doesn’t mean injured workers with physical injuries are immune from coercion by their insurers: many of my clients are invited to attend insurer-approved “work-hardening” programs. Although allegedly designed to test and develop the claimant’s ability to withstand certain movements and activities that they could come across in a real workplace, these programs tend to result in reports suggesting the claimant is work-ready, regardless of the severe pain experienced by many workers during sessions.
In some cases, injured workers may be able to push back against suggestions from their insurer, especially if they are already in treatment that is backed by their existing medical practitioners as the most appropriate course of action.
If your disability insurance claim has been denied or cut off and you’re considering hiring a lawyer, check out our blog post on questions to ask a disability lawyer before hiring one.
KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
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