By Nainesh Kotak
Steel yourself for a fight with your long-term disability insurer two years after receiving your first benefit payment. Although the terms of each LTD group policy will differ, the vast majority take a crucial turn 24 months into the relationship when the test for coverage changes.
For the first two years, workers must show that they are totally disabled from performing the essential tasks of their own occupation to receive benefits. However, after that point, the policy wording typically requires an insured person to be totally disabled from employment in any occupation for which they are “qualified or may reasonably become qualified by training, education or experience.”
Suitability for any type of work
The new test is much more stringent and tougher to meet since it’s no longer the specific tasks of your own job that are at issue. Instead, the question becomes your suitability for any type of work, which makes the two-year mark a popular time for insurers to seize the opportunity and terminate benefits.
In fact, I’m increasingly finding that insurers will not even wait until the two-year anniversary before informing workers that their benefits will be cut off at that point, with some particularly brazen providers giving as much a year’s notice.
A termination as premature as that gives you a sense of the kind of bias LTD claimants can expect from some insurers, who can’t possibly be interested in looking at the full picture of a person’s health if they’re making a decision that far in advance.
Inappropriate return-to-work plans
Prior to a termination letter, you might find your LTD insurer suggests a “transferable skills analysis,” with a view to matching your abilities and education with potential alternative work. This may be a good idea in theory, but in practice, the results serve little purpose other than to bolster the case for termination of benefits by purporting to show that claimants have other work options.
It’s not unusual for professionals hired by the insurer to deliver the results of an analysis without ever having met the insured person. And don’t be surprised if the boilerplate ideas they come up with make no sense in terms of a realistic return to work. I’ve seen too many suggestions for work as a parking attendant, cashier, data entry clerk or some other form of sedentary job to keep count.
Those with mental health conditions are unfortunately particularly vulnerable to termination of LTD benefits at the 24-month mark, on the basis of inappropriate return-to-work plans.
Insurers slow to recognize the impact of mental health conditions
Society has come a long way in recent years in terms of our treatment of those with mental illnesses, but the insurance industry lags a little when it comes to understanding the debilitating impact of conditions such as anxiety, depression, post-traumatic stress disorder and obsessive-compulsive disorder.
When your day-to-day life is being disrupted by a lack of sleep, multiple medications and social isolation, it’s not always possible to return to any form of work, regardless of that person’s level of education.
Many of these terminations are ripe for legal challenge, and we have advocated strongly on behalf of people with mental illnesses to show that they do in fact require benefits for total disability.
Still, workers with physical disabilities should not expect the visibility of their injuries to insulate them from the possibility of termination after two years of LTD benefits.
Insurers will often suggest that employees undertake tasks that are well outside their skillsets or retrain at a late stage in their career, despite spending their entire working lives in manual labour occupations such as order packing or forklift truck operation. Even lighter work or sedentary tasks can be a challenge for someone suffering from chronic pain after working in a physical job.
In these cases, our approach will often be to obtain opinions from medical experts, which may include the individual claimant’s treating physicians — their family doctor or any specialists they are seeing — or another professional hired by the law firm on the client’s behalf.
Whoever performs the assessment, we will ask them to comment on the injured person’s diagnosis and symptoms, as well as their ability to function in day-to-day life or in a working environment.
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.