By Nainesh Kotak
No injured employee should be punished for a failed attempt to return to work, but long-term disability (LTD) insurers often find a way.
Everybody wins when a once-disabled worker recovers to the point that they feel ready to go back to the workplace — as long as their doctors agree it’s safe — after a period of receiving LTD benefits: the employee can get on the road to receiving their full income again, while insurers love nothing more than the prospect of ending benefit payments.
Recovery not always linear
However, things can change quickly, and the return-to-work attempt could prove premature if it re-aggravates the insured person’s injury or prompts a relapse of their medical condition. Recoveries don’t always progress in a straight line and setbacks are to be expected, which is why most LTD policies contain what is known as a “recurrent disability” clause.
The provision allows LTD recipients to skip the waiting period that normally comes with a fresh claim if they’re forced back off work because of the same medical issue within a certain period — generally six months.
Depending on the specific terms of the policy, the claimant may have to start from scratch if the period of work between benefit payments lasts for longer than this, or if they sustain a fresh or unrelated injury.
In theory, the recurrent disability clause incentivizes LTD recipients to engage in a return-to-work program with the promise that they can continue receiving benefits immediately if the attempt has to be quickly abandoned. Bypassing the “elimination” or “qualifying” period is a significant draw since LTD policies usually impose waiting times of between 30 and 120 days for new claims.
Denials rarely overturned
But in practice, it’s a different story. Too many insurers fail to live up to their end of the bargain after a failed return, seizing the opportunity to deny or terminate benefits.
In many cases, the insurance company refuses to honour the recurrence clause and reinstate benefits, either because they won’t accept that the disability has returned or because they believe the employee has stopped work on grounds unrelated to the original disability.
If you don’t already have a lawyer acting for you when an insurer refuses to reinstate your benefits, this is the time to get one. Your LTD provider may inform you of an internal appeal route to challenge the decision, but this procedure is generally futile.
Insurers — like students grading their own tests — don’t tend to find much fault with their original answers, so denials are rarely overturned. Instead, LTD claimants spend months on their appeal, only to end up in the same place they started.
When insured people come to us following a reinstatement denial as a result of a failed return to work, we help them obtain updated assessments from their medical providers and fresh assessments if needed, in order to support their claim of a recurrent disability.
If litigation is ultimately required to force reinstatement of benefits, a failed return to work actually ends up being very good for our clients’ cases, since it demonstrates their willingness to resume some form of employment and to mitigate their damages.
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 and Alberta, 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, Keswick, Kingston, Ottawa, Banff, Brooks, Calgary, Edmonton, Fort McMurray, Grande Prairie, Jasper, Lake Louise, Lethbridge, Medicine Hat, Red Deer, Saint Albert and other locations.