My most memorable case of 2016.
The past year has seen many interesting and surprising cases land on my desk. But my most memorable case involved a woman I’ll call April. April had been employed by a financial institution for a number of years when she developed cancer that forced her to stop work in May 2001. She applied for long-term disability benefits under her employer’s group insurance policy. Her claim was approved and benefits were paid starting in November 2001. Although the cancer treatment went well, April developed a number of mental illnesses including major depression, a generalized anxiety...
read moreThe insurer contacted my doctor directly.
Your disability insurance company has asked your treating physician to complete a questionnaire regarding your ability to work and current medical condition, what should you do? Requesting that updated questionnaires be completed by a claimant’s treating physicians seems to be standard in the review process. Usually, these forms consist of yes or no questions, check boxes and requests for comments on restrictions and limitations. If you know the insurance company has requested such questionnaires from your physicians it is a good idea for you to make an appointment with your physician...
read moreWhy an insurer may ignore a treating doctor’s opinion.
Many people, as well as their doctors, believe that when they file a claim for disability benefits their disability insurance company has to accept the medical professional’s opinion that they are disabled. Common sense suggests this is a reasonable assumption – but it couldn’t be further from the truth. Why? Because many insurers simply do not want to pay disability claims and, when armed with discretionary language in the policy, the insurer has the final say as to who is “disabled”, not the treating doctor. Making matters worse is the fact that the insurance company is...
read moreReducing work hours may imperil disability coverage.
Many people who are struggling to work due to an acute unexpected medical condition do not have the opportunity to prepare or plan for filing a short and or long term disability claim. My experience is that most people who eventually file disability claims have chronic medical conditions which have been ongoing for months and even years. During this difficult period disabled people often find themselves engaged in an heroic effort to continue working. People engage in this long battle for many reasons, one is often financial, and the other is simply their own credibility – they like...
read moreShort term disability approved, but long term disability denied.
One issue I see all too frequently in my practice is the situation where an insurance company approves a short term disability claim for a period of time (perhaps the maximum time frame, usually no more than 180 days) but then turns around and denies the long term disability claim. Most individuals do not understand how the same insurance company, reviewing essentially the same evidence, and using what is frequently the same definition of disability, can make such contradictory findings. After reviewing hundred of disputed disability claims my experience is that most insureds are simply not...
read moreAlways apply for CPP disability benefits.
If you have been receiving long-term disability (“LTD”) benefits for over a year your insurance company will likely require you to apply for Canada Pension Plan (“CPP”) disability benefits. This seems like a no-brainer at first, until you realize that if you win CPP disability your insurance company basically gets to keep all the money. You will have to give the insurance company the retroactive payment you get from the CPP, your overall monthly income may go down slightly. and, you might get an unexpected tax bill for the retroactive payment, even though...
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