In Ontario, individuals receiving long-term disability (LTD) benefits are often shocked when their insurance company informs them that their access is being cut off.
The reality is that many claimants don’t know what should set off alarm bells before it’s too late.
READ MORE: Cut off long-term disability in Ontario? 3 things you must do
Here are four “red flags” that your insurer could be getting ready to cut off your access to LTD benefits.
1. Your insurer asks you to participate in an independent medical examination
While many Ontarians believe independent medical examinations (IMEs) are an objective, third-party assessment, that is rarely the case.
Since IMEs are paid for by your insurance company, they get to choose which medical practitioner will assess your ability to work.
In our experience, insurers usually have at least one doctor who will provide them with the information they need to justify cutting off a claimant’s access to LTD benefits.
READ MORE: Asked to submit to an IME? Here’s what you need to know
If your insurance company asks you to participate in an IME, contact an experienced disability lawyer at Samfiru Tumarkin LLP immediately. We can help you prepare for the assessment and explain what you need to do afterwards.
2. Your insurer suddenly requests medical or functionality updates
In some cases, insurance companies randomly ask claimants for medical updates and information about their daily activities after minimal contact.
If you find yourself in this situation, proceed with caution. There is a very good chance that your insurer is trying to make a case for why you should be cut off LTD.
READ MORE: 4 reasons why long-term disability claims are rejected
In your updates, be honest with your insurance company and make sure that everything is consistent with the information you have already provided.
3. Your insurer recommends a work hardening program or rehabilitation
It’s not uncommon for insurance companies to pressure claimants to re-enter the workforce while they are still disabled.
If you receive a phone call from your insurer, and they recommend a work hardening program or rehabilitation, don’t agree to anything. The goal of this program is to help you gradually return to work.
Before ending the call, ask your insurance company to provide you with their return-to-work plan in writing. This document should include the proposed return date or the number of hours that they recommend you work each week.
READ MORE: Insurer forcing you back to work in Ontario? 3 things you must do
Once you receive the return-to-work plan from your insurer, contact Samfiru Tumarkin LLP. We can review the document and advise you of potential next steps.
Even if you don’t have your insurance company’s return-to-work plan, you should still reach out to our firm. We provide free consultations for issues involving LTD and can answer any questions that you have.
4. Your insurer constantly mentions your “change of definition” date
After being on LTD for two years, the criteria to be considered “totally disabled” changes. This is known as the “change of definition” date.
To continue receiving disability benefits, you must prove that your condition prevents you from doing any work, not just your own job.
Insurance companies often use this change as an excuse to cut individuals off LTD – claiming that they no longer meet the definition of “totally disabled” under their policy.
If your insurer keeps mentioning your change of definition date as you approach the two-year mark, or suggests that you are able to do other jobs, seek legal counsel as soon as possible.
READ MORE: Most common mistakes people make when they are denied long-term disability
In some cases, insurance companies send claimants a letter ahead of their change of definition date – informing them that their access to LTD benefits will be cut off.
If this happens to you, and your treating doctor has clearly outlined in writing that your condition prevents you from doing any work, it would be considered an anticipatory breach of contract.
We can assess your legal options and ensure that you receive the compensation you deserve.
Let us fight for you
If you believe that your insurer is getting ready to cut off your access to disability benefits, or they already have, contact an experienced disability lawyer at Samfiru Tumarkin LLP.
Our compassionate team regularly resolves issues involving LTD, short-term disability, life insurance, critical illness and mortgage insurance claims across Canada.
We provide consultations at no cost to you and don’t get paid unless we get results. Over the years, we have helped thousands of Canadians, including Julie Austin and Sandra Bullock, secure the compensation that they are legally entitled to.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
A troubling case that our firm recently handled involved an administrative assistant who was struggling with rheumatoid arthritis.
After receiving LTD benefits for nearly two years, she noticed that her insurance company was mentioning her change of definition date more often.
Concerned that her insurer was getting ready to cut off her access to disability benefits, she reached out to Samfiru Tumarkin LLP for a free LTD consultation. We informed her of her rights and potential options in the event that her insurance company decided to stop her benefit payments.
As she feared, she got a phone call from her insurer on her change of definition date – notifying her that she was being cut off LTD because she no longer met the definition of “totally disabled” under their policy.
Doing her best to maintain her composure, she asked her insurance company to provide her with a denial letter before hanging up.
Once she received the document, she reached out to us again – resisting the urge to appeal her insurer’s decision without consulting a disability lawyer.
After reviewing the denial letter and the reports from the administrative assistant’s treating doctors, it was clear that the insurance company didn’t do a comprehensive review of her file.
In their reports, the employee’s treating doctors specifically noted that her condition prevented her from doing any work – even on an hourly basis.
READ MORE: The insurer cut off his benefits. Then his lawyer reviewed his medical assessment
Following conversations with the administrative assistant’s insurer, we were able to secure an extremely favourable amount of compensation for our client.
Think you’re about to be cut off long-term disability? Received a denial letter?
Contact the firm or call 1-855-821-5900 for a free consultation with a disability lawyer. We help Canadians across all provinces (excluding Quebec). Get the advice you need and the compensation you deserve.
Sivan Tumarkin and Albert Klein are disability lawyers at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in employment law and long-term disability claims. The firm provides legal insight on Canada’s only Disability Law Show on TV and radio.