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Disability benefits for complex regional pain syndrome: 3 things to do if your claim is denied

A man massages his wrist while sitting in front of a laptop. Milos Dimic / Getty Images

A troubling case that my team and I recently resolved involved a machine operator who was cut off long-term disability (LTD) benefits two years after his claim was approved.

Struggling with complex regional pain syndrome (CRPS), the individual received a denial letter from his insurance company on his “change of definition” date—informing him that he was no longer considered “totally disabled” under their policy.

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Shocked by his insurer’s decision, the machine operator decided to contact Samfiru Tumarkin LLP for a free LTD consultation.

Confident that he had a strong case, we told him to get the denial letter reviewed by his treatment team.

The machine operator’s treating doctors couldn’t believe that they weren’t consulted before he was cut off LTD. They clearly outlined in writing that his condition prevented him from doing any work—even on an hourly basis.

With full support from the medical professionals involved in his care, the machine operator contacted us again.

Following conversations with his insurance company, we were able to secure an extremely favourable amount of compensation for our client.

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READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer 

For Canadians who can’t work due to CRPS, disability benefits can provide a crucial financial lifeline.

If you’re denied or cut off LTD for any reason, don’t panic. Here are three things you need to do.

1. Get your insurer’s reasons for the decision in writing

It’s not uncommon for insurance companies to deliver the “bad news” to claimants over the phone.

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If this happens to you, contact your insurer immediately and request a denial letter. This document will force them to “lock in” their reasons for rejecting your claim or cutting off your access to LTD benefits.

READ MORE: 4 reasons long-term disability claims in Canada are denied  

Once you have the denial letter in your possession, connect with an experienced disability lawyer at Samfiru Tumarkin LLP. We can review your situation, assess your legal options and help you secure the compensation you deserve.

Even if you don’t have this document, it’s still in your best interest to contact my firm. We provide LTD consultations at no cost to you.

2. Discuss the denial with your treatment team 

After receiving the denial letter from your insurance company, schedule a meeting with your treating doctor. It’s very important that the document is brought to this appointment.

During the meeting, ask your physician if they agree with the insurer’s decision. If they disagree, have them explain in writing why your condition prevents you from resuming your job duties.

In the event that other medical professionals are involved in your care, gather their opinions as well. The more supporting documentation you can provide, the better.

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READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims 

If your access to disability benefits is cut off on your “change of definition” date, like the machine operator, make sure your treating doctor clearly outlines in writing why your condition prevents you from doingany work—not just your own occupation.

3. Contact us 

Being denied or cut off LTD can be devastating. For many of my clients, they weren’t sure how they were going to support themselves or loved ones financially without access to disability benefits.

In this situation, it’s crucial that you get the right legal advice before appealing your insurance company’s decision.

READ MORE: 3 reasons you shouldn’t appeal a denied long-term disability claim 

The compassionate team at Samfiru Tumarkin LLP regularly resolves issues involving LTD, short-term disability, life insurance, critical illness and mortgage insurance claims across Canada.

We provide free consultations for these types of matters and don’t get paid unless we get results.

Over the years, my firm has helped thousands of Canadians, including Julie Austin and Sandra Bullock, secure the compensation they’re legally entitled to.

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Denied or cut off long-term disability? Asked if you want to appeal your insurer’s decision?

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 is a disability lawyer and co-founding partner 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. 

 

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