A chilling case that my team and I will never forget involved a bank clerk whose access to long-term disability (LTD) benefits was cut off at the two-year mark.
The individual, struggling with severe narcolepsy, received a denial letter from her insurance company on her “change of definition” date—informing her that she was no longer considered “totally disabled” under their policy.
Horrified by the update, the bank clerk turned to her spouse for guidance. She was encouraged to contact Samfiru Tumarkin LLP for a free LTD consultation.
Confident that the bank clerk had been wrongfully cut off disability benefits, we told her to get the denial letter reviewed by her treatment team. Stunned by the insurer’s decision, her treating doctors clearly outlined in writing why her condition prevented her from doing any work—even on an hourly basis.
With full support from the medical professionals involved in her care, the bank clerk contacted us again. Following a brief phone call with her insurance company, we were able to secure the compensation that our client was owed without getting the courts involved.
READ MORE: Insurer being difficult? 3 reasons you should hire a long-term disability lawyer
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Sleep disorders, like narcolepsy, can have a profound impact on an individual’s ability to perform their job duties—even with appropriate treatment.
For Canadians who aren’t able to work due to a sleep disorder, disability benefits are designed to provide financial peace of mind.
If you’re denied or cut off LTD for any reason, here are three things you need to do.
1. Get your insurer’s reasons for the decision in writing
Instead of delivering the “bad news” in a letter or email, some insurance companies notify individuals over the phone.
By informing claimants verbally, insurers are able to adjust their rationale in the event that the decision is challenged.
If this happens to you, don’t let your insurance company hang up before agreeing to provide you with 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 common reasons long-term disability claims are rejected in Canada
Once you have the denial letter in your possession, seek legal advice. Even if you’re waiting for your insurer to send this document along, it’s still in your best interest to schedule a consultation with a disability lawyer.
2. Discuss the decision with your treatment team
Another important step after you’ve been prevented from accessing LTD benefits is to bring the denial letter to the doctor providing primary care for your sleep disorder.
Request a meeting with them at their earliest convenience to go over the document. If your doctor disagrees with the insurance company’s decision, 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.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
If your access to LTD benefits is cut off on or around your “change of definition” date, like the bank clerk, remain calm. In this situation, make sure your treatment team clearly outlines in writing why your condition prevents you from doing any work—not just your own occupation.
3. Contact a disability lawyer
Being wrongfully denied or cut off LTD can be incredibly distressing. Many of my clients weren’t sure how they were going to pay bills or put food on the table without access to disability benefits.
Following an unjust denial, it’s crucial that you get the right legal advice before appealing your insurer’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, we’ve helped tens of thousands of Canadians, including Sandra Bullock, Amanda Jollymore and Mitchell Murphy, secure the compensation they’re legally entitled to.
Denied or cut off long-term disability? Asked if you want to appeal your insurance company’s decision?
Contact Samfiru Tumarkin LLP 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 long-term disability claims and employment law. The firm provides legal insight on Canada’s only Disability Law Show on TV and radio.
