Can my insurance company cut off my long-term disability benefits after I have been approved?

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When an individual suffers from a disability that prevents them from working, they can apply and receive approval for long-term disability (LTD) benefits. These are offered through private insurance or an employer’s group benefits policy.

Getting approval for LTD, however, is only half the battle.

Many claimants discover early on that their relationship with their LTD insurer is adversarial rather than supportive. That’s why I’m often asked when an insurer can terminate LTD benefits.

Why insurance companies cut off long-term disability benefits

There are typically three reasons why an insurance company terminates LTD benefits:

  • The person no longer meets the criteria for receiving LTD under the LTD policy
  • The person is not complying with the terms and provisions of the LTD policy
  • The person has reached the policy’s age limit, which is typically 65

Nothing can be done to keep your benefits from being terminated once you reach the maximum age limit on the policy. But the same can’t be said about the remaining two reasons that insurance companies usually give for denying LTD claims.

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READ MORE: What to know about your long-term disability rights in the age of COVID-19

Claimants should not accept their insurer’s decision to cut off their LTD benefits at face value, especially if the benefits are the financial lifeline that enables them to pay their mortgage and other bills.

There is a perceived power imbalance between a disabled individual and a multi-billion-dollar insurance company. But individuals can take on insurance companies when they decide to stand up for their rights and seek legal advice from a reputable disability law firm such as Samfiru Tumarkin LLP.

What to do if you no longer meet the criteria for LTD benefits

I hear from a lot of individuals after their insurers inform them that their benefits will end because they no longer meet the criteria for receiving LTD.

Upon careful review of the insurer’s decision to stop benefits, I often find that their position is wrong — and actionable.

READ MORE: What you need to know about independent medical assessments

Insurers often use hired experts or consultants to review a claimant’s medical files without ever assessing the claimant in person. These experts may determine the person is not sufficiently disabled from working, contrary to what their own doctors say.

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In this situation, it’s crucial that you obtain fast and accurate legal advice to avoid losing significant LTD benefits.

What non-compliance with an LTD policy means

Insurers often cite non-compliance with an LTD policy when a person refuses to take certain medications or is unable to participate in certain prescribed treatments. When I speak with claimants about these issues, though, there is almost always a valid explanation for their choices, often supported by their treating doctors.

Insurers may interpret a refusal to accept a certain treatment as non-compliance under the LTD policy when that is not the case.

When an individual is confronted by a hostile insurer, they should not back down and let their benefits end prematurely. There could be significant money at stake, which they stand to lose if they do not challenge the insurance company. They should reach out to us immediately so that we can advise them on their legal rights.

What to do if you’re told your LTD benefits will end

When an insurer decides that your benefits will end on a certain date, the date you are informed of that decision is when you can — and should — seek legal advice. Don’t wait until you are mere days away from the cut-off date.

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If the insurer’s position is without merit, they are in breach of the LTD policy. You can take legal action to enforce your rights under the principle of anticipatory breach.

This legal principle holds that when a party to a contract (such as your insurer) has communicated an intention to do something that amounts to a failure to fulfill its contractual obligations, the party who suffers the harm as a result of this failure has a right to take legal action to enforce their contractual rights.

READ MORE: Long-term disability claim denied? This is why you need a disability lawyer

This means if your insurer says your LTD benefits will end for a reason you dispute, such as not meeting the criteria for receiving LTD under the policy or non-compliance with treatments or another provision in the policy, you have the right to take action immediately, and you should contact us to discuss your options.

If you do not do that, and instead choose to wait it out or appeal the insurer’s decision, you may eventually find yourself in the position of being cut off from LTD and having no money to pay your bills.

Have your long-term disability benefits been cut off? Do you have questions about your LTD policy that the insurance company has failed to answer?

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Contact the firm or call 1-855-821-5900 for a free consultation with a leading disability lawyer in Ontario or British Columbia. Get the advice you need — and the compensation you deserve.

Sivan Tumarkin is a disability lawyer and partner at Samfiru Tumarkin LLP, one of Canada’s leading law firms specializing in disability claims and employment law.