Insurance companies offer long-term disability benefits to businesses large and small across Canada so people can rely on financial support if they are injured or otherwise medically unable to work.
But insurers generate profits by paying out less in claims than they collect for providing these policies. In my experience as a disability lawyer at Samfiru Tumarkin LLP, this often looks like denying claims to avoid paying the benefits.
As one of Canada’s most visible long-term disability law firms, thanks to our work on TV, radio and online, we receive hundreds of calls and questions every week about disability claims and what to do when problems arise.
Here are some of the most common questions that our disability lawyers encounter.
1. Do I have to apply for CPPD benefits if my insurer asks me to?
Under most long-term disability (LTD) policies, the insurance company will be entitled to an offset, or deduction, for any money you receive in Canada Pension Plan disability (CPPD) benefits.
If you fail to apply for these benefits after the insurer has asked you to, they will have a right to deduct what you might have received had you applied for and been granted CPPD, even though you are not actually receiving those payments.
READ MORE: 4 reasons why long-term disability claims are rejected, and how to fight back
2. What should I do if my insurance adjuster or case manager isn’t responding to my voicemails or emails?
I tell clients to create a paper trail by sending emails and letters, as opposed to making phone calls. If you do make a call, send a quick email outlining the conversation immediately afterwards.
If there is eventually a complaint, or we must file a legal claim for compensation on your behalf, it is extremely difficult for you or your disability lawyer to prove when phone calls were made and what was said during those calls, if they were never well documented.
I also suggest that clients remain polite. Often claimants get frustrated by the LTD adjudication process, especially when they’re not being responded to promptly. But it’s important to remain polite and professional in case your communications are ever reviewed and weighed through a legal lens.
READ MORE: How to reduce stress when dealing with a long-term disability insurer
If you have kept clear records of several attempted communications in a row and continue to fail to receive a substantive reply, you should advise your adjuster in a non-threatening way that you will have to provide your next email to their internal ombudsman or complaints department. Every insurance company has this department, and their contact information can be found online.
If you still haven’t received a substantive reply within a week or two, send another email outlining all your failed attempts and copy their internal complaints department on the message.
Finally, if things have not changed in the weeks that follow the latest step, you should contact a long-term disability lawyer at our firm for a free consultation, as your legal claim for compensation may have already begun to crystallize at that point.
READ MORE: Can your long-term disability insurer force you back to work?
3. Will I stop receiving LTD benefits if I return to work?
Typically, your LTD payments will end if you return to full-time work. That said, if you are returning on an insurer-approved graduated return to work program, in which your hours start off reduced and then gradually work up to full-time, the insurer should pay you a top-up during the ramp-up period.
There are also certain LTD policies that contain “partial disability” or “residual disability” terms, under which you can be paid LTD benefits even if you go back to your job, as long as you aren’t working a specific number of hours or earning a certain amount of income.
READ MORE: What to expect when hiring a lawyer to fight your disability claim denial
4. Will my long-term disability benefits automatically end at age 65?
Under all LTD policies, there will be a set age at which your disability payments will automatically end. That age is usually 65.
That said, I tell clients to ask case managers early in the process what that age is and to confirm that by having the case manager send the wording of that term of the policy or the whole policy itself.
5. Can the insurance company cut off my LTD benefits?
Often people ask if an insurer or an employer “can” do something. But just because something isn’t permitted legally doesn’t mean they can’t or won’t do it. Insurance companies will sometimes cut off legitimate disability claims, even if the proper medical documentation has been provided or the claimant has met the proper qualifications of their disability policy.
READ MORE: ‘Get full support from your doctor’: Disability lawyer’s guide to making insurance claims
If your insurance provider denies your claim, you should always review your options before accepting their decision.
I once had a client ask me if her insurer could cut her off LTD benefits if her CPPD application was denied. I confirmed that they could — because they can do just about anything — but that if they did, we would start a legal claim against them, because that wouldn’t be a valid basis for a denial.
She was eventually denied both CPPD and her disability benefits, but we were able to resolve her LTD claim for a favourable amount of compensation.
Has your LTD claim been denied? Do you have questions about your disability claim or how to deal with your insurance provider?
Contact the firm or call 1-855-821-5900 to secure assistance from a long-term disability lawyer in Ontario, Alberta or British Columbia. Get the advice you need — and the compensation you deserve — from the most positively reviewed disability and employment law firm in the country.
Michael Gerhard is a disability lawyer and senior associate at Samfiru Tumarkin LLP, one of Canada‘s leading law firms specializing in long-term disability claims and employment law. The firm provides free advice through the country’s only Disability Law Show on TV and radio.