3 signs your long-term disability claim may be denied

As a prominent disability lawyer who hosts television and radio shows across Canada, I receive many questions from the public about their long-term disability (LTD) claims.

Often, the measures taken by insurance providers set off alarm bells, as they tend to be precursors to an LTD claim being cut off or denied. It’s at these critical junctures that my team and I can play a vital role in determining whether you receive financial support that you are legally entitled to from the insurance company.

Here are three signs that your long-term disability claim may be denied or cut off.

READ MORE: 5 common questions asked by people on long-term disability benefits

  1. They want you to go to one of their doctors or non-medical specialists for an assessment

It’s usually not a good sign when your insurer wants you to undergo a review with one of their doctors or non-medical specialists. It can be a costly process for an insurance company, which typically does all it can to keep its profit in its pockets — hence their attempts to deny your benefits when you need them most. In our experience, they will request an independent medical examination (IME) or an assessment with a non-medical specialist if they think it will result in your long-term disability claim being denied or cut off.

Story continues below advertisement

Most insurance policies require claimants to submit to an assessment, and you must cooperate with your insurer if you want to access your benefits.

READ MORE: Asked to submit to an independent medical assessment? Here’s what you need to know

In our experience, a vast majority of the doctors and non-medical specialists used by the insurance industry produce assessments that favour the insurers by including reasons why your LTD benefits should be terminated. They do this because they are paid by the insurance companies. If their reports don’t support the insurer’s aims, they may not be hired to conduct additional assessments of claimants in the future.

If you are asked by your LTD insurer to do an IME, be sure to make a record of the assessment, ask for a copy of the report, take your own notes and talk immediately to a disability lawyer at Samfiru Tumarkin LLP. We understand how intimidating the IME process can be, and our team can help you understand your rights throughout the examination and provide the support you need.

READ MORE: 4 reasons why long-term disability claims are rejected, and how to fight back

  1. They suggest you start a return-to-work program

Your adjuster will make this recommendation if they believe that you are well enough to return to work, even if you and your doctors don’t agree with that position.

Story continues below advertisement

This attempt to put an end to your LTD payments often happens around the two-year mark (or slightly earlier) of your disability claim, and usually after you are asked to submit to an assessment. That’s because, when this milestone hits, the insurance company’s gauge for your disability claim changes from “Can you do your own job?” to “Can you perform any job that you’re qualified to do?”

Your insurer will then try to gather evidence that you can hold down “gainful employment,” even if it means a job that generates 40 per cent less income.

Don’t assume that you’re ready to go back to work just because the insurance company tells you that you’re ready to do so. Their goal is to put a stop to your disability payments by compelling you to do something that you’re not ready for, just to help their bottom line.

Know that your insurer can pressure you to go back to work by threatening to stop your monthly LTD benefits, but they can’t force you, especially if your own doctors support the fact in writing that you’re not medically ready to return to work.

READ MORE: 4 reasons why long-term disability claims are rejected, and how to fight back

  1. They ask about your social media postings or tell you about surveillance they have conducted on you

 It costs insurance companies a great deal of money to conduct surveillance on people receiving LTD benefits. Much like an IME, their goal is to use their findings to try and cut off your LTD benefits and deny your claim.

Insurers use private investigators to follow you and record your actions through photos and video. These so-called “private eyes” will also comb through your social media profiles. They want to catch you in a compromising situation that casts doubt on your disability and shows you are actually able to work.

Story continues below advertisement

While it is legal for the insurance company to spy on you, there are limits to what they can do. For example, a private investigator cannot trespass to collect information. In some cases, like our successful case on behalf of abused Barrie teacher Julie Austin, surveillance can actually strengthen your claim for LTD. In this case, OTIP tried unsuccessfully to rely on photographs of Austin, obtained through surveillance, to justify denial of her LTD benefits, but these photos only further proved the presence of her disability.

READ MORE: Bullied by your long-term disability insurance company? When to contact a lawyer for help

 When you apply for LTD, always assume that your insurer will take a peek into your life. While you should be mindful of your conduct and wary of what you post online, you should never feel intimidated by the insurance company. You have done nothing wrong besides using and paying into the policy to get the compensation you are owed when you can’t work.

If you believe your LTD claim may soon be denied, don’t panic. Contact Samfiru Tumarkin LLP immediately for a free consultation. We can answer your questions, deal with the insurance company directly on your behalf and get you the compensation you deserve.

Do you need help understanding your disability policy? Has your long-term disability claim been denied? 

Story continues below advertisement

Contact the firm or call 1-855-821-5900 to get a free consultation 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.

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. He provides free advice on Canada’s only Disability Law Show on TV and radio.

Sponsored content