Approved Your Benefits

Throughout your long term disability claim, your case manager will constantly be asking for an update on your condition and the treatments you are receiving. They will continuously want your doctors to provide notes and fill out forms. There may be times when you will feel that the pressure is too much, and the constant contact and questions are preventing you from the need to focus on your health. It is important to do your best to give your case manager what they ask for so that they don’t use your lack of compliance or a lack of medical proof as a reason to decline your disability benefits. If you are concerned about what your case manager is requesting, contact our office.

Your insurance company may ask you to be evaluated by one of their doctors/consultants to get their opinion about your medical status and ability to return to work. They are a third party, hired and paid for by your insurance company, and it is their role to find reasons that you should be able to return to work. It’s important to remember that their doctors’ opinions do not override your doctor’s opinions about what’s best for you. If your insurance company is pushing you to do something that you and your doctors don’t believe is best for you and they are threatening to stop your disability benefits if you don’t comply, then it would be best for you to speak to your doctors about this. The only thing that your insurance company can control is the decision to pay your disability benefits. They are not the ones to decide if your disability leave is justified. If the insurance company decides to stop payment, you should contact us immediately.

Your case manager will suggest that you try and return to work. They won’t always ask you outright (though they might), but may suggest that you speak to a rehabilitation consultant or an occupational therapist to discuss a return-to-work plan or to find another job that you can do instead. You should not feel forced into returning to work if you are not ready. When in doubt, speak to your doctor about what is best for you and your health. Your insurance company may try to threaten you by cutting off your benefits if you don’t return, but their intention is to stop payments once you are back anyways. If your insurance company is trying to force you to return to work, it would be best to contact us to discuss your rights.

“The change of definition is a point in the disability claim where many people are denied their long term disability benefits. Under most group policies this occurs at the two-year mark. For the own occupation period (usually the first two years) the test is whether you can work at your own job, after two years the test changes to whether you can work at “any occupation”. While they may try and generalize it by saying you can find a minimum wage job, it is not as simple as that. If they are saying you can work, it needs to be at a similar skill level and a similar pay scale to what you were doing before. If you can’t do this kind of work, they should be continuing to pay your benefits beyond this point. You may receive a letter well in advance of this definition change, warning you about the upcoming change of definition and possibly threatening that benefits will not be paid beyond this date. If you are denied at the change of definition or have questions about it, contact us.

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Your case manager might push you to apply for CPP (Canada Pension Plan) Disability. This is not your regular pension, but a disability benefit provided through the CPP umbrella and does not come out of your CPP entitlement that is available for retirement. Most group policies require that you apply when asked and if approved, your insurance company has the right to deduct the amount approved from your monthly disability payment You are not receiving less of a benefit amount, but the amount you are being paid is now coming from two sources (your insurance company and CPP Disability). You may also receive a lump sum from CPP Disability and this money most likely will need to be paid back to your insurance company. If CPP Disability denies your claim, it does not mean that your insurance company can deny your claim as well. Their definitions for disability are different. If you have questions about the interplay between your long term disability benefits and CPP Disability, contact us to discuss.

There are many tactics that your case manager will use to make you feel unsettled and unsupported. You may feel that your case manager lacks any sympathy for your situation and is overly aggressive when communicating with you. They may have unrealistic demands and expectations that they require you to meet and will threaten to cut off your disability benefits if you do not comply. They may also try and ignore your doctors’ instructions, feeling they know what is best for you. They are not looking out for your best interests. Do you find that your case manager is constantly changing? This is a common tactic to make sure that you are unable to build a relationship and to keep you on the edge of your seat. If you feel that your case manager is not treating you appropriately, contact us to discuss your rights.

If you are nearing the end of your short term disability benefits or EI sickness benefits and are still unable to work, you will need to apply for long term disability benefits. Even if the same insurance company provides short term disability and long term disability benefits, you and your doctor may be required to submit new forms and documentation. It is important that you are aware of when your long term disability benefits begin and provide your documentation in advance of the transition period so that if approved, there is no lapse in payment period. If you are unsure what to do, contact our office. If your long term disability benefits are denied at this transition, you should contact our disability lawyers for a free consultation.

There are times when you may feel that you are being watched and think that your insurance company is spying on you. Arranging for a private investigator to conduct video surveillance is expensive and not common unless your case manager has suspicions about your truthfulness and feels they can catch you being less disabled than what you have reported. This does not mean you can’t enjoy life, but it is important that if you are telling your insurance company that you never engage in certain activities that these statements are accurate. If your activities are consistent with what your doctor recommends and also what you have reported to the insurance company, you should not be concerned about video surveillance.

What is more common is online surveillance, where your insurance company will look at your social media to detect if you are doing something you should not be doing. You should be very careful about what you post on social media and who has access to see your information. Consider who could be seeing your posts and misinterpreting them. If you have questions or concerns about surveillance by your insurance company, then contact us.