Client's Disability Benefits Terminated; Insurer Alleges Non-Compliance with Treatment
Anthony's earliest memories involved spending time in his family's barbershop. As a young man, he learned how to cut and shave hair from his father and began to work as a full-time barber after graduating from secondary school. When his father retired, Anthony inherited the shop, and it became his pride and joy. He embarked on what would become a forty-year career as a barber.
Repetitive Tasks Cause Disability
Anthony was in good health until his early fifties, when he began to experience concerning physical symptoms. It started out as tingling in his fingers and then, numbness in his hands and wrists. Finally, the problem progressed into constant shooting pain (progressive chronic pain) and loss of strength in both of Anthony's hands.
An MRI revealed carpal tunnel syndrome, a progressive condition caused by compression of the median nerve in the wrist. Years and years of repetitive arm and hand movements that were a part of his job were now preventing Anthony from working. Anthony's doctor suggested rehabilitation and if there were no improvements, surgery. One thing he was clear about was that Anthony should take a break from the barbershop or his condition could worsen.
Progressive Chronic Pain Disability Claim Approved
Anthony submitted a claim for disability that was part of his life insurance policy. They approved the claim, allowing Anthony to focus on rehabilitation. He closed the shop indefinitely and visited his physical therapist twice a week.
Insurance Company Alleges Non-Compliance with Treatment
Six weeks after Anthony was first approved for disability benefits, his case manager called and asked when he was scheduled for surgery. Anthony informed her that he was currently seeing a physical therapist and was not sure if he was going to have the surgery he and his doctor had discussed. A week after this telephone conversation, Anthony received a letter stating that his benefits had been terminated. The reason cited in the letter was "non-compliance" with recommended treatment.
Benefits Terminated and Appeals Denied
Anthony and his doctor were taken aback by this; they assumed that the insurance company had misconstrued his clinical notes and records. Together, they submitted an appeal. When that was also denied, Anthony knew he was in trouble. Anthony's neighbours, who had had their own troubles with their insurance company in the past, recommended he contact Share Lawyers for a free consultation.
Legal Action Taken
Anthony met with Share Lawyers and was assured that it wasn't the end of the road for his claim. After a thorough assessment, he was provided with a clear explanation of what to expect after suing the insurance company for benefits. It was a great relief to know that, while legal action was not an overnight resolution; the firm would handle every step of the process so that he no longer had to battle with the insurance company. He could finally focus on getting better from his progressive chronic pain while his lawyers focused on winning him the maximum settlement possible.
Working toward a Settlement
After reviewing Anthony's policy and medical history with a fine-tooth comb, Share Lawyers prepared their case against the insurance company. In mediation, Share Lawyers used expert medical evidence to identify that Anthony had fully complied with all recommended treatments at different points in his disability. The insurance company argued that Anthony should have opted for surgery as soon as he could not continue working; however, Share Lawyers demonstrated that in Anthony's case, surgery was recommended as a last resort, and that he was pursuing other less invasive options when he was terminated from his benefits. The case was settled after many hours of aggressive negotiations between Share Lawyers and the insurance company's legal counsel. Anthony was finally awarded a sizeable lump-sum to cover disability benefits owed, a portion of benefits he would have received in the future, as well as a portion of his legal expenses.
After the Settlement
Anthony was pleased with the outcome of his case because it afforded him the time to make the best choice for his health. Ultimately, he did require carpal tunnel release surgery, and he was able to return to work a few months later on a modified basis.
*Names and identifying details have been changed to protect the confidentiality of all involved.
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