The lawyers at Aaron Waxman & Associates are experienced with Disability, Personal Injury and Employment claims.
Our new long-term disability series examines the various aspects of a disability claim. This blog post will look at what your responsibilities are during your claim.
When you first receive an approval letter, it may contain a section that says “Your Responsibilities” or something along those lines. This information will also be in your policy. Your insurance company has certain expectations of you while you are receiving benefits. The reason the insurance company outlines these responsibilities is because they want you to be aware of what you need to do in order for benefits to continue and what you should be doing throughout the course of your claim.
These responsibilities can include:
#1 – Make best efforts to recover from your injury/illness
Your insurance company expects you to make a reasonable effort to recover and this includes demonstrating the following:
It is important to note that your insurance company will be asking your doctors/treatment providers for information and updates periodically. The insurance company will also contact you for updates on your current treatment and functional status.
#2 – Make best efforts to participate in a rehabilitation plan
There is an expectation that you pursue rehabilitation options when appropriate.
If you are unable to participate in a rehabilitation plan, you are expected to provide medical evidence that demonstrates your restrictions and limitations and how participating in the program will prolong your recovery.
#3- Make best efforts to participate in a return to work plan
Your insurance company wants to see you make a reasonable effort to return to work.
It is important to remember that your insurance company wants to see that you are actively working towards a return to work, whether at your own occupation, or in an alternate occupation.
#4- Make best efforts to pursue other benefits
You may be asked to obtain benefits from other sources that you may qualify for.
The reason you are asked to do this is because your insurance company is allowed to deduct certain sources of income as what is known as an “offset”, such as the CPP benefit from your LTD benefit.
#5- Advise of any reportable income
You must inform your insurance company if you are receiving any income other than your long-term disability benefit in order to avoid an over-payment of LTD benefits.
Examples of reportable income are:
Be sure to check your policy for what counts as reportable income as this affects your benefit amount and if it turns out that your LTD payment needs to be adjusted, you could end up in a situation where your insurance company “overpaid” you and they have to recover money from you.
#6- Advise of any changes to your health
If you have had any significant changes to your health status, it is important to notify your insurance company as this can affect your ability to participate in any rehabilitation programs or return to work programs.
Significant changes to your medical condition include new diagnoses, new findings on diagnostic imaging or testing or scheduled surgeries.
These responsibilities generally relate to providing information, facilitating your recovery and pursuing other sources of income.
What if my claim was denied?
Even if your claim has been denied or you think it is about to be denied, it is still important to participate in, and seek ongoing treatment and pursue the appropriate treatment options for your condition.
This is particularly important for claims that involve conditions such as fibromyalgia, chronic pain, chronic fatigue syndrome and psychological illnesses. These types of illnesses are difficult to diagnose with objective testing such as bloodwork or diagnostic imaging and this is why it is important to attend regular doctor’s appointments and attend regular treatment so your physicians can determine your limitations and restrictions and document your ongoing symptoms that prevent you from working.
Insurance companies may deny claims for invisible illnesses due to a lack of objective medical evidence or because a person has not participated in treatment/followed treatment recommendations or is not under the care of an appropriate physician.
We hope this blog has helped to give you a sense of how your claim is being assessed and reassessed and what your insurance company is looking for in order to keep paying your benefits.
At Aaron Waxman and Associates, we have represented many clients whose long-term disability claims have been denied. If your benefits have been denied for any reason, do not hesitate to call our law firm for a free, no obligation consultation with a licensed lawyer that can be arranged at a date and time that is convenient for you.
* This blog is for informational purposes only and is not meant to substitute legal advice. Please read our disclaimer for further information.
* All of our lawyers are licensed by The Law Society of Upper Canada
* Office in Toronto and able to represent people in the province of Ontario