But Your Doctors Say You Are Still Disabled?
It is not uncommon for doctors and insurance companies to have differing opinions about returning to work. Usually, the disagreement about eligibility for ongoing long-term disability benefits occurs when the definition of “disability” in the insurance policy changes from an “own occupation” definition to an “any occupation” definition. The change in definition of disability typically occurs after two years of disability. Generally, this means that the criteria for ongoing eligibility for disability benefits have changed. This is when the insurance company will be reviewing the person’s capacity to work to see if they meet the new definition of disability.
Long-term disability policies are not all created equal. They do not have standard wordings like an Ontario car insurance policy. Some long-term disability policies will have more flexible definitions of disability. The same insurance company, such as Great-West Life, may have many different policy wordings and definitions of disability. It is possible that two Ottawa residents injured in the same accident could have completely different disability insurance policies with the same insurance company. One individual could be covered for disability at his/her own occupation until age 65 and the other person might only have coverage at his/her occupation for 2 years or less.
It is important that individuals who have been receiving long-term disability benefits obtain legal advice concerning their entitlement to ongoing disability payments. Sometimes disputes can be resolved quickly if there is misunderstanding or lack of communication with the treating physician. It can be very distressing to feel pressure from an insurance company to return to work when the medical advice is to remain off work. Sometimes benefits are arbitrarily cut off when there is significant medical evidence to support an ongoing claim for benefits. This can result in claims for “bad faith” or “punitive damages” in addition to claims for retroactive payments.
Our lawyers routinely advise and assist people with long-term disability claims. Contact the lawyers at McNally Gervan LLP for a free consultation if your long-term disability claim is about to be denied or if you have been denied coverage. It is important to act immediately because your disability insurance policy will have a time limit in which to commence legal action.