Disability Benefits Cut Off by Your Insurer?

Disability Benefits Cut Off by Your Insurer? | Lecker & Associates - Toronto Employment Lawyers

People receiving Long Term Disability Benefits have enough to worry about. The last thing they need is to have their disability benefits cut off. After all, your Employee Benefits Booklet generally indicates that you are entitled to receive at least 66% of your income each month if you become ill and are unable to do your job.

The Law calls this a “Peace of Mind” provision, which you should be able to rely on in case of illness or injury.

Unfortunately, life is not that simple. During the first two years of being on Long Term Disability leave, insurance companies will request regular reports from your physician. They employ legions of claim examiners who review these reports like hawks. The first indication of your recovery will trigger the next phase of how your file is handled.

Long-Term Disability Benefits Cut off – Why Do They Do It?

Insurers set the bar very low for defining recovery. Even a slight reduction in your pain medication or a doctor reporting that your condition has improved is sufficient for them to consider you rehabilitated.

Realistically, you may still be in no shape to get back to work. Regardless, your file will be flagged in order to get you off their payment roster. You will likely see a new level of harassment start, forcing you to return back to work before you are able.

The most volatile period will come after you have received Long Term Disability Benefits for over two years. Most policies redefine their coverage at this stage. Even if your medical situation remains unchanged, you may find your disability benefits cut off completely or severely limited on the grounds that you are capable of working some type of job based on your education, training and experience. Regardless, this is when many insurance companies begin aggressive campaigns to force you back to work into any occupation.

This will be a very vulnerable time for you. Unfortunately, this is when many employers also consider terminating your employment under a legal doctrine known as “frustration of the employment contract,” rather than having you return as “damaged goods.”

This occurs when the Employment Contract essentially becomes impossible to fulfill, such as when the Employee’s disability is so severe that they will never be able to return to work, whether on a modified basis or otherwise. In this case (or if the Employee has formally resigned), the Employer is no longer required to continue to provide benefits to the Employee.

The insurance company will care about none of this. They are only looking for an opportunity to discontinue their disability benefits. After endless requests for additional and updated medical information from your attending physician, they will push you back to your employer who in turn will want nothing to do with you, and you end up dejected, frustrated and feeling like the proverbial hot potato.

Rather than claiming frustration, if in fact, the Employer terminates your employment, they are required to continue paying your benefits (as provided) throughout the notice period. Long Term Disability benefits are to be provided up until the age of 65.

Peace of Mind Contracts

Well before you get to this stage, and especially when you are at this stage, consider hiring an experienced lawyer and conserve your energy for your recovery. The law is on your side and crystal clear in this matter. And our team of experienced employment lawyers are intimately familiar with it:

Your Employee Benefits package is a “peace of mind” contract. And that is precisely what you should expect from it. Our courts award serious fines against parties who inflict unnecessary mental injury and harassment on Employees simply trying to claim their entitlements.

How We Can Help

Lecker & Associates have acquired a deep specialty in this area of law over 35 years of practice. We have built up cases with similar circumstances to systematically prove that insurance companies act in bad faith when individuals have their disability benefits cut off.

Furthermore, they risk very costly litigation for forcing you back to work before you are ready. They cannot unilaterally impose this upon you against the opinion of a trained medical professional. In fact, to further strengthen this case, our lawyers would bring an independent vocational assessment to the table that will objectively assess your readiness for the job market.

And finally, there is one more protection you receive under the law. The Ontario Human Rights Code protects you from discrimination on the basis of a disability.

If this article describes your situation, contact us. We can likely relieve a lot of your stress at the first assessment meeting which is free. There is no need to fight this one alone. And if legal fees are keeping you from seeking out our help, we make that part very easy too.