Disability Benefits Cut Off | Co-Authors Ian Hurley and Bram Lecker

Disability Benefits Cut Off by Your Insurer?

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, doesn’t your employee benefits booklet indicate you would receive at least 66% of your income each month if you were suddenly unable to do your job?  Under the law, this is a Peace of Mind provision.  You should be able to rely upon it in the event of an illness or injury.

But life is not simple. During the first two years of being on long term disability, 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 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 be in no shape to get back to work. Regardless, your file will be flagged for getting you off their payment roster. You will see a new level of harassment start, forcing you to return back to work.

The most volatile period will come after you have received long term disability benefits for 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. This is when many insurance companies begin aggressive campaigns to force you back to work into any occupation.

The “Hot-Potato” Situation

This will be a very vulnerable time for you. Sadly, this is also when your employer will consider terminating your employment. Perhaps life has moved on at your office during your absence? And after your prolonged absense, they no longer need your services, especially on a modified basis. They would rather not have you return back to work as “damaged goods”, an odious HR term.

When the employment contract becomes impossible to fulfill, your employer could terminate your employment under a legal doctrine known as “frustration of the employment contract”.  This can occur, for instance, if you have been off for a lengthy absense or if your disability is so severe that you will never be able to perform your duties on a modified basis or otherwise. In this case, or if you formally resign, your employer is no longer required to to pay your benefits.

At the other end, your insurance company will be looking closely at their bottom line. When two years are up, they will seek out any opportunity to discontinue your benefits. And they will make endless requests for more and updated 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.

Peace of Mind Contracts

Well before you get to this situation, 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. Our team of experienced employment lawyers are intricately familiar with this battle.

If your employer terminates your employment for “frustration of the employment contract” they are not required to pay you severance. However, they still owe you notice.  And during the notice period, you are entitled to all your benefits, including LTD, which often amounts to 66% of your income.

Furthermore, some serious illnesses and permanent disabilities would satisfy the requirements for you to receive LTD benefits to age 65, as laid out in your benefits booklet.

Your Employee Benefit package is a legal peace of mind contract. And that is precisely what you should expect from it.  Our courts impose serious fines on parties who inflict unnecessary mental injury and harassment on employees simply trying to claim their entitlements.

How We Can Help

Lecker & Associates have acquired 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. We ensure all parties adhere to the intent and spirit of this peace of mind contract . It is a legal component of your compensation package and one you are rightfully entitled to.

Furthermore, the insurer risks very costly litigation for forcing you back to work before you are ready. They cannot unilaterally impose conditions 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, 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.

Read more articles like this one about Disability Benefits.  Lecker & Associates has successfully represented employees for over 35 years.  Here is an overview of our Legal Services.

If this article can help an individual you know, please consider sharing it.