Disability insurance and benefits can be complicated. Below are answers to commonly asked questions. For skilled, experienced advice on your particular disability claim, please call our office at (250) 352-3321 or call toll free at 1-800-579-5338 to arrange an appointment.
1. I have just been informed that the disability insurance company is cutting me off benefits and I still can’t work. What should I do? Make sure that they have given you the decision to cut off benefits in writing and confirm with them that they have given all the reasons for denying you future benefits benefits, including the information they are relying upon to terminate the benefits. This situation generally requires experienced legal help; we suggest you get a copy of the policy and call our law office at (250) 352-3321 to arrange an appointment.2. Should I appeal the decision of the disability insurance company to deny me benefits? Unless your disability insurance policy specifically says that you have must appeal the decision through the disability insurance company’s internal process, we suggest you immediately see a lawyer. The initial decision is seldom overturned without a lawyer, even if further information is given to the disability insurance company by your doctor or other practitioner.
3. The disability company offered me a lump sum payout. How can I tell if it is a good deal? A disability insurance company only offers a lump-sum payout when they think this will enable them to pay you less. Very often, a disability insurance company will make it difficult for you to collect benefits, then turn around and offer you a lump sum payout.In such situations you should have a lawyer review the proposal and the other options available to you that the disability insurance company may not be telling you about.
4. I don’t have a copy of my disability insurance policy. How do I get a copy? All of the disability insurance company’s obligations to you, and all your obligations to the disability insurance company are set out in the policy. It is important to get a copy,and if there are sections you do not understand, to get a lawyer experienced with disability insurance claims to explain the policy to you.To get a copy of the policy, ask the person you are dealing with from the disability insurance company for a complete copy of your policy. They will often say it is long and hard to understand and they will offer to just provide the relevant pages or sections or try to provide you with just the abbreviated version found in the pamphlet. Insist on the whole policy, and the version in effect at the time you became disabled. If you are in a group benefit plan, and the disability insurance company is refusing to provide a copy of the policy, ask the plan administrator for a copy of the policy.
5. How disabled do I have to be to claim benefits? Very often people find it more and more difficult to do their occupation because of a condition that is continually getting worse. Benefits should be claimed when a medical practitioner says that you should not be working, not when it is impossible for you to work.
6. The disability insurance company is taking a long time to decide if they will pay me benefits. How long can they take? There are ways to speed up the decision making process. You should ask the disability insurance what information they require, and what part of the policy entitles them to this information. If you believe the information you provided is adequate, you should speak to a lawyer about how to speed up the process.
7. The disability insurance company told me that they wouldn’t pay me benefits unless I sign other agreements saying that I will reimburse them from any monies I get from another claim I have. Should I sign this? This is often called “benefit leverage”– holding back benefits unless other conditions are added in. In some circumstances, this could be seen as bad faith conduct on the part of the disability insurance company justifying aggravated and punitive damages. Such forms should not be signed until you consult a lawyer. If you have an ICBC or other personal injury case ongoing, you should consult your lawyer in that case,ensuring that he has experience and knowledge is dealing with this type of situation.
8. I don’t understand what is meant by the term disability. I can’t work, but the disability insurance company says I am not entitled to benefits. Why is this? Your entitlement to benefits depends firstly on the working of the policy, and secondly, what the Courts say the words in the policy mean when considering your particular situation. A disability insurance policy can say that you are considered disabled when you are unable to perform the essential duties of your own occupation. With that definition,your limitations are compared to doing the job you did prior to disability. The more challenging definition in a disability insurance policy is for any occupation. Such a definition is read taking into account the individual’s circumstances including education,training, experience, income level, existence of jobs in the area among other factors.Any occupation does not mean a brain surgeon must take a job as a parking lot attendant.
9. I can’t work, but my doctor says that I am not totally disabled. Why is this? There are many ways of interpreting totally disabled.The doctor may be using the wrong interpretation. The proper interpretation is found in the disability insurance policy.
10. The insurance company wants me to see their specialist and doctors. Do I have to? In most policies, there is a term that they can have you see as many specialists and doctors that they believe is reasonable. In being reasonable, the nature of your disability must be taken into account.If your disability makes it difficult to travel appropriate accommodation must be made.
11. I have been asked to fill out extensive questionnaires.What are they for and do I have to fill them out? The questionnaires are often to determine what you believe your actual limitations to be, and to find out your skills and abilities that can be used to determine your employability. The responses are often compared to other documents and records obtained from your employer, doctor and other practitioners to determine the accuracy of the information provided. These questionnaires should only be filled out if required under the insurance policy, and in consultation with the other parities providing information to your disability insurance company.
12. Can my employer fire me if I become disabled and claim benefits from a disability insurance policy? Terminating employment while off because of disability or illness may be an act of discrimination. The employer may be liable to you for a significant lump sum payment. If that occurs, you usually still qualify for benefits from the disability insurance company.
13. I am receiving benefits because of an accident where I have a claim against ICBC or another party. Will the disability insurance company keep making disability payments after I settle this case? Very often the disability insurance company will claim an interest in the settlement. This could be in accordance with the terms of the policy, because of an agreement you made with them or because of precedents set by other court cases. The case should not be settled until you fully understand how the settlement would effect the payment of benefits. For this, you usually need the assistance of a lawyer experienced in this area.
If you are concerned about your entitlement to disability benefits, or their amount or duration, we can help you. Please call us at 250-352-3321 or toll free at 1-800-579-5338 to speak to Terry Napora. We look forward to helping you.
