Conflicts with co-workers and management are regular occurrences in all manner of workplaces throughout Canada. Disputes with co-workers can arise over personality clashes, jealousy, gossip/backbiting, sexual harassment and competition. Disputes with supervisors and management can occur as a result of unfair performance reviews, salary and bonus issues, overtime, and excessive workloads. Whatever the reason, workplace conflicts can potentially cause a tremendous amount stress and anxiety.

Unfortunately, workplace conflicts can also have very serious mental health ramifications. For some people they can result in serious anxiety disorders, major depression, psychiatric trauma, and other psychiatric conditions. Even with medication and treatment by a specialist, these disabilities can be long-term in nature and completely prevent a person from being able to return to work.

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Occasionally, an insurance company will approach a disabled claimant and offer to pay them a one-time lump sum payment rather than continuing to pay monthly disability benefits. In exchange, the claimant signs a “Full and Final” release whereby they surrender all further entitlement under the group disability policy.

In most circumstances, an insurance company will offer a lump sum settlement if they believe it is unlikely that the claimant’s health situation will ever improve. Thus, rather than pay monthly benefits until the claimant reaches age 65, the company will look to reduce their liability by offering a one-time lump sum payment which is discounted.

There are pros and cons to accepting a lump sum offer. Read the rest of this entry »

Over the last several years, insurance companies have been aggressively pursuing access to claimants’ online profiles with Facebook and other social media networks. Their primary goal is to obtain photographs that depict a claimant engaged in social activities or performing physical tasks. If the insurance company feels that the photographs demonstrate a person is not disabled, or is evidence that a person has not been truthful about the extent of their activities, they may rely upon the photographs to deny a disability claim or terminate disability benefits.

Can photographs be relevant to a disability claim? The answer is yes. For example, if a disability claimant makes a claim for severe depression and tells the adjudicator that they never socialize and rarely leave their home, photographs of the claimant attending numerous social gatherings during the time she claims to be disabled would most likely be deemed relevant. While the photographs may not prove that the claimant is capable of working, they would potentially speak to the credibility and truthfulness of the claimant - both important factors in disability claims. Read the rest of this entry »

Surveillance is a common tool used by disability insurance companies during the adjudication of a disability claim. The insurance company will hire an investigative firm to secretly take photos and video footage of a claimant and observe a claimant’s activities. If the insurance company believes the surveillance proves the claimant is capable of working, then they will likely deny or terminate the disability claim.

Is activity noted on surveillance sufficient to justify the denial or termination of a disability claim? Certainly the answer would depend on the type, frequency, and duration of the activity, as well as the nature of the claimant’s disability. However, surveillance often has only limited relevance to the question of whether a claimant is truly disabled. Read the rest of this entry »

Ensuring that you maintain regular care and treatment for your disability greatly assists the strength of your claim. This means visiting your doctor on a regular basis, being examined and treated by specialists when necessary, and ensuring that you take medication as prescribed by your treating physicians.

 Undergoing regular treatment and visits to your doctor help to demonstrate to the insurance company that you are suffering from a valid disability and are therefore unable to work. Also, many short-term and long-term disability policies contain clauses that require claimants to be under the regular care of a qualified physician in order to qualify for disability benefits.

 It is important to continue getting medical treatment even if your disability claim has been denied. A court or tribunal is much more likely to find a disability claimant as being credible if there is evidence that he or she has been regularly seeking treatment for their sickness or injury. Read the rest of this entry »

A common reason that a disability insurance company will cite to deny a long-term disability claim is that there are no “restrictions or limitations”. Essentially, the disability case manager has reached the conclusion that the medical condition the claimant is suffering from and the symptoms the claimant is experiencing are not severe enough that they would prevent the claimant from being able to work in their own job.

A “restriction” refers to tasks or actions which a person is unable to do as a result of a medical condition. For example, a person who suffers from a severely herniated disc may be restricted from bending, pulling, pushing or lifting over 15 pounds. A person with vision problems may be restricted from driving. Read the rest of this entry »

The definition of disability is the crucial backbone of every disability insurance policy.  Both group long-term disability (LTD) policies and individual policies contain a definition or a test which a claimant must meet in order to be eligible for benefits. The definition can take many forms, but the fundamental elements can be expressed as follows:

Having a sickness or suffering an accidental injury

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As a result of that sickness or injury being unable to perform your job duties.

In some policies, you must be unable to perform all the duties of your occupation to meet the definition. Read the rest of this entry »

Disability insurance companies often deny legitimate disability claims on grounds that there is “no objective evidence of disability”. This reason can be expressed in several alternate ways. For example, that symptoms are “self-reported” or “subjective in nature”.  However couched, the fundamental message is that the insurance company does not accept you are experiencing severe pain or fatigue because you cannot prove it objectively.

However, both pain and fatigue are purely subjective experiences. There is no x-ray, MRI, ECG, or any other diagnostic test that will show a severe migraine headache, or extreme pain in the lower back, or debilitating fatigue. There is no “pain-sensor” or “fatigue-test” which can prove or disprove that you are experiencing the symptoms of fibromyalgia or chronic fatigue syndrome. Read the rest of this entry »

Group long-term disability (LTD) insurance is designed to protect employees of a company in the event that they become disabled as a result of a sickness or an accidental injury. The insurance pays out a monthly benefit if the employee is unable to work in their own occupation.

However, most group LTD policies contain a “Change of Definition” clause. This clause states that after a period of time (commonly two years), the definition of the term “disability” changes such that you no longer qualify for benefits if you are able to perform “any occupation” for which you are reasonably fitted by way of your training, education and experience.

Take the hypothetical example of Tom the Mechanic. Tom has been a mechanic for 20 years when he begins to develop Rheumatoid Arthritis in both his hands. Read the rest of this entry »