2 year Review Process

Hi Folks,

This was a while ago and they concluded that I was unfit for work so there is no rush with this but I am curious as to other people’s experiences around this and if they are similar to mine.

When my 2 year mark came around my payments were cut off for 5 months. None of my medical records were requested before this date nor was my GP contacted for information. I would have logically thought that the review process should have started in advance of this date and the point was to show whether you were fit to return to work on that date, not 5 months later. Also it seemed unfair to have my payments cut for 5 months after the 2 year mark while they then “reviewed my case”. Basically just wondering if that’s the norm?


I haven’t reached 2 years but I have cppd so I doubt I’ll be cut off.
The insurance company knows there is no hope of return to work for me.

Well that’s good jammer, they should leave you in peace hopefully so : ) I’m just really curious about other people’s experiences. It all seemed so badly handled in my case but I have no comparisons, hence this post ; )

I was approved at the 2 year mark as well. 6 months later they advised I was to start rehab to return to work. My Dr. and Specialist fought for me to no avail. My payments during those 6 months had continued tho. They cut me off as soon as my Doctors stated i could not do any rehab or return to work. I ended up having to sue the Insurer while living without income for 18 months. We settled.

The norm is that the insurance company would have started this review 12 months out from the change of definition date. Technically there is nothing to require them to do this, but is is standard practice from leading disability insurers in Canada.

Certainly the situation you are describing could result in problems for your insurance company if they did not have good faith grounds to make the denial. Denials have to be based on medical information or a lack thereof, so it would depend on what the existing medical information said about your claim. What you are experiencing is not normal practice.

David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.

What kind of problems for the insurance company? What is the remedy for an insured not getting paid without a good faith reason? I am having a similar problem where my insurance company regularly misses payments until I chase them up. I’m pretty sure they’re just failing to track and meet their internal requirements for releasing payments when they are supposed to (eg they have been saying they need to contact my doctor for an update for over a year but haven’t sent a request yet) but I don’t know what I can do to make them get on top of it so I get paid on time. Having to keep an ‘emergency fund’ to cover late payments is difficult and costly…

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Thanks Mr. Brannen, I appreciate you taking the time to respond and realise you would obviously need more information. It was just a small part of the overall issues I have been dealing with in relation to this insurance company. It has been a nightmare on so many levels but I know I’m not the only one who has these issues. As per my other post (IME & Medical Records) they are sending me for an IME soon. I’m just trying to get my head around some facts so if I need help down the road I have everything I need, I’m considering calling for a half an hours consultation to see what my options are going forward. Not knowing what is legally acceptable and what is not can be incredibly difficult and makes it so much harder for us to protect ourselves. This forum definitely helps a bit so thank you for that.

Caro - . I’m sorry to hear the difficulties you are having. Unfortunately it’s nothing new and seems to be yet another way they try to make things difficult for the client. I had similar issues, on several occasions it took me over 10 days to get my payments through. At a minimum you should keep track of every time this happens (dates, steps you have to take in order to get the payment through (phone calls, emails etc). You should also send them an email/letter outlining the real life problems an distress these late payments are having on you and how they are impacting your life. I would also make sure you correspondence with the Insurance company in writing as much as possible so you have a record of everything that is said and done. A consultation might not be any harm and may give ideas on where you stand legally and what you can do to sort this issue out. I truly hope everything works out for you.