2 years ending from being off work


#1

I have been approved both for LTD and CPPD
LTD insurer sent a letter to me and copied My employer HR dept. saying I can’t do my occupation or any occupation.

I contacted HR to see if my Health and Dental benefits are still covered and she said as long as I’m an employee I’m covered.

HR contacted me last week and mentioned about a severance pkg to include 10 months of pay sling with 10 months if coverage for Health and Dental and tgst my LTD payments won’t be affected.

She said my dr had to fill out a functional assessment form.

My question is why do I have to get my dr to fill out this form when they know u can’t go any occupation?

Please advise if I should get this form filled out by my physician


#2

It’s great you’re getting severance.
They probably want the form for red tape.
You could ask HR why they need the form.
My first caseworker (insurance company) said I would get “how are you feeling” form once a year. Another caseworker wanted a bunch of forms every few months. I told her what the first caseworker said so they stopped bugging me (I’m not holding my breath it’ll last though).


#3

Not sure if it’s good news about severance as the insurer will deduct it.

I’m not sure why work needs to have a functional form filled out when they already were told by insurer I can’t work at any occupation. Do I have the right to say no and what would the consequences be if I didnt.

Is there away around not giving the severance to the insurer. If they do have to get it how does that affect my Ltd payments

Thank you


#4

Does your policy specifically say they are allowed to?
Dos the insurer know the amount and they requested it?

No idea except it sounds like red tape to get rid of you.
Maybe so they are covering their asses so you can’t sue them for wrongful dismissal later
It is unlikely they have the same documentation as the insurer.
Instead of having 3rd hand information, they have first hand information.
I’d HR those questions.

Contact Resolute for a free consult:
Free Consultation Request — Resolute Legal


#5

No the insurer doesn’t know yet but I told HR they will deduct it. HR are going to check with tge insurer


#6

Hopefully you will find out it is not deducted.
Some are and some aren’t it seems.
You could argue that was money earned when you were healthy.
If it is a significant amount, I would get the free consult.


#7

How do I get a private consult and is there a fee?


#8

Legally, an employer just can’t take the insurance company’s word for it. Employers need the information directly from their employee’s doctor (or a doctor they hire). It works in reverse too, if the insurer said “the employee is good to return to work”…but the employee and their doctor disagree…then the employer could not just rely on the insurer’s opinion, to force the employee back to work.

Severance in these situations is an open area of the law. There are two views:

  1. There is one view (supported by a long line of judicial decisions) that a person, who is permanently disabled from all work, does not have a right to ongoing employment. In those situations the employer can simply dismiss the employee for cause – the cause being frustration of the employment contract. This is called the common law doctrine of frustration. In this situation, no severance is owed.

  2. On the other hand, there is emerging law – not as well supported, but still there – that says in some situations, the doctrine of frustration cannot apply, even if the employee is permanently disabled from all work. In those situations, the employee would have the right to remain as an employee on permanent medical leave and receiving LTD benefits. In this situation, the employer would need to give reasonable notice of termination or pay severance.

So, what we see is that many employers do not take the hard line position as describe in 1. – that they can dismiss an employee disabled from all work – with no reasonable notice or severance owed. Most will offer reasonable severance as a way to avoid legal fights or human rights complaints related to 2.

Whenever you accept a severance package it is important to have it reviewed by a lawyer who is familair with both LTD and Employment laws. Often these severance packages will include things related to your future rights to appeal or sue the LTD insurer if they ever closed your claim in the future.

Even though an insurer says that they believe you are disabled from any occupation…they can and sometimes do change their minds later, so you want to make sure you have the right to sue the insurer if you need to, even though not likely to happen.


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.


#9

Thank you so much for your response


#10

If you are fired in situation #1, can a person sue for #2?


#11

Maybe, it depends on circumstances and if you are on an approved LTD claim. It would really depend case by case if you could be successful.


#12

My employer has asked me to discuss separation agreement . Taking too long for functional assessment. I’m sure the severance pay will be apart of that.$100k

It’s not in my best interest financially to take severance as I also have to pay taxes on the lump sum CPPD thst was sent to LTD.

Can I say nothing to enforce them to say the 2 yrs us up and you have 30 days to continue your health and Dental on your own.

I am approved on both CPPD and LTD until 65 unless my health changes.
Please advise
Thank you


#13

My best advice is to speak to a disability lawyer. You may also want to review with a financial planner your options )second opinion)

You need case specific and knowledgeable advice. A good lawyer is worth paying to review.


#14

You can get a free consult from Resolute Legal.
See the main website for the link.


#15

Hi Katie, This sounds like a complicated situation. I think you really need to consult with both an experienced employment lawyer and a financial expert before you can draw any conclusions as noted by David, Allyoops and Jammer.

If I was in your situation, I would think about the following in any future decisions:

  • As an individual you CANNOT purchase an individual health and dental policy worth anything close to a group health and dental policy, assuming that your employer’s group policy is mandatory for all employees (note that a group health/dental plan where participation is voluntary is really more like an individual plan). Your employer will tell you there is an individual plan you can qualify for as long as you apply for it within XXX days of termination of your group plan, but the plans are RARELY close to equivalent. The individual plans have very low limits on claims (e.g. would a $500-$1,000 annual limit on drug claims help most disabled employees?). The individual plan assumes you are buying the coverage because you will use the benefits, therefore you are paying for the cost of the assumed claims over the course of the year (more like an equal billing plan akin to those offered by utility companies). In the case of a group plan, the risk, or cost of claims, is spread over a large number of employees who can’t choose whether or not to participate in the plan, therefore the maximum annual claim amounts for each employee can be much higher. There are some individual plans with higher benefit limits and monthly costs, however, you need to be underwritten, which means you need to answer medical questions and you may not qualify for the plan or, if you qualify, any drugs or treatments related to your current illnesses may be excluded. Read your group benefits booklet very carefully and then review the websites of a few advertised individual health plans and you will understand what I’m talking about.

  • People receiving disability benefits are the most likely to have the largest drug and medical expenses, and, depending on which Province you live in, the loss of your group health benefit coverage could FAR EXCEED the amount of your monthly LTD benefit… (this is why some employers do not allow employees on LTD to continue to participate in the group health plan!)

  • Don’t assume you’ll owe tax on the CPPD back-payment lump sum that was sent to your LTD insurer unless your LTD is non-taxable. If your LTD payments are taxable, you will not be double-taxed on this lump sum. You may run into a few hassles sorting it out, but you will never pay tax twice on the same amount.

  • Retaining your status as an employee is valuable beyond the possibility of continuing to participate in your group health and benefits plan. You may be still accruing service in a pension plan or receiving other employee benefits. If there is any possibility of you returning to work, even in an accommodated position, your chance of success is much higher if you have an employer to return to. People can be enticed by the short term idea of severance and may even initiate the topic of employment termination with their employers without realizing what they may be giving up in the medium to long term. Employers are generally not unhappy to successfully terminate disabled employees even if they have to pay them severance since, unfortunately, disabled employees are considered to be a liability these days and not an asset to the employer regardless of what you may have contributed in the past. Make sure that you really understand the cost/benefit equation from YOUR perspective before making any decision. You really need professional advice on this topic before engaging in any discussion because you are up against your employer and LTD insurer who DO engage experts before any discussions with you.

Best wishes.


#16

Hi Joanne
Ltd is non taxable . Therefore I have to pay the taxes on CPPD .

I know I can continue on to my HEalth and Dental but will have to pay myself

They will offer me severance but it isn’t in my best interest financially.

If i don’t answer the email what could they do?

If I receive severance it will mean no LTD for awhile . I don’t think it’s worth taking a severance and risk been cut off by LTD when I have 7 years left to 65.

Not sure what to do? Any advice?


#17

Katie - The relationships with your employer and LTD provider are both critically important.

Your employer has been asking you to provide a functional assessment form from your GP. It sounds like it is taking a long time and you are questioning why they really need it. David addressed that question above. Should you ignore the queries from your employer? If you want to remain an employee on an approved medical leave (your current status), then you must communicate with your employer and based on what David has posted elsewhere, they require information on your functional limitations (not your diagnosis and not your prognosis) to figure out whether THEY can accommodate you in a position at work. They cannot rely on the insurer’s assessment. It may sound irrelevant and unnecessary, but it’s an important process for them and for you. Just because they are asking for this form doesn’t mean they are planning to terminate your employment and please note there isn’t really a connection between the 2 year any occupation clause in the LTD contract and your employment contract. They are entirely separate contracts between different parties. There’s a high probability if you ignore your employer and don’t do everything you can to provide this information ASAP, you risk termination of your employment. I’m not say that will happen, as I have no idea of any details, but you are playing with fire if you don’t seek professional advice and/or provide the functional limitations information.

Also, when you say you can continue your health and dental but will have to pay yourself… you need to be very clear on this. If your employment is terminated, even if you remain on LTD, there is no possibility of remaining on your employer’s group health and dental plan even if you are willing to pay the premiums yourself. During the notice period or severance period leading up to the final employment termination date, you may remain on the plan, but once you are terminated (i.e. notice and severance, if applicable, are over), you cannot remain on the plan. There are a few people who are eligible for “retiree” group health and dental plans sponsored by their employers and there are others who are “medically retired”, but these benefits are almost unheard of outside the Federal Public Service and a few other government plans and the odd private sector plan. I point this out so strongly because if you don’t understand this clearly, this could mean financial devastation for many people depending on their drugs, medical treatment and their province of residence.


#18

Does this mean I “have” to sign the separation agreement?

My employer wants to discuss agreement before getting the report?

Is that ok to do?


#19

Katie - Nobody can force you to sign an agreement… ever. An agreement signed under duress (forced) can be easily challenged later. When an employee is terminated, they usually are called to a meeting and are not told the purpose is to terminate their employment. They will be told their employment is being terminated and will be given a letter and separation agreement “offer” and will be told to take it away and review it with a lawyer. The HR person will discuss the offer briefly, but the employee being terminated will be in shock. Many people just want to sign it on the spot when they look at the $$$$$ on the paper. They want it done. They may be happy to see $$$. They want to get out of the building ASAP. They don’t read the other absolutely critical paragraphs on the page and, of course, most people don’t know what a reasonable offer and conditions should be in their situation. Your employer will not let you sign the termination offer on the spot because they know the agreement won’t stick unless you have an opportunity to have legal advice.

I can’t give you advice, but if I was presented with your situation today, I would:

  1. make an appointment with my GP ASAP for the purpose of completing the overdue functional limitations form
  2. send an email to my employer today to say I am meeting with my GP on xxx date for the purpose of initiating completing the form and will advise them after the appointment when the GP will have the form completed
  3. book an appointment with an employment lawyer immediately to review your employment circumstances and the impact of employment termination on all sorts of things (health/dental benefits, pension, LTD offsets, etc.,),

Please note that I am an anonymous person on the internet who really knows nothing about you and I could be well meaning person, but really possess no particular expertise about the employment, benefits and disability fields! You really need to engage a professional to review the details of your case.

Best Wishes.


#20

I have told my employer that my GP is waiting on a report from the pain clinic before he will fill out the functional assessment report.

How can I discuss an agreement if the report isn’t completed?

I’m willing to do what they ask.