3 months to change of definition date


#1

First post!

I’m on LTD with my job in a management role in a corporate environment. I’m approaching my 2 year mark. Over the 2 years I’ve received calls/emails for updates fairly regularly and not without creating more anxiety. I’m off work for C-PTSD, MDD and GAD. The stress from my job was the tipping point that sent me over the edge.

I’ve spoken to a vocational rehabilitation place once, they never called again after the worker said to me… “Oh my you are definitely not ready to go back to work. "
I see a new psychiatrist in 2 weeks and I am sure they are relying on that report to close my file. I made in excess of 100k in my job and I was a stellar employee (per my reviews and constant promotions, not me bragging). Now I’m staring at” any OCC" definition possibility. What will that mean? I kind of understand that since my salary was high, they are going to try any way possible to get me off the books.

I’m anxious about the psychiatrist, I read on ratemymd that he’s a insensitive ass so I’m worried. How should I prepare for this appointment so I don’t jeopardize my claim? And what does any OCC even mean… Suddenly I’m a Walmart greeter making min wage??


#2

Good to see you on this forum.

By the way there are hundreds of posts on this forum that talk in detail about all this.


#3

When they evaluate your case at the end of 2 year mark they will take into consideration your education, skills, current salary and so on. It should be something close to what you used to do. I saw a report from an occupational therapist that my insurer ordered at 2 year mark. It showed that they were trying to match my skill, education and salary to a new occupation that is similar to what I used to do. So they can’t just ask you to become Walmart greeter as it doen’t match neither your skills nor your salary.


#4

Are you sure you want to change your psychiatrist close to 2 year mark? New psych doesn’t know your history.


#5

If they cut you off you can always sue them. Probably your settlement in this case will be higher too.

Did they ask you to apply for CPP-D?


#6

They haven’t asked for me to apply for CPP-D. Is that unusual?


#7

I have no choice on the psychiatrist. Last one was addictions related thru the hospital for acute need and no longer have that issue. It’s very hard to get a psychiatrist here in BC. I’m beyond worried about the fact that he doesn’t know anything about me


#8

Ususally they ask to apply for CPPD after 1 year on LTD. They may still ask you to do so.


#9

It is important you go into the meeting with the psychiatrist with an open mind and be cooperative. It is possible this person will write a report you disagree with, but sometimes the report will be support your disability claim well.

“Any occupation” has a very nuanced meaning that will flow from the definition in your disability insurance policy, and then how courts have interpreted that specific definition, or the words and phrases in the definition. These wording of the “any occ clause” varies slightly from policy to policy, so you can’t simply rely on general statements or the experiences of others.

Generally speaking, “any occ” has not been interpreted by courts to literally mean ANY occ., in most situations. It is a nuanced concept that can include factors like your age, work experience, transferrable skills and your prior level of earnings. So for example, I had a client how earned $150,000 per year and she would meet the definition disability from “any occ” if she was incapable of earning more than around $90,000 per year. This is an example of an income threshold that is found in SOME own occ definitions but not others. If the insurer presents you with jobs they say you can do, and that qualify as “any occ” you could have a disability lawyer review for you. They would need to see your group insurance booklet that describes the LTD plan.


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.


#10

Thanks for the info David. The “gainful earnings” level (%) is often documented in the contract and sometimes in the employee LTD booklet. In the above case you cite, it sounds like the level during any occupation is 60%. Once an employee is on LTD, if the contract between the employer and the insurance company is changed and the gainful level is reduced, can this be applied retroactively to employees already on LTD? For example, if the gainful level is documented as 75% in the contract in effect when the employee starts his LTD claim, could the employer and insurance company change the contract several years later to a 60% level and then apply it to old claims and cut people off on that basis?


#11

I have every intention of attending the appointment with the new psychiatrist but it’s on my mind literally several times a day causing alot of anxiety.

At what point should I consider looking at getting a lawyer? Wait for the probable termination of LTD?
And at what point should I request a copy of my file and the LTD booklet?


#12

I personally wouldn’t get a lawyer until/if they cut you off.
Maybe they won’t cut you off. :slight_smile:

I kept a copy of my benefit booklet.
It is a summary from your employer.
I would request that from HR or get it from a coworker.
I think mine might also be on the insurer’s website.
I don’t think you can get the full policy without having a lawyer request that.
I wouldn’t bother unless you get cut off and your lawyer needs it.
In the mean time, save your money and try to hope for the best.
Maybe your doctor has an idea to treat your anxiety.
Maybe a social worker can help you deal with it.
Good luck.


#13

Went to the new psychiatrist today.

He was really nice. Very down to earth and easy to talk to. Bawled my eyes out several times. He had me for 1.5 hours and wants to see me again next week.
He thinks I’ve got serotonin toxicity as I suffer from myoclonic jerks daily and severe restless legs. Made some changes to my meds, hoping to see some small relief at least. Considering Pristiq and clonezapam once he’s seen me more.

Advised me that this is best I’m likely ever going to get and told me to apply for CPP-D as he said in his opinion I can’t/won’t be able to work.

I’m wiped out and I have a massive skull cramp. :cry:


#14

That sounds very positive to apply for CPP-D.
Best of luck.