After being disapproved for LTD I have to return to work. Will this affect my continuing an appeal?


#1

I have used my sick benefits of 15 weeks from EI and have patiently awaiting the decision on my Sunlife LTD claim. Finally, after being without an income for nearly two weeks I finally get a call informing me my claim is not approved. Needless to say I am devastated. I will be taking further action on this decision but in the meantime, financially I have to get my Dr. provide a release for me to return to work. Will returning to work jeopardize any further action I take?


#2

Call Resolute for a free consult.


#3

Likely yes as most policies have a definition of disability that you must be unable to do 50-70% of your duties. If you can do that and your Dr. provides a release that you can work it will be harder to appeal,
Do you have a union?
If you go back to work and on reduced hours this, depending on your policy, could cost you in lower benefits ie: If you return to reduced hours any new disability claim may be based on that new lower salary.
If you return to work and can not do the job, you could end up losing both your job and LTD.

If you do return to work you should know your rights and your employers duty to accommodate. You and your Doctor would need to place restrictions or options for reduced hours, job modifications. Or a release to try and have reviewed within a few weeks time.

I am not a lawyer and if you feel that you can not manage work you really need to learn your rights. Most legal opinions and lawyer blogs that I have read is against returning to work if you have your Doctors support to stay off work.


#4

You don’t need to force yourself to go back to work if you are sick.

There are financial assistance and disability support programs available in every province.

They may provide some immediate financial assistance to you and your family to pay for housing, food, medications.

There are also worker’s compensation programs that you may be eligible for.

Also check with your bank if your credit cards, loans, line of credit were insured. Financial institutions may waive some of the account balances while you are on disability.


#5

You can return to work AND continue your appeal. In fact, I highly recommend this to just about everyone. There is no downside to this. You will either be successful and be able to work or you will prove beyond a doubt that you tried and it didn’t work. We will even file lawsuits while people are doing a trial return to work. If the return to work is successful, we can just convert the claim to be for past benefits owed.


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 reliabile 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.


#6

David’s advice is very good. Here is a case that supports trying to go back to work;
In Foden v. Co-Operative Insurance Assn., (“ Foden”) the plaintiff returned to her job as a secretary following a 14 month absence after a motor vehicle accident. Her return to work was driven by her desire “to prove that she was not disabled” as well as by her financial need, despite the fact that her injuries persisted and she did not feel up to the job… The Court found that the plaintiff was totally disabled and therefore entitled to no-fault automobile insurance benefits. The Court’s treatment of the relevant facts may be summarized as follows:
The mere fact that Mrs. Foden returned to work and kept on working for six months does not, in my opinion, ipso facto disentitle her. Nor would a dismissal from her position by her employer – if one had occurred – have proven that she was incapacitated. A return to work and a dismissal from work are nothing more than facts to be taken into consideration in relation to the underlying question – was she disabled? That question is not answered by the employer’s acceptance or rejection of an employee. That question is for the Court.
No one, in my opinion, should be discouraged from attempting to take up their former work, or any work, out of fear that the attempt might be held against him. Far from necessarily proving that an insured has the capacity to perform his task it may, as in my opinion it does here, prove the reverse. There is no better evidence of incapacity to perform a task than the failure of an honest and sustained attempt to do it.


#7

Update. I was in the process of RTW even though my Dr did not want to
provide a release, when I received a letter in the mail confirming that I
WAS APPROVED to receive CPP Disability benefits beginning May 2017. To be
in receipt of CPP Disability means I cannot work, right? At that point i
looked at my financial options and decide to retire, with only 17 yrs
service, plus my CPP Disability to live on.

I was wondering how Sunlife can deny my claim while CPP agrees that I
should not be working. To me this is a direct contradiction.

After checking with my pension centre about continuing an appeal against
Sunlife I’ve decided to proceed.

How strong is this approval from CPP Disability as evidence in my appeal?
Do you have any suggestions on how to proceed?

Thank you,

Ruth Newhook
709-257-3735


#8

Don’t choose retirement yet Ruth–please stop and review all options! Congrats on CPP-D! That is huge in your favour. It also goes to help prove that Sun Life was trying to enforce a RTW that was unreasonable. You have good options-please do not retire yet!


#9

ooops-just read this! Appeal away and keep an eye on the statue of limitations -you may need to sue Sun Life if they deny your appeal-it would be in your interest to keep all options open.

And do not quit or resign from work!!! You want to review all options first!


#10

I was told by my pension center I should still appeal the decision. I will
be collecting my pension (which is only 34%) and the CPP Disability. They
told me if I win the appeal Sunlife will have to pay me the difference
between the 70% they have to pay less the sum of the other two. I estimate
the difference about $750. per month the i would be eligible for.

Why do you say not to do this?

Ruth


#11

If i am collecting CPP-D it means I can’t be working. But Sunlife says I
can work. If I go back to work then that is contrary to the CPP-D and I’d
lose that. At least by accepting the CPP-D by regular CPP retirement
continues to increase until I am 65 at which time the CPP-D stops, my
regular retirement CPP kicks in at the higher amount along with my OAS.

The maximum with Sunlife LTD is only 2 yrs isn’t it?

Please advise asap. My retirement is in process now.

Ruth

Ruth


#12

You have CPP coming in-so that helps money wise. You may have options to place your job on hold-disability leave-then they may continue with contributing to your pension and you have a job if you get better. Your pension should be held off if it will increase in the future. Really you should speak to a financial planner or accountant. Taking retirement now could effect what you get in the future and if you get disability benefits from Sun Life you would get a larger amount from them.

Its up to you-but taking early retirement may not be the best road-however it is your choice. Usually holding off on retirement means more for later and if you get Sun Life-why reduce your LTD for them if it costs you down the road?

You might miss out on severance. But collecting retirement maybe in your best interest too-or you might choose if you feel your life is limited. Lots of variables.


#13

Usually for own occupation then after that til 65 for any occupation. Some policies are shorter though.
You can always opt for retirement later and have Sun Life make up the difference now. Sun Life says you can work-your Doctor does not agree-and CPP-D helps to confirm this.

You are appealing with Sun Life because you can not work, who cares what they say-its all about what you can prove


#14

Unfortunately the ER only covers my pension for the 13 wk elimination
period but I now owe the ER almost $1200 just for the pension pmts for
those 13 weeks. I had to sign a document refusing to count any LWOP after
the 13-weeks. If I want to continue increasing my pension I have to pay
out of my own pocket which is about $400 per month. I can’t afford living
on just CPP-D much less pay for my pension. I just turned 60 so there is
no penalty against my current pension. And choosing the cpp-d allows me
the opportunity to leave my retirement cpp untouched until I turn 65.

At 60 years old the options are not too different over the course of 5
years.

Ruth


#15

My initial claim to Sunlife for LTD was Jan 23, 2017 followed by the 13 wk
elimination period which ended Apr. 23rd. Had I been approved my LTD
should have started at that time. May 31st I was informed I was not
approved. I turned 60 on May 24th and had been previously approved for my
retirement CPP to start June 30. When I first applied for LTD I was told
to apply for CPP-D which I did. By now I was without an income for a
month. I had no idea how long it would take for an appeal so my Dr.
release me to “try to RTW” but he didn’t want to.
That was after I reached out to Resolute to see if I could do this and was
advised to go ahead.
I contacted my ER saying I had to come back to work due to financial
reasons at least while I tried to appeal the case. They didn’t seem too
eager to put things in place but also suggested I check all my options such
as retirement. While doing this I found out I was approved for the CPP-D
which certainly helped with my income. I contacted my pension center who
informed me how much my pension would be with CPP-D or with CPP
retirement. The disability was the better option.

My income would be <2/3 my normal income but I needed money soon! June 6 I
informed my ER of my decision to retire, sent them my resignation and
received their acceptance. I contacted the pension center who put all the
papers in the mail.

I received the papers on Tues but didnt get them back in the mail until
last Friday. I then called the pension center and asked about the impact
winning an appeal with Sunlife would impact my pension. They informed me
Sunlife would have to pay a difference.

I never thought to question whether or not Sunlife would still pay if I am
retired???
Will they still pay?

Ruth

Ruth


#16

Yes, they should as you applied before you resigned, and getting the retirement helps them with a lower amount. The fact that your pension dept. advised you to appeal and if you won your appeal then Sun Life would pay the difference, and you relied on that…that could put your employer on the hook if they don’t or if that was wrong advice.

Bottom line is Sun Life’s denial of benefits forced you to take an early retirement as working was not a realistic option.
I am not as familiar with how retirement and LTD works but others that have posted here I believe are getting retirement pension and LTD.

Best news is that you are getting money coming in. You have resigned so that is a done deal I assume.

Go forward with the appeal and don’t worry about what is done. Your posts will be very helpful for others…

Now it is your time to take care of you. When this is all sorted out and you figure out what is coming in then please go to your bank and sit down with a financial planner (free at the big banks) and have them calculate a budget for you. Once you retire the biggest frustration will be how inflation gobbles up your income and you will need a plan for that.


#17

that is great news! So you made a good choice if the pension is the same as it would be at 65!


#18

It depends on your policy, sunlife might have to pay 70% (60% in my case :-() until you’re 65.


#19

I am putting together as much information as possible for my appeal so I
asked my family doctor to provide additional information being requested by
Sunlife. He finally got back to me and said he don’t see what additional
information he can provide other than what he already gave them.
Unfortunately my family Dr. is leaving his practice by the end of July. He
has been the only consistent doctor I’ve had since being diagnosed with FM.

Any suggestions on how to approach this?

Ruth


#20

Mines 60% too. they market it is 66.7% but that is only the first x $ (the rest is 50% above x).