Anyone on a RTW program with partial LTD benefit?

Disability Insurance
1

I am on an approved return to work program with my employer and they report my hours per month to my LTD insurer. The insurance company then pays the difference between what I am actually earning (low hours right now, working up) and what I would have earned working full time. My insurer gets the report of my hours at the very end of each month, and then calculates and pays my LTD benefit in the second week of the month. :+1:

However, I am on leave from my office, as is everyone else, due to COVID-19. It is paid leave so far, very fortunately, so I am making the exact same amount from work that I was in the pay period prior to being on leave (not much, but it helps). Instead of submitting timesheets, my pay system apparently just bases everyone’s pay on the hours entered for the last pay period, and if any adjustments need to be made it’ll be done when we’re back. Mine won’t need adjusting, it’s the same. And my doctor isn’t going to request an increase in my hours while I’m not there, that wouldn’t make any sense.

Here’s the problem - I don’t know if my LTD insurer got that report of my hours from work at the end of March, or if the people who normally send that info are even at work (our HR/payroll is not located locally, so I don’t know). I cannot access my work programs, and so can’t contact the HR person who was directly dealing with my case, even if they are working. I have put in a request via email which is what they ask us to do, and still have not heard back. :hourglass_flowing_sand:

I have given every bit of information I have to the insurer, including the hours I am being paid for, the work situation, any info I get from managers, etc. They also needed a detailed medical update from my doctor, which has been provided. The last communication that I got from them was that everything I provided was very helpful due to the situation, and to keep them up to date. Their communication back to me is spotty too, however, so I haven’t gotten any indication from them as to what will happen. :grimacing:

Is anyone else in a similar situation? The LTD benefit is still the biggest part of my income each month, as I slowly work up my hours. I can’t squeak by for long without it, and as I’m still employed I obviously don’t qualify for any emergency benefit. :expressionless:

2

Would you qualify for any emergency benefits because I read if you qualify for ei sickness then you get emergency benefits?

Has the insurance company said they are cutting you off?
If not then I would expect them to keep paying you at the same rate.
Good luck.

3

Thanks, jammer. I wouldn’t qualify for EI or CERB as I have not been laid off or lost my job, we are currently still being paid pending our return at some point. I only work 15 hours per week, so LTD makes up the balance. I haven’t been cut off as of yet, however they do depend on the reporting of my hours from HR, which is where my concern is. I’m thinking that the only way I’ll know is simply waiting and seeing at this point.

I hope everyone on the forum is doing well, as I imagine many of us are at higher risk with Covid-19. Stay safe!

4

Hi Nip,

This is going to boil down to whether your insurer continues to view you as being in an “approved return to work program”. In normal times, 100% they would view your return to work program ended and would cease payments immediately. However, we are not in normal times and I have seen many insurers doing the right thing and not attempting to take advantage of the situation. Certainly, they could take the view that your return to work program is no longer active and might withhold payments. In these situations I suggest people be open and honest with the insurer about the situation and send them copies of your pay stubs to prove the income amount.

It is important to know that Insurers view these return to work programs as temporary. With most group LTD policies they don’t provide for an ongoing situation where the insurance will pay a “top up” for a person permanently working part time. So, group LTD insurers will not voluntarily pay a top up, but sometimes you can win that with the legal appeal to an outside decision-maker. We have been successful with winning top ups or settlements of top up disputes, but this has always been done with legal proceedings – they won’t agree to do it voluntarily.

As for the CERB, you are right that you would have to be without employment income to qualify.

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.

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5

Thanks, David. My hours have steadily been on the increase with my approved RTW, and the insurer has actually told me that being conservative on how much how soon is a good thing…I assume because it decreases the chances of relapse and having to go back on full LTD. It seems quite bizarre that they would consider my RTW as ended, seeing as we are essentially “on hold” but still employed right now, with no choice in the matter. I’m not even allowed to work from home at this time. Of course, not much would surprise me with the insurance company. However my doctor is unlikely to recommend an increase in my hours at the moment when it’s a moot point, so I don’t know why they’d reasonably expect that.

At any rate, it’s a minor pain in the butt compared with what some people are experiencing atm, so I suppose I shouldn’t complain too much. :blush:

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6

Still no word. If they were going to cut me off for no reason, at least I might be able to apply for CERB. So irritating as the bills don’t stop just because a massive insurance company decides to be a dick with no explanation. :expressionless:

7

If you qualify for CERB, apply. :slight_smile:
Read the threads on CERB.

8

I imagine that even if I were cut off LTD, i still wouldn’t qualify - while my hours are low due to RTW, I still am technically employed. I may not make more than the allowable amount to apply for CERB however, which would be where I would have to look into before applying. I imagine it’ll all come out in the wash, I am particularly impatient as the last few years of back and forth has left me without savings to speak of. Ah money, what problems it causes. :crazy_face:

9

As long as your employer still pays you.
I don’t think you have to be laid off to get CERB, just reduced hours or no pay due to the pandemic.

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10

I appealed the LTD. Before the LTD approval, can I RTW gradually? I’m on financial crisis…I don’t know what to do.

11

I don’t imagine that working any amount of time would allow for your LTD appeal to be approved, as they would see it as proof that you ARE able to work and therefore don’t qualify. It’s very hard playing the waiting game when you have no income, I definitely sympathize.

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12

Please call a lawyer such as Resolute Legal for advice. They give free consult.

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13

Do you work in federal?

14

No, I’m just speaking from my experience that in order to qualify for LTD, you would need to prove that you are unable to work in any meaningful capacity for the foreseeable future. RTW is a step if and when you become able again to attempt to re-enter the workforce, should your disability improve or resolve. Definitely worth contacting Resolute for a consult, they were a huge part of my claim being successful after multiple rejections. :slight_smile:

15

Thanks Nip. I have done my first appeal while I’m on EI. My doctor extended my sick leave until June. However, I’m frustrated about paying my bills! I don’t know how am I going to survive the appeal isn’t approved.