Appeal "qualified" but only for 3 months?

Hi there,

I just went through a very lengthy appeal of 6 months that was recently accepted under the “any occupation” for the second time however the letter I received states “effective to the earlier of: your ability to return to work to an alternate gainful occupation or October 15th 2017” and i have to sign it before they give me any money.

I received this letter on July 3rd which gives me roughly 3 months of support before they plan to cut me off again. I have suffered extreme stress for the last 6 months because they completely cut me off with no support without any warning and I have maintained that I am unable to do what they say and have provided documentation to support this that they have denied. They expect me to return to 70% of my previous position which was full time. I tried returning to work 2 years ago to a 0.5 position and was unsuccessful. I feel as though i could maintain 12-15 hours a week, either 4 or 5 hours every other day. After that the pain becomes intolerable for me. This is not 70% of my previous employment. I want to return to work and do something but i can’t do what they say i can do, I can only manage so much before its painful and I can’t concentrate. I am frustrated and overwhelmed with stress. I have a psychiatrist referral in the works because i have been suicidal and i plan to do more intervention with my physical issues to provide them with updated info to show what i am suffering with and how my condition has not changed. I can’t possibly complete all this within 3 months, along with rehab they expect me to complete. I don’t know how to do all this within the time frame they have allotted me.

Is this letter fair? To say i qualify for benefits only for 3 months before i will be cut off again? I have done the rehab services before when i tried to RTW 2 years ago and it didn’t help me. My specialists claim there is nothing more they can do to help me, they have explained that i can maintain 3-4 hours before its too painful (I also suffer horrific migraines if i go beyond tolerance) so the fact that the insurance company is forcing this RTW or they will cut me off is overwhelming me. My file has been handed over to 4 different caseworkers in the last 6 months and I feel like no one is really managing my file properly. The person who made the decision to cut me off had my file for less than a month. I am 36 so it seems like i should be a healthy individual who should be able to work more. I struggle with sitting too long and my background is computer work so i really don’t see any other job for me within my employer that doesn’t require me to sit at the computer all day.

I don’t want to be on LTD forever but i need support to change to an “alternate gainful employment”. Can I take any courses while on LTD to try and change careers that may work for me so that I can be employed? I have seen online courses that i can do at my own pace that i may be able to do but i am not sure if they will cut me off because i am trying to better myself and they’ll see this as me being capable. The last time I was supposed to be on a GRTW they cut me off immediately, even after i failed to be successful and it took a further 4 months to get back on so I’m really anxious about making any form of what seems like progress when i need ongoing support before I can make it on my own.

Your response is greatly appreciated, sorry for the length


I’m curious, what kind of “alternate gainful employment” do you think you can do?

I’m sure I read the answer here but I can’t remember it.
I think it is the same as this US answer:

any activity may be held against you, particularly activities inconsistent with your disability claim. While you’re reading it, check the policy to see if there is a vocational rehabilitation or education clause in it - some LTD plans would help someone in your situation go to school, in hopes that you can get back to work and they can stop paying you LTD at some point.

Be careful is the bottom line.
Maybe ask your work HR person.

You should be careful signing this kind of agreements. It may mean that you won’t be able to appeal again or sue them if it gets to that point. And there is no certainty that your condition will improve by October. Get a legal advice.

the trouble is I can do a little work but its the prolonged use that becomes a problem for me. I tend to be able to manage about 3-4 hours of work before the pain becomes an issue for me and I develop swelling in my arm and can’t manage. So when i do functional capacity tests, that last all of 3 hours and you type for 5 mins at a time, I seem like I’m fine and they assume I can work full time or 70% of full time based on 3 hours of testing which is untrue. I have explained to them that its the prolonged use thats a problem but you know insurance companies, they run with any form of “might” or “may” and assume you are fully capable. If I overexert myself, i end up with migraine headaches that can last anywhere from 1-3 days so i don’t see how any employer would hire me when i’m not reliable and may be sick. I want to work but i don’t see how I would appeal to any employer. I have considered taking online courses that i can do at my own pace and maybe i have to find a job that is not sitting all day, one I can move around but only work for a max of 4 hours! I don’t know what i can do…its very frustrating. And it seems like insurance companies are either all or nothing. They don’t let you work for what you can manage and top you up. It’s either full benefits or no benefits so its hard. I wouldn’t mind working 15 hour weeks (what i could handle) and they take what i make off my benefits and just top up but they don’t seem to do that…i want to feel like i can contribute something but Im feeling trapped.

I think you are at that point where you have to have a one-on-one consult with a lawyer to see what your options are.

I think I read that cpp disability defines any reasonable amount of work as anything that makes you over $15k/year.
Anything less than that and you’re disabled.
I sympathize that is frustrating.
David (Resolute)) has said he hates functional testing.
You don’t want to be on disability forever but maybe you have to be.
You haven’t been on LTD for 2 years but you’ve already tried a return to work.
Has your employer tried to give you duties you can do?
They have a legal duty to accommodate.
I think you need to negotiate with your current employer.

I think you should get the free consult from Resolute.

I am going to be blunt.
You are not employable currently based on the conditions you have described.
Go to your Doctor regularly. I can tell how anxious you are by your post. Pain is maddening and it definitely causes psychological difficulties and depression. Get your doctor to refer you to specialists and look at anti-depressants.
Possible referrals could be to a neurologist, psychiatrist, pain clinic, sleep study.
You have a duty to try to get better and that is your job now.
If you can’t get better then by seeking help you will have the proof.

Tell your doctor how much you are struggling and get pulled off of work and referred for more help and tests.
If the Insurer causes you issues with your claim then get a lawyer.

Request a copy of your claim file on Monday-in writing. If you need an email addy just post which Insurer it is and I will get for you.
Stop saying you might be able to work 4 hours a day -because it is likely a pipe dream right now,

Treat yourself kindly—your Insurer will not

1 Like

No-do not sign that without talking to a lawyer

This is a complex situation and you really do need one-on-one confidential advice. The lawyer would need to see the letter they are asking you to sign. It is not unusual for them to say you are approved but only to the end of “own” occupation period. You need to plan for fact that your benefits will stop when the defintion of disability changes. Based on what you have described, very likely you will need to use court process to have any chance of success in getting benefits paid after the change of disability defintion. See below if you want a free consultation from our office.

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.