Hello and thank you for your time in advance. My predicament started in the middle of May. I received a message from my case manager saying that a letter sent to my Dr requesting an update for their files was returned. Canada post in Alberta was changing addresses in my town and I had no idea their address had changed. I forwarded the new address and heard nothing back.
Fast forward to July. I had a regular scheduled Dr appointment at which time we discussed my form. I left the office with the knowledge that my Dr would reach out if she needed to go over the questions, otherwise the forms would be finished and sent.
Fast forward to two weeks ago. I get a notification from my caseworker saying I have been cut off my benefits as of August 31 st. She gave me no indication beforehand that papers weren’t received. I phoned my Dr right away and got in. Her nurse told me she submitted the requested information the day before my appointment. They were both apologetic but I am left with the possibility of my benefits not being reinstated. I am terribly scared. I have no way of returning to work.
I have been on LTD since 2015. CPP-D/LTD since 2018. Disability Tax Credit since 2024, back paid. The lawsuit for my injury paid out in 2022, after my health was determined to not improve anymore. Nothing has changed for me, in fact my physical health has declined really.
I don’t know what to do if they don’t reinstate my benefits. If they do, I am terribly worried it could happen again. I have always been very diligent answering my caseworker. I have always been on time seeing my Dr and I left my last appointment understanding she would submit my papers in time. I don’t see how this was my error or how I could force my Dr to hurry. Do I have any options?
Have you written a letter or email to your case worker? If not, I would write a letter with the details of the explanation about the readdressing by the town and/or Canada post, and that due to circumstances beyond your control information the insurance company sent to your doctor was never delivered within the specified timeframe.
I would call the doctor’s office to inquire about the date the required information was or will be submitted, to include with the letter to i case worker.
Also, I would also request the letter be reviewed by the case workers supervisor or a manager that can rectify the situation.
Wishing you the best, try and take care of yourself <3
Yes, I have written a letter to her about why things were delayed, twice. She has just ghosted me. Once I was sent the notice that I was cut off, I was given until the 7th of October to get them in or my file would be closed.
The papers were sent into my caseworker on the 26th of September via email. My case worker confirmed that the papers were received on that day. I wrote another email on to my case worker on the 2nd asking for confirmation that she received them. I have not recieved a reply.
Should my case worker have not given me the opportunity to prompt my Dr before being cut off? I was never given a date that my Dr needed them done by. The letter of cut off was given 4 weeks after the cut off day, August 31st. With no information given to me that they were not received before the 31st.
Hoping to clarify some detail,is the date of October 7, 2024 the date when medical info was required?
And, after your message to case worker request for confirmation on September 26th, 2024, there was a form of confirmation, by the case worker, of the receipt of medical update for your file? Was the confirmation in writing via emai, posted letter, or verbal?
Has there been an interruption of payment, to date?
Asking these questions trying to determine what to suggest…
The letter should state your right to appeal and what that entails. Does it say if they receive the medical docs they will review and make a decision to reopen claim?
You have no idea how much I appreciate not feeling alone.
So, my Dr was to have the paperwork submitted to my caseworker by July 31st( I only found this out from the nurse at the office, which means by September 26th, the papers are roughly 8 weeks late. I had my appointment at the beginning of July for the paperwork to be completed. The caseworker never gave me a heads up that the papers weren’t recieved. Until I got the email on September 19th. I also found out that My Dr went on extended holiday, shortly after my July appointment.
When I recieved the email on September 19th saying my benefits were suspended as of August 31st because the papers were not given by the 31st of July. I had until the 7th of October to get them in or my account would be closed. They never gave any instructions for next steps. I didn’t receive my September payment at all. My payments have been stopped.
I went to the clinic to find out what day the paperwork was sent and the nurse let me know the were sent on September 26th. I asked her if she could also email them to my caseworker just incase my caseworker says they weren’t recieved. The nurse said the papers were sent right to my caseworkers email and that the caseworker confirmed receipt of them in an email back to the nurse. My caseworker has not answered me personally. I emailed her asking if she had gotten them, but she has not answered me, only the clinic.
*Request for information from Dr returned to sender in April
*Email to me about returned to sender Request for new address in May. ( The clinic thought they would be able to keep their mailing address as it was at the post office not to the door delivery. I informed case worker that their physical address was changing. Then the clinic was informed their mailing address would be changing and I was not updated on that. The caseworker sent the original request to the new physical address, not the mailing address. If she had of sent it to the original mailing address, it would have been forwarded and there would not have been an interruption)
*Sometime between May-June Request was resent to new address and recieved by clinic.
*Made appointment for forms and check up Beginning of July.
*Benefits paperwork was to be submitted by July 31st.
*From July until September 19th there was no contact from my caseworker.
*Letter about benefits being cut off as of August 31st, 2024 was recieved September 19th.
No, QueenCoddie, there wasn’t any instructions to do so. Only that, if the paperwork wasn’t recieved by the 7th, my file would be closed. If the paperwork was recieved by then, they would let me know my next steps. I know for certain the paperwork was recieved by my caseworker on the 26th of September. The nurse at the clinic recieved an email response from my caseworker thanking her for sending them through.
Yes, it was an annual update. However, my requests for updates seem to come far more often then annually. More like quarterly from myself. And twice a year from my Dr. Thank you for your time.
Now that all the information has been sent to the insurance company I would do the following:
Send a short email to your claims manager twice a week (Tuesday and Thursday) stating they have all the information needed (as of Sept 26) to quickly reinstate your LTD benefits, but you still have not been notified that your benefits have been reinstated. State in the email this your xx email that hasn’t been responded to yet.
ln that same email ask why you were not given any warning or notification that your medical information had not been recieved and that would result in benefits termination. I would also ask that a insurance claims supervisor contact you on how this can be avoided in the future.
I would also ask in the email why there needs to be such overly excessive frequent reporting as your medical condition is likely never to change. In your case a yearly update is sufficient.
Do this relentlessly to create a paper trail until they reinstate your LTD. You can also google the Ombudsman email address for your insurance company and copy them on every email you send. I advocate to treat insurance companies with full force (almost to the point of being hostile) the moment they step out of line. You got this. Cheers
This advice is amazing! Thank you so much for taking the time to help me with a procedure. I will get started now. I have now looked up the ombudsman email and will CC them in communication until my benefits are reinstated. You have given me great hope!!
It’s best to see your doctor every month. Go in for a blood pressure check or weight check. This way you will know if your doctor is filling forms and sending them in time.