Does a person's age at time of LTD approval affect insurance companies approach to ongoing payments?

Hey,
Wondering if age affects how insurance company views ongoing claim. Was approved months ago…in late 50’s…have 51/2 years till age 65?

I ask because I continue to see a lot of surveillance and assume they are in an aggressive mindset with goal to try and cut off benefits.
Any opinions?..hope im not sounding paranoid…but as some say… paranoia is but a heightened sense of awareness !!!

I don’t think age has anything to do with it.
The test is whether or not a person meets the definition of being disabled.
More people likely become disabled as they age but I don’t think that is what you are asking.

thanks for your reply RaptorsFan.

I agree that to be approved you have to fit the definition for disability. Just don’t understand why the amount of undercover monitoring they are doing when I clearly am hardly ever able to even leave the house.

I think age and type of disability matter.
If you’re under 50 then it’s more likely.
It is cost-benefit for the insurance company.

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That’s fair. The younger you are, the longer the potential claim, then yes the insurer has more incentive to focus on those claims.

It’s a misconception that insurance companies do a lot of surveillance. I believe 15-20 years ago there was more of this. I don’t think it’s generally effective and it’s very expensive. Last time I saw it done was 10 years ago and it was about 5,000 for a couple of days. I’m guessing if you have been on an approved claim for a few months this would be 100 percent unlikely. But I understand people get paranoid sometimes. And yes I do work in the disAbility field and have for almost 15 years for two of the major insurers. I just wanted to alleviate your anxiety around the likelihood of this.

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Taz, this is my first time responding on this site. Greetings from Liza. I’ve got a first question.

Would you be able to share whether or not Sun Life from RCMP Federal Government, Civilians Position AS-02 would be given me the option of a ‘lump sum pay out’?

I’ve inquired twice and was told that according to my policy, it’s impossible. I’m not sure if this is factual or not?

I’ve had several major accidents over my 48 years. As if September 29, 2013, I’ve been placed on ‘Retirement Disability’. I have a very small FederalPension. Sun Life pays a fraction of the AS-02 wage. I’m on CPPD, forced by Sun Life. This is until the age of 65. I’d like an educated opinion IF it’s true. IF not true, is it best to get a Lawyer involved to pursue this for me?

Second question is about health care benefits. I was cut off a while ago. I was sent a letter stating that my federal pension was reduced and there were not enough funds to pay for my Health Benefits. I was sent a letter that I owe upwards of $3,000. Pay or my health benefits would be cut off. I do not have the funds to reinstate my health care plan.

Due to my health, disabilities, care coordinators and advocates changing so much, I have lost track of time frames, paper work and am besides myself since I’ve been cut off and am paying out of pocket health care expenses.

I have a home, pay a mortgage and many other utility and essential bills.

My Husband is self-employed and needs to be my main care giver. This has made things difficult financially. We struggle since 2013.

We firmly believe that having the ability to pay-off our mortgage would be a great financial aide, since we’d be able to afford paying for all the essentials via his self-employment.

Might I then qualify for ODSP? THEN I would have the priviledge of Health care coverage due to multiple disabilities?

This has been lingering in my mind off and on for a few years and would be very much appreciated if I had a professional educated response.

Thank you!

Your first question is contract specific. Not related to the insurance company. Every contract is different and you have to remember this is your employer contract. Some do settlements some do not. Sometimes it is frustrating from the insurance end as we recognize settlement may be a win win but cannot implement it.

The health benefits question is also employer specific many of them cease health and dental at or around the two year point. You may be able to apply for government supplement if you are in the lower income range.

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ODSP is means tested.
The limit is very low I think but it is worth investigating.
I don’t know how you would quit CPPD and get ODSP.

The bottom line is that if an insurer doesn’t want to offer a buyout of an approved claim, then that is the end of the conversation. There are no rights to buy-out. Group policies don’t contemplate the idea of a buyout of an approved claim. In the past, I been told by Sunlife that they cannot offer buyouts of approved claims under the Federal Government LTD Plan. So, that is consistent with what you are being told.

For questions about ODSP, you should ask them directly. To qualify for any ODSP your family’s monthly income and assets need to be less than your monthly expenses. They key thing here is assets, so if you have financial equity in a home you may not qualify [Correction: in Ontario a principle residence is exempted when calculating your assets for purpose of ODSP]. I can’t speak to your specific situation so you need to speak directly with ODSP.


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.

I agree with Taz that surveillance is likely less common than some people think.

We continue to see video surveillance done in about 10-20 percent of the cases that we see. Again, my firm has a skewed perspective because we are only seeing people with denied claims in many instances.

Video surveillance done by a private investigator is very expensive, but insurers will pay for it in cases where they believe that it is the only way to prove their belief that the claimant is lying or exaggerating out his or her disability. A recent example is that we had a client who was put under video surveillance while attending a medical examination arranged by the insurance company.

It is now more common for there to be online and social media surveillance. I would say that is being done in almost all cases if the claimant has public accounts and there is any concern by the insurer that the claimant is not being truthful.

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I think ODSP lets you have a “principle” residence and car…
Savings are a no-no I think.
I would read the ODSP website.

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Yes, you are correct Jammer. There is an asset limit of $40,000 or $50,000 for a couple, and there are a number of exceptions and principle residence is one of the. You can go hear to see the full list:https://www.mcss.gov.on.ca/en/mcss/programs/social/directives/odsp/is/4_1_ODSP_ISDirectives.aspx