Long-Term LTD Claim, CPPD Approved — Now Possible Functional Assessment

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1

Looking for some opinions from people familiar with LTD/CPPD and the transition to an “any occupation” definition.

I’ve been on LTD for several years due to a post-viral condition involving ongoing central dizziness, cognitive issues, fatigue and other symptoms that affect my ability to function consistently. My doctors have continued to document that I’m unable to work, and I continue to have regular medical follow-up.

My LTD is through a union-sponsored group plan with Alberta Blue Cross.

I was approved for CPP Disability in early August, with the approval being retroactive. Alberta Blue Cross is aware of the CPPD approval and has already adjusted my LTD benefit accordingly.

I recently had a lengthy phone call with my LTD case manager. He went through a very detailed discussion about my daily activities and functional abilities, including things like screen time, concentration, reading, walking, household activities, etc.

I explained that I continue to have significant limitations and that trying to do activities for any length of time can cause my symptoms to flare. I also explained that I don’t feel capable of sustaining any type of employment and that my doctors continue to support my inability to work.

The case manager mentioned that before potentially moving the file to a maintenance-type status, they want to determine whether I could perform some type of work. He also mentioned the possibility of an OT/physiotherapy functional assessment, although it sounded like this would need to be approved before it could proceed.

What I’m having trouble understanding is why an OT/PT assessment is being brought up at this stage, particularly after the recent CPPD approval. I understand that CPPD and LTD are separate programs and that the insurer can conduct its own assessment, but I would have thought the CPPD approval would provide significant supporting evidence.

The case manager said he would keep in touch and that I should hear something shortly.

For those who have been through something similar:

• Is an OT/PT or functional assessment a normal step before an LTD file is moved to maintenance?

• What does the assessment typically involve?

• How much weight does CPPD approval generally carry with an LTD insurer?

• Does being sent for a functional assessment necessarily mean the insurer is considering a return to work, or can it simply be part of determining whether someone has any sustainable work capacity?

I’m just trying to understand what may happen next. Thanks.

2

I’m confused. Are you on LTD any occupation now, or under own occupation?

--If “Own” for now:

CPP-D is largely ignored by insurers these days while you’re on claim because, the thing is, if they don’t terminate your claim, they don’t have to care. If they terminate your claim and it’s litigated, they look like a big fucking idiot as CPP-D is approved.

But it’s not breach of contract unless they terminate payments…so yes, in the ltd contract they can ask that you do OT/PT, etc, and you have to comply as long as your doctor supports it and it’s safe and your efforts are reasonable and not causing additional harm

basically they’re throwing shit at a wall and hoping something sticks to give them an out to terminate your claim. They’re just desperate because they know once your file gets to approval for any occupation, they’ve lost the main battle

but at long as they keep paying you, they can throw shit at a wall

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Im currently on LTD any occupation since 2023

4

I expect that they are trying to answer two questions -

Is there any suitable employment that you might be able to do that’s been overlooked?

And is there any reasonable prospect of your condition improving?

It’s pretty normal for them to jump through the paperwork hoops. I would not read much into them doing it. The sad reality is that if people are not able to get back to work relatively quickly, they are more likely to never be able to return to work. Reading how you described your conversation it gives me the impression of a person idealistic and new to the job who does not yet understand how difficult recovery is for many conditions.

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He’s a new case manager and hasn’t been on the job that long is what I understand.

6

Yeah I would just chalk it up to them being keen to set a baseline and not yet being overwhelmed by the magnitude of the job and being underresourced.

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This is the weirdest part about the whole thing though. It is a big deal to be approved for any occupation. The insurer has basically shot themselves in the foot by approving you for any occupation and then now trying to do OT and stuff

The insurer would have been much better off forcing you to do OT and other things before the approval for any occupation…

From a legal perspective if they ever were to terminate your claim this would look stupid in front of the courts and depending on the other circumstances of your situation you might even be able to win on the claims of bad faith and…punitive damages

8

Well it depends. The insured needs to continue to be unable to do any occupation for each month that their claim is paid so it can vary over time.

9

I agree but once the insurer deems the claimant as fully disabled the insurer has to go out of their way to prove that they’ve either recovered or they have found an occupation that the claimant is suited to do.

It is far far easier to get someone to do pt or OT while they are still under own occupation because it is legally much safer for them to deny at that stage versus after approval for any occupation

10

Its been 4 years I’ve been on LTD, they basically want to add the final piece of the puzzle before moving into maintenance from what I understand. So I don’t know since I find it odd why after all this , they brought this up.