LTD cut off; appeal denied; Employment Status changed - what now?


#1

Hi everyone! I’m new here. I have looked through many of the Forums but there hasn’t been any answers that I could apply to my situation. I am in Alberta. I am now 55 years of age - female. (I volunteer this info to you)._

I fell ill in 2011 - but continued to work. My Family Doctor went out of her way to find out what was wrong. Test after test. I was referred to the Chronic Pain Clinic - which after a year of waiting - I attended for 2 years. I was referred to an Internist in 2013 - who diagnosed me with “Liddle Syndrome”. He referred me to a Rheumatologist who diagnosed me with “Polymyalgia Rheumatica” but after 11 months and a lot of prednisone, kenalog shots and methotrexate injections - she decided her diagnosis was incorrect; that it was just “trigger point pain” and said “have a nice life”. Seriously she did - my Husband was with me plus I recorded the appointment! My symptoms were getting worse; not better and I went on Short-Term Disability April 2013.

It’s now 2014. Fortunately I was still seeing the Internist and my Family Doctor regularly - both were extremely upset with her. Regardless my Internist was starting to see a lot of patients referred to him with similar circumstances. So - as long as I was willing to think outside the box - would I consider being tested for Lyme Disease. I answered a lot of questions, sent bloodwork in for testing - and lo and behold - it came back Positive according to the Lab’s requirements and Positive according to the more rigorous CDC requirements! Ugh! I then endured a 16 week aggressive treatment program. I was approved for LTD in April 2014. I was then approved for CPP-D several months later. I was sent for an IME - and diagnosed with Fibromyalgia. I was also diagnosed with Major Depression Disorder.

So - now I have: Liddle Syndrome; Lyme Disease; Chronic Pain Syndrome; Fibromyalgia and Major Depressive Disorder!

I received 1 year of Short-Term Disability paid by my Employer. I received 2 years of LTD paid by Manulife (to 65 if eligible). I was then approved by Manulife as “totally disabled” and continued receiving payment for 6 more months. I appealed but was still denied. My Employer continued to pay for my benefits (health, dental, insurance, DB pension plan). I was sent for a FCE with a Chiropractor - who subsequently decided that I was able to work in a “Sedentary Position”. Manulife cut off my payments October 2016. They told me prior that they would put me through a 6 week Rehab - but my Family Doctor advised not to do it! She argued with the Case Manager for 2 hours about my health but said they either wouldn’t answer her questions or argued with her. I commend her for fighting so hard for me!

My Employer then cut off my benefits Feb 2017 but moved me into the status of “Leave of Absence without Pay” and said I could continue my Benefits if I paid for them - but only until mid-October when . Without an income except for CPP-D we were headed for financial ruin. My Benefits cost close to $1,000/month. My family stepped forward and put the Benefit payments into an account for Feb to mid-Oct for the Employer to withdraw to pay for my Benefits. I take 16 prescriptions/day!! I turned 55 in September.

I contacted a Lawyer. Litigation has started. But here’s my question! What will/can the Employer do when mid-October comes around? I don’t know why they didn’t keep my status as LTD without Benefits as they know from my Specialist and Family Doctor sent scathing letters to Manulife about trying to send me back to work! Now that I’m 55 can they “Involuntarily Retire” me? or let me go With Cause? If they gave me a severance package (I worked for them for 32 years) how is that going to affect the Litigation? If there’s no severance but I’m still terminated - that puts me into the Company’s “Retiree” status. The upside is I’ll be eligible to receive a pension monthly plus get basic health and dental benefits thru the Company (Employer paid). My Lawyer has expressed that I should take a settlement from Manulife if we win versus continuing with LTD if the Company retains me because he feels 6 months after the Litigation - Manulife will just find another reason to cut off my payments a few months down the road.

So to sum it up (sorry for the book!) - mid-October where does this leave me with my Employer? Terminate? Continue as is? And if they terminate where does that take me in the Litigation process?


#2

Is that an IME paid by the insurance company and was that why they cut off your benefits?
A disability lawyer is the answer to the insurer cutting off benefits.

In Ontario (don’t know about Alberta), an employer can get rid of an employee if they believe the employment is “frustrated”.
No one can force you to retire but that may be your best option.
I’m not sure why my friend retired at 55 (I wish he’d asked my opinion first).
Sunlife was reliable so he had no reason to although I think his retirement income is higher than his disability income was (he worked for the feds).

If Manulife reinstates your benefits and the employer terminates you and pays severance then Manulife might be entitled to the severance money.

I would go with what your lawyer says.
I assume he has a copy of the master insurance policy?

If the employer terminates you, you will likely lose the group plan/benefits.
Read this thread Employment terminated?


#3

The IME was paid by the Insurer and went through with no issue as he determined I had Fibromyalgia. This was performed while still in my first 2 years of LTD. The FCE was also paid by the Insurer and was performed 3 or 4 months after the 2 year mark (totally disabled) by a Chiropractor - which is why they cut off my benefits.

In our Company - the policy is that when an employee is 55 and is terminated they are automatically “involuntarily retired” - and usually with a severence (unless it’s with cause). They then go into a “Retiree” status which enables them the option to draw on their pension and receive continued minimal basic benefits such as health and dental as well as converting their insurance to their own policy up to a max of $200,000 without a medical. It’s actually a very generous program. I worked for a large Oil & Gas Company. I’m also very familiar with the policies because I worked in HR.

I am unaware of what my lawyer has. We’ve only had 2 meetings. The first was to advise him of Manulife cutting off my benefits and did I have a case to take them to Court. The second was to provide him with all the information I had collected from all my Doctors as well as Information received from Manulife as well as my Employer’s Benefit program on LTD.

I think it’s time I had a followup meeting with my Lawyer to find out what his views are. We are in extreme financial trouble right now. We have spent the past year surviving on CPP-D and my husband’s income. Our debt load is too high. We’ve exhausted all of our RRSP’s and savings and are living on credit. Even if we sold our house - we still cannot afford our debts and rent is higher than our mortgage.

Ugh!


#4

I think you need to follow up with your lawyer.
I think you can sue for financial distress caused by them cutting off your LTD.
Is it a lawyer specializing in disability claims?

Sounds like you’re on top of it, good luck.


#5

Have you looked at the option of a consumer proposal on your debts? Bankruptcy.ca is a good place to look over and has a forum. We were able to negotiate through a proposal 23 cents on the dollar owed for my spouse.


#6

I will definitely be following up with my Lawyer - yes he is specifically a Disability Lawyer. I’m just panicking because of our financial state but that’s a good point asking for financial distress as well! Brilliant - thank you!


#7

Thanks Allyoops! Yes - we have considered a Consumer Proposal. The first Insolvency Agent we met with told us that it would cost us $2,000/month - he most definitely was NOT helping us at all. He seemed to be enthusiastic in the beginning and the next appointment it was like we were a bother to him. So we then went to 4 Pillars for assistance. They charge a $4,000 fee and I told her that if I couldn’t afford my day-to-day bills how could I be expected to pay their fee?? However she said she didn’t have the authority to alter the fee but management could. We may have to go back and see what they can do regarding the fee. If only I knew what my Employer was going to do!


#8

I would be hesitant for 4 pillars–and instead speak to another insolvency trustee. Any fees with a trustee are legislated --and are calculated in the payments if the proposal is accepted. There are free non profit services but all they do is get the interest stopped.

4 pillars–personally I say no to that when there are much safer and better options.


#9

Thanks for the heads-up. I looked into the website Bankruptcy.ca and there’s an office here in my city so I’ll be calling them to see what they can do for us. Thank you for that! I’m also looking into EI Sick Benefits. My group insurer stopped my LTD payments almost a year ago so I’m not sure I would qualify or not from EI but it won’t hurt to call them and find out for sure if I explain my situation. I didn’t even know it was available until I started doing research on Employment Law.


#10

You should really take these questions up with your lawyer as he or she will have the best understanding of the context of your situation and laws of your province. As a general rule, employers are able to unilaterally dismiss a person from employment, after that person has been on an extended sick leave (typically 2-4 years or more) and there is no prospect of a return to work, even with accommodations. This is governed by the law of frustration of employment contract.

The rules re: company medical plans vary widely from situation to situation and are governed by the employer’s worklpace policy and/or a collective agreement in union situations. Bottom line though, employers do often have right to require employee on sick leave to pay 100% to say on the plan. Employers also have option to require people on sick leave to be removed form medical plan.

Regarding settlements vs going back on claim, this needs to be a careful decision between you and your lawyer. I have seen situations where we get people back on payments and things are fine, in some other cases the insurance company makes life very miserable for the person.


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.


#11

Thank you for responding David. I will definitely be making a follow-up appointment with my Lawyer to discuss all these questions. I asked it on this forum in case someone had already been in my position but I think I might be unique/rare. My Lawyer did state that he normally goes for a settlement because if I’m put back on the claim the Insurer will just repeat their doggedness of cutting me off. Although the Settlement will never be a replacement of income I would have earned had they kept me on LTD until 65 which is very unsettling - I’m continuing with the lawsuit because I think this billion dollar company should be taken to task for ignoring my own Doctors and cutting me off just to keep their Company profitable. There honestly should be some sort of Law against this type of behaviour from Insurers!


#12

We all know that when one is ill that all things affect you! First your dealing with the illness then the insurance companies then the creditors then the stress of all this things combined!!! Have learned a lot about creditors and how everything works you can learn to deal personally with your creditors and if your able their are way to try to negotiate your debt where they may work with you don’t let them intimidate you and thier rules they have to follow!! Been throw it with them and know how how stressful it can be!!! Becomes a revolving wheel illness, stress finiacial ,stress, health insurance company stress ,Health stress ,family stress, mental stress it becomes over welhemed don’t know the rules on contacting some one personally but could give some help and ideas !!!I went throw dealing with creditors and how I was to able to resolve my issues with out having consumer perposal they wanted thousands of dollars if I had thousands of dollars would of payed my dept they want a piece of the pie and only had crumbs but may be able to help!!! Can’t promise but it another thing that creates so much stress that just makes everything so much worse and there is light at end of tunnel This is another issue that when some one is disabled that they have to contend with!!! That’s what i mean when I say that we need to form cummunity! we might be weak as sick individuals but together we can build a foundation to a better day! Everything is such a learning curve! Where all in this together, dealing with all the same issues . Lets lean on each other, let’s support each other so we know that we are not alone in this journey I have the support of my wife ,my kids and family but some are a lone in this and no one should be if we can help it!!!