I have reached the one year. mark of my LTD claim. I have Lupus, fibromyalgia , depression and anxiety, and chronic pain. The doctor just sent an update that specifies that at this point I could not work. They just sent me a letter that states “based on information that we have received to date it appears that your benefits will not be continued after your own occupation period ends”. I have a copy of the report the Doctor sent them, it says that response to treatment is partial, and prognoses is guarded at this time. Should I ask them how they came to this conclusion? Thanks for your help, this forum is awsome
Ask for a copy of your claim file as per your right under PIPEDA first.
ie: My current prognosis is your guarded. I do not understand how you based on the information provided that I will not meet the change of definition. This is stressful.
Please send me a full and complete copy of my claim file.
Short-and proof of receipt. You can also cc the privacy officer at the Insurer.
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You need to be referred to a pain clinic for chronic pain
Request for a sleep study
Should be referred to psychiatrist.
Lupas -specialist.
If you have benefits for psychologist and/or physio–start using this so you have chosen the care providers.
I have done all of the above. Thanks for your help
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Then you have lots of medical proof.
What we did is pay a few hundred dollars gathering up complete copies of all medical records and had those included in the claim file.
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Maybe the insurance company doesn’t have those records.
Should I be forwarding a copy of the doctors progress notes evey time I visit the specialist?
I probably wouldn’t have.
I would ask the insurance company if a letter from your specialist saying you have x symptoms and are undergoing treatment but are unable to work at this time would be sufficient to get your claim approved beyond 1 year (is your occupation period 1 year?).
If they say no then ask them what they want.
If they say there is nothing you can do then I would get the free consult from Resolute.
I’m still in the “own occupation” category.
I don’t think I would send them all the reports unless they asked and they seem to be asking.
I would tell them in some way that you have had a sleep study (maybe the letter from the specialist is enough or maybe they want all the reports up to now).
I have been approved until next Sept…2 year mark. They said that their is not sufficient evidence that would cover the “any occupation” period. I still have some time. Thanks for your help😀
It sounds positive since you have time to prove the “any occupation”.
Good luck.
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After I sent 5 years of all my husbands medical records, I only requested copies of test results or MRI’s and such and forwarded those.
In sending the letter that they do not have sufficient evidence to approve benefits past the change of definition they are in the process of stacking your claim file for a future denial and/or put you on notice that your claim “at this time” does not support the any occupation.
Likely in 3 to 9 months you will be scheduled for an IME or a rehab program-maybe both. If you are feeling that you would be able to return to employment then this could be helpful. Given your multiple health issues a return to work may not be realistic.
Often Insurers use IME’s and rehab programs to get medical reports to stack the claim file with opinions that do not agree with your Doctors.
Sending in all medical file information from your various providers and hospital records from the time your symptoms first started to being investigated is you stacking the claim file with your records.
Keep the original records and email or fax copies of everything to them. Do not mark up or write on any records. Keep the receipts for costs paid as you can claim on your taxes. Also with your records send to the Insurer copies of those receipts.
By doing this you give the Insurer an opportunity to review your history and save face if they allow the claim after the definition change. You also have multiple Doctors so it makes an IME more difficult and your Insurer will have to send those records before your IME to that Doctor.
If they don’t a lawyer would want to know why.
By askiing in my last response for your claim file you can also see how they came to the decision at this time that you would not qualify after year 2. You might also see that they just sent the letter an no real review by any medical professional was ever undertaken. In that case you keep that for a future lawyer to challenge if ever needed.
You should get a note book–do not rip out any pages and track your day to day activity, pain and fatigue levels.
Medical records and a notebook tracking your activity would also be helpful if applying for CPP-D
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Thanks so much for your help! It is very good advice!
We have a saying at Resolute Legal – the less detail they have in the denial letter, the harder it is to win an internal appeal with the insurer – it is often a sign they are just taking an unprincipled position and will deny no matter what. You should follow up to ask them to be more specific. Another way around this is to request a complete copy of the LTD claim file as you will discover the “real” reasons in there, or an experienced disability lawyer can review your situation and tell you the “real” reasons.
Contact us for a free confidential consultation if you want us to give specific advice on your situation.
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.
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Thanks for your reply. The harder it is for them to win, or the harder it is for me? I have until next Sept, my case worker said nothing had changed, and they haven’t made a decision. I’m going to try to not get too stressed at this point. I sent a message to my Union Rep to ask if I could hire my own lawyer in the event that I need one. I’m just waiting to see if I get CPP D. This site is so very helpful, it has enabled me to to stay relatively sane through this whole process. THANK YOU!
I think @David_Brannen means the insurance company has already decided to deny you regardless of evidence.
BUT I would be positive in that if you provide them with the information they want, they will approve you.
Worst case is you gather the information and have to sue, it’s not the end of the world.
You have a year so I would suggest being extra careful with money.
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Yes, Jammer is exactly right. My comment was more in a general sense. You will want to continue to provide updated medical information and have doctors comment specifically on your ability to do work in any other occupation. A word of caution is that many doctors have an incorrect belief of what it means to be totally disabled from “any” employment – the meaning of this phrase is very nuanced and depends on policy wording, your personal characteristics, your work skills, and your work history.
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.
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So thankful, my CPP D was approved, first try !!! Thanks to Resolute Law. I read the forums and free booklet and followed their very explicit instructions. When I have to repay Sun Life will they adjust the T4 slip so it reflects how much they actually paid me after repayment. If not my actual income will look larger than it is. The next step will be to apply for Disability Tax Credit.
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Awesome, congratulation.
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Good news, my union rep said if I need the services of a lawyer, I am not required to use the union’s. Although I hope it doesn’t come to that, its comforting to know I have all my bases covered.
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I received a call a few days ago saying my LTD will continued until I’m 65. I have only been off work for 16 months, so to say the least I was very surprised and relieved. Is it likely that my company would let me go before the two year mark?
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