Termination of coverage


#1

What does this mean for LTD. An employee’s coverage under this Plan will terminate immediately upon the occurrence of the earliest of the following events?

The employee attains the age which is obtained by subtracting the qualifying period from 65?

This plan terminates.

Does this mean if the company goes under that I am screwed or if they renegotiate the plan and change the terms they can cut me off?

I am receiving long term disability from my work insurance company and they cut me off and I appealed and I I am now long past the 2-year point. They sent me a form for update to be sent and also said that my doctor needed to fill out a form but then called me back and said no my doctor does not need to fill out the form yearly now as my company is not requiring it. This doesn’t really make any sense to me? If I’m supposed to have ongoing medical care then why do they not want an update from my doctor yearly stating that I am still totally disabled? I mailed the form back to them and they keep telling me that they sent me letters and reminder letters for the form but I didn’t and I never received the first form in the first place. In the past I have faxed them everything and kept my fax receipt cover sheets so they could not deny that they didn’t get it but now I don’t have access to a fax to do that. I no longer have a case manager and I am dealing with the payment Department. Could you tell me what this means and why they are no longer wanting medical information if I am required to keep seeing the doctor? I did a peel on my own and I won the appeal and they reinstated my benefits.


#2

No, you have coverage until 65 if you have an active claim.

If you do not have a claim and your employer cancels the Insurance or switches Insurers—then of course employees would not have coverage.

Insurers always have this type of wording


#3
  1. They don’t want to spend anymore case management fees on the claim–you have been approved for the long term

  2. Continue seeing your health care providers and Doctor on a regular basis because sometime in the future they may pull your file for active management or ope to see you are not under regular care and cut you off.

  3. If at anytime you receive an activity form to fill out you have been or about to be placed under surveillance.

Be happy for now–they just plan to pay you


#4

I have not received an activity form but I did receive a update form apparently that I am supposed to receive yearly now.


#5

What is an activity form please…I received a yearly update form that requests my other income and that they can communicate with my employer and 3rd parties.


#6

Both sites–even though USA are good references for how Insurers act. Do not apply though any of the legal cases or advice as this is from the USA and not applicable to our courts. Please seek a lawyer for legal advice.


#7

Maybe it is like doing taxes online.
The CRA says not to mail in receipts but keep them in case they ask for them later.
They may ask for proof of medical later but for now they don’t need it.
Go with it. :slight_smile:


#8

As mentioned by other members, this simply means your “right to file a new disability claim” ends just before you turn 65 years old. This cause does not apply to existing disability claims that are approved, being appealed or are subject of a lawsuit.

However, it is important to keep in mind there are often clauses in a disability plan that apply to existing claims. Events, that if they occur, can cause the existing approved claim to terminate. For example, many group plans for government employees or large employers will have a clause that says payment of benefits will stop if you “retire”. I have seen this catch many people unaware and the results can be financially devastating – because the person thought they would continue to get both LTD and their “retirement pension”. Again, this is a case by case thing, but you need to keep these types of things in mind.


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.