The Dreaded Two Year Mark


#1

Long time lurker here. I wanted to thank everyone, as I’ve read every single post on this message board and it has guided me to handle my claim as well as I can. I keep organized copies of all communications with the insurance company in a binder, since the application to the most recent request for a doctor’s assessment. I keep notes of all phone calls or ask the insurer to send them over. I have disabled all social media profiles. I was also very conservative with my money during STD and the first year of LTD, knowing that having a good savings account could make life manageable if my insurance company decided to play games with me.


#2

My opinions. -)

I would say the ball is in their court.

Same here.
I am not a year in and I’ve been approved to 65 but I won’t be surprised if they try to cut me off in the future.
There is a saying, “hope for the best but prepare for the worst”.
Do you have CPP-D because that apparently helps keep the insurance company at bay. :slight_smile:

I never even made $5k/month when I was employed.

How does that even work?
LTD coverage under your parents policy?
What do they base the amount you get on, potential earning?

No idea.
It is not something I worry about.

Not very likely because of your very good medical support.
Does your LTD amount increase each year for inflation?
Many do not.

It probably is if that is what you asked for.


#3

I am not sure of your disability but the insurer seems to be most co-operative given your high benefit and young age! I am sorry that you are disabled. Not all claims go off rail or into the fight zone. If you have a recognizable disability with strong objective proof then it would not be worthwhile to challenge your claim.

Insurers tend to be more critical of psychiatric, mental health, chronic pain, fibro and chronic fatigue claims, Those that are more on the subjective side of proof are easier to challenge. Or those who have yet to even get a diagnosis but have failing health. With the above mentioned claims they will almost always say you just need physiotherapy activation and likely a psychologist.

When my husband had surgery, heart attack–those claims went very smoothly. When he had chronic fatigue, chronic pain and failed surgeries --his claim started to get more actively managed and the claim derailed.

That said my spouse is in an odd situation as he is suing the Insurer who is still paying part of his benefits each month. His claim has to do with the medical rehab and CPP-D.

If they know you want a settlement it will likely be very low. The 60 pages is likely most of the contract–it should say how long you are allowed to be out of Canada.

I would not contact your Insurer and wait for them to contact you. Keep up the documentation on your claim-if ever the claim is challenged your documentation will help to get a quick resolution. You would be a lawyers dream client.


#4

If you get an activity form then expect surveillance. Given your high benefit amount they could justify spending some money. That said–if your claim is really strong they may just file it in the once a year call you file.

I read in a Manitoba court case the Insurer sent an older lady to knock on an Insured’s door to ask to use the phone. The Insured claimed she could not walk without a brace–she had no brace. She lost her claim.

Another case in Ontario the investigator tried over many days to film an Insured who said they could barely leave their home. All the investigator recorded was one time reaching out the door to get mail. The investigator wrote that the Insured must be on to him as he wasn’t able to get anything more. Insured won.

A lot of times if they know you have a doctor appt. or schedule for an IME they may use surveillance.


#5

Which is why people should not write absolutes on their claim documentation.