Will Ltd pay for treatment?

I have been off on Ltd for 11 months due to profound hearing loss as well as vertigo. My employer medical benefits have been discontinued and I am now paying out of pocket for a minimal amount of benefits.
At this point I am waiting for a hearing implant which I will be responsible to pay for with no adp or benefits that helps pay. The hearing implant will cost btw $7000 and $10000. In addition my Dr has said he believes physiotherapy may be useful in aleviating my vertigo symptoms but again it will not be covered under my current benefits and will cost approx 1100 per month. Are these costs (the implant and physio) things I can ask my Ltd (Cigna) to cover or will I be opening myself for trouble? I have saved the for the implant but the cost of physio is definitely not something I could do on a monthly basis. Any advice would be greatly appreciated.

I do not know but I have an opinion.
Why did your employer benefits get cut off so early, I would think that before the 2 year mark is unusual.
I don’t see any reason not to talk to Cigna except I don’t know who is supposed to pay for recommended treatment.
I would think Cigna has to pay but if not then it is too risky.
So, good question.

Contact Resolute for a free consult.

When I questioned my employer terminating my benefits I was told it was common practice to stop at the 1 yr mark. I went on sick leave in August 2016 and up until the 1 yr point I had to pay my portion of my benefits out of pocket but was able to keep my full package. Losing the benefits was a hard pill to swallow but now with the additional treatments my Dr is suggesting it quickly taking a financial toll I am highly motivated to seek treatment but at $1000 a month there is no way I can do it. Thanks for the input Jammer. Has anyone else had to ask for treatment to be paid by an insurer?

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Most disability policies do not require the insurance company to fund treatment, therapy or related expenses. While you can certainly request that they consider paying for treatment or expenses that may assist you in ultimately overcoming your disability and ultimately returning to work, the decision to fund such expenses is completely at the discretion of the insurance company. They may agree to fund therapy or other expenses, if they feel that this will result in a quicker return to gainful employment, but otherwise they are not under any legal obligation to pay these expenses.

I wonder if the insurance company can cut a person off for not pursuing treatment that would cause financial hardship for a person to pursue.
You doctor hasn’t said 100% that treatment will work.
I would ask your doctor to write a letter saying that the treatment might be beneficial (I’d be very careful about the wording).
This a question for a lawyer, I hope David chimes in. :slight_smile:
Best of luck.

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Thank you Jammer. I also worry that not pursuing treatment will result in termination of Ltd payments. I am not sure if I can be forced to pay for physio out of pocket and I agree it would be a major hardship to find an extra $1000 per month. I would love to hear David’s take as well. Had anyone else requested an insurance company pay for treatment and how did that go?

Talk to trrillium benefits…Yes I was cut off benefits after 1 year as well Worked there 20 yrs never missed a day and get cut off after a yr Goes to show ya how your employer cares about you lol

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Unless the medical plan is guaranteed by a collective agreement (union), then the employer can cut off medical plans at any point. The only requirement is that they treat all employees equally and it can’t be a retaliation to single someone out. There is no right to stay on a group medical plan if you are off work on a sick leave or other type of leave.

LTD insurers do not have to pay for medical treatment or expenses, but can do so if they wish. They will only pay for things they believe will either help you return to work or that will say that you “should” be able to work, even if you really can’t do so. You can present any expenses to them but it would have to be something they view as enabling you to return to work.

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.