Personal Injury

Scales tipped in insurer's favour with LTD claims

By Patricia MacInnis, AdvocateDaily.com Senior Editor

Insurance companies are ramping up their scrutiny of long-term disability claims and employing tactics to deny benefits, Toronto personal injury and disability lawyer Nainesh Kotak tells Benefits Canada.

Kotak, principal of Kotak Personal Injury Law, says such measures are counterproductive as most people don’t want to be off the job any longer than necessary and would return to work faster if they allowed to do so.

The online news site reports that a recent study by RBC Insurance Services Inc. revealed that almost half of employees on disability said they felt pressure from their employers to go back earlier than they felt they were able to do so — a substantial increase from the previous year’s study, where only one-third of respondents said the same.

One of the issues claimants grapple with is providing insurers with the medical documentation to support the fact they’re unable to work, primarily because doctors tend to be so busy, Kotak says.

“Claimants’ physicians are often reluctant to fill out disability forms, and the brief conversations these doctors typically have with disability insurance company staff nurses often leads to mischaracterization of the doctor’s view of the claimant’s work-related restrictions,” he says. “We are definitely seeing more insurers deny claims based on what they perceive as insufficient medical information.”

That situation is exacerbated when insurance companies demand independent medical assessments or require that claimants participate in a rehabilitation program of their choosing, Kotak says.

“Often these doctors are not really independent and will give an opinion that contradicts an opinion from the claimant’s doctor that her patient cannot return to work,” he says. “The same is true when the insurer chooses a functional ability assessor or rehab program: their reports will not be favourable to the claimant.”

Kotak says insurance companies frequently resort to social media scrutiny of a claimant’s accounts as an investigation tool, an inappropriate tactic.

“People are doing things like updating their resumés on sites such as LinkedIn in the hope that they will get back to work even as insurers are using that sort of thing to question whether they’re totally disabled,” he says.

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