Any person who makes a claim for Canada Pension Plan (CPP) disability benefits must supply medical evidence that he or she has a “disability” within the governing legislative definition. This is routinely done through expert evidence provided by a qualified, impartial doctor to whom the claimant has been referred by other treating physicians.
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Earlier this year, the Ontario Court of Appeal ruled that disability insurers in Ontario do not have to provide written notice of the applicable Limitation Period when a claim is denied, other than as set out in the Insurance Act, R.S.O. 1990, c. I.8, as follows: “Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.”
If an insured returns to work full time after a gradual return to work program or on a trial basis and is unable to continue working, he may be wondering about the next step. Will he have to file a new short-term disability claim or long-term disability claim? Does he need to re-qualify for benefits and go through another waiting period?
Many workplaces or private insurance plans provide their employees with short and long-term disability benefits if they are unable to work due to an illness or other medical condition. To qualify, most insurance policies require a medical report from a doctor or specialist that details the illness or injury they’ve suffered. The report must also include details outlining how the insureds’ condition disables them from performing specific tasks and functions of the job. Generally, doctors may also include a date when they can expect to return to work.
What does the term “offset” mean and how does it apply to a long-term disability claim? There are many insurance policies contain a provision that allows the insurer to reduce the amount of an insured’s monthly benefit if he receive benefits from certain sources (“offsets”). The sources referred to for the most part relate to income the insured would be receiving because of his current disability. Examples of common offsets include:
While insureds are receiving benefits, a case manager periodically reviews their claim to determine if they continue to meet the policy’s definition of total disability. When considering this criteria, their ability to work is taken into consideration as it relates to the medical condition as well as what the expected recovery time is and if they have received/are receiving appropriate treatment.
When people apply for short-term or long-term disability benefits, it can be as a result of a physical or psychological injury or illness. Many people are unable to continue working as a result of psychological illness such as depression or as a result of a chronic pain disorder. One of these is complex regional pain syndrome (CRPS). Complex regional pain syndrome can interfere with a person’s daily activities and ability to complete the essential duties of his or her job.
In Parmar v. Teachers Life, Ontario Superior Court Justice Faieta summarily dismissed the plaintiff's claim for disability benefits as limitation-barred.
Claims can take time to win as the insurer has to be satisfied that the applicant’s disability is not only legitimate, but also meets the definition of “disability” contained in the policy of insurance. The tricky thing for adjusters is that every LTD policy is different. They all contain different definitions of disability, different time lines to consider, along with different benefit amounts, such as the following:
A recent case called Cvetkovski v. Canada (Attorney General), involved a 50-year-old man who had applied unsuccessfully for Canada Pension Plan (CPP) benefits. He had a long history of psychological disorders which made it difficult to relate to others, and left him with low energy or motivation to do his job.
Western Medical Assessments (WMA) provides expert medical assessment services to insurance companies, lawyers (both defense and plaintiff) and employers. Our reputation as one of Canada’s most respected disability assessment companies is premised on our trusted network of thousands of clinical experts — mostly specialists — across all medical disciplines (physical and psychological). We’ve been entrusted to complete 63,000 independent medical examinations (IMEs) as our clients appreciate our medical direction, evidence-based medical opinions and complete independence from any ethical conflicts of interest.