Teachers Battling Back-to-School Blues

Making an OTIP LTD Claim for a Mental Health Condition

https://www.pexels.com/photo/adult-back-view-beautiful-bench-316889/

Over the course of the pandemic, I have heard from many teachers experiencing serious and debilitating stress and anxiety. Last year, many teachers were forced to pivot from face-to-face to online and then back to face-to-face. This school year has come with its own challenges–health and safety concerns and juggling in-person and online teaching, concurrently.

In addition to the unique challenges of educating and supporting students in this pandemic, teachers must also manage their own personal stress and worries around the pandemic as it relates to their own and their families’ health and well-being. Combined, these various constant and long-term stressors can take their toll.

For some teachers, the demands of teaching and living through the pandemic has been difficult but manageable. However, for others, the stress of returning to school this year and teaching either in-person or online has been a harrowing undertaking and not all teachers will be successful in their return to the classroom.

This article is for teachers who are struggling with mental health conditions and are not able to return to work after a period of sick leave and may need some guidance with respect to submitting an OTIP LTD claim for mental health conditions.

Mental Health Conditions Resulting in OTIP LTD Claims

It may be that the accumulated stress of these past several months and recent weeks has caused an aggravation of a pre-existing mental health related condition or it could be that all this stress has triggered a new mental illness. In either case, you may find that your mental health is suffering. For some of you, your mental health may be severely limiting your ability to perform your duties as a teacher, let alone perform your regular daily activities (such as parenting, socializing, self-care, housekeeping, recreation, reading, communication, etc.).

As you probably know, some of the most common mental health conditions are: depression, anxiety, personality disorders and bi-polar disorder. These conditions can severely limit your ability to work and may form the basis for an OTIP long-term disability claim.

Of those conditions, over the past several months, we have seen a surge of claims based on depression and anxiety. According to the World Health Organization, depression is a leading cause of disability, affecting approximately 300 million people worldwide and can lead to long-term disability. According to WebMD, the most common types of depression are: major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder (SAD), psychotic depression, peripartum (postpartum) depression, premenstrual dysphoric disorder (PMDD), “situational” depression, and atypical depression.

Teachers Struggling with Depression

While you may feel “off” or “not like yourself”, you might not realize that you could be experiencing symptoms of depression and anxiety. Some symptoms for you to look out for now, in the coming weeks and in the coming months, include:

  • Persistent sad, anxious, or “empty” moods
  • Feelings of hopelessness or pessimism
  • Fatigue
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Insomnia, early-morning wakefulness, or sleeping too much
  • Appetite or weight changes
  • Thoughts of death or suicide, suicide attempts
  • Aches, pains, headaches, or cramps and digestive problems without a clear physical cause and that do not ease even with treatment

Teachers Struggling with Anxiety

In addition to depression, we see many teachers and other professionals suffering with anxiety and panic disorders. There are several types of anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, phobias, agoraphobia, separation anxiety, selective mutism and medication-induced anxiety disorder. These conditions alone or combined with depression, can be difficult to manage and often requires intensive treatment to improve functioning to the extent that returning to work is possible.

According to WebMD, the main symptom of anxiety disorders is excessive fear or worry. Anxiety disorders can also make it hard to breathe, sleep, stay still, and concentrate. Your specific symptoms depend on the type of anxiety disorder you have. Many of the teachers we have spoken with in recent weeks are experiencing many of these and other symptoms of anxiety. Some teachers will be able to manage and overcome their anxiety, while others may struggle to function or return to or continue to teach.

Some of the most common symptoms of anxiety to look out for are:

  • Panic, fear, and uneasiness
  • Feelings of panic, doom, or danger
  • Sleep problems
  • Not being able to stay calm and still
  • Cold, sweaty, numb, or tingling hands or feet
  • Shortness of breath
  • Breathing faster and more quickly than normal (hyperventilation)
  • Heart palpitations
  • Dry mouth
  • Nausea
  • Tense muscles
  • Dizziness
  • Thinking about a problem over and over again and unable to stop (rumination)
  • Inability to concentrate
  • Intensely or obsessively avoiding feared objects or places

Unable to Perform Duties of Your Regular Assignment

Symptoms of mental illness, and most commonly symptoms of depression and anxiety can impede your ability to perform the “duties of your regular assignment” and make it impossible for you to work, let alone perform many of your other responsibilities.

You might find it difficult or impossible to plan and prepare lessons, engage and teach students, complete marking, evaluate student performance, attend and participate in meetings, be on time for classes, be mentally present while teaching, promote a positive learning environment, learn and adapt to teaching online, and to enforce and comply with the countless health and safety protocols that are expected to be in place.

However, if you are struggling, it is important you seek medical attention and possibly help from your union or a lawyer, as soon as possible to ensure that your LTD claim is approved in the first instance and if not, to be prepared to dispute any potential denial.

Knowing your limits and knowing when and if to stop working and apply for Sick Leave is critical. Stopping work while you are still functioning fairly well and completing your duties, may not be a good idea and could lead to the denial of your sick leave and LTD claims. Continuing to work while you are not well could strain your relationship with your colleagues, students, administrators and your board. Sick leave could be a way to take some time to recover while preserving your relationships with your employer.

You may also wish to consider accommodations to allow you to continue to work. It is important that you do not agree to accommodations that essentially change your regular assignment to the extent that you are no longer doing your regular duties nor earning your regular income. Working part-time could jeopardize a future OTIP LTD claim.

If you are considering going on sick leave or applying for LTD or considering accommodations, it is important to speak to your union or to a lawyer to ensure that your rights under your plan and your employment rights are protected.

OTIP Definition of Disability

Under the OTIP LTD plan, to be eligible for benefits, for the first part of your claim (the qualifying sick leave period and the following 24 months) you are considered disabled if, because of illness or injury, you are unable to perform the significant duties of your regular assignment. After this period, you are considered disabled if, because of illness or injury, you are unable to be gainfully employed.

The OTIP LTD definition of disability is all about functioning. As with other types of “invisible” conditions (conditions for which there is no objective testing, like x-rays or blood tests, etc.), you will need to be able to prove to OTIP that your mental health condition is so severe that it limits your ability to do your duties as a teacher (either in the classroom or online).

Proving Your Mental Health LTD Claim to OTIP

Mental health based LTD claims can be very difficult to prove and often result in litigation, when OTIP or some other insurance company denies the claim on the basis that the person’s symptoms are “self-reported” or that there is “no objective medical support” for the claim or that treatment is “not indicative a of a severe disabling condition” or that there is simply “insufficient evidence” to support disability.

Despite the challenges of supporting these claims, mental health disabilities are real and can be serious and long-term. These are legitimate claims that may need the assistance of your union or a lawyer to help you persuade OTIP of your inability to work. It is important to have an extensive medical record of your condition. When you see your doctor there will be a record of what you said and about the nature and severity of your condition and the treatment prescribed and the effectiveness of treatment. Be open and honest with your doctor, to ensure that the records are a true reflection of your condition because OTIP, like other insurers, may misinterpret something written in your medical records and rely on that information to deny or terminate your LTD benefits.

Comply With Treatment Recommendations to Support your OTIP LTD Claim

In terms of treatment, OTIP can deny or terminate your claim, if you are not receiving appropriate treatment. Since depression and anxiety, like many other mental health conditions, are treatable, OTIP will expect that your condition will improve with treatment. While OTIP and you will want a quick resolution of your symptoms and a quick return to your functioning and teaching, this is not always the outcome.

It is helpful to argue you have a severe condition if you attended regularly for treatment, sought the assistance of specialists (such as psychologists, psychotherapists, social workers, psychiatrists, group therapies) and followed doctors orders with respect to medication and other recommendations such as exercise. OTIP may then be better able to extract the nature and severity of your condition based on the recommendations of your doctors and the type of treatment you have been prescribed.

Include Physical Conditions in Your Mental Health OTIP LTD Claim

In addition, any physical symptoms that your depression or anxiety may present will likely help your case because physical limitations are more objective and more easily assessed and understood to be debilitating.

You and your doctors may find it simpler to document and record symptoms such as fatigue, aches, and digestive problems than irritability, sadness, dark feelings, and anxiety. If you have physical symptoms resulting from your mental health conditions or if you have other physical symptoms (such as pain or sleep disorder) which have been aggravated by your mental health condition, it is critical to include these conditions, at the outset and in your initial claim form for benefits. You can also remind your doctor to include these conditions in the form he/she will submit on your behalf.

The Importance of Disputing a Denial of Your OTIP LTD Claim

Sometimes it takes many months and even years to return to normal functioning. It is therefore critical to dispute any denial or termination of your benefits. A lack of income during recovery from a mental illness can have serious consequences, not only for your financial future (impacting your pension, as well) and also for your long-term prognosis for recovery.

We know how incredibly difficult it can be for people with severe depression and anxiety to seek proper treatment, let alone contact their union or a lawyer to help with the denial or termination of their OTIP LTD claim. However, the teachers who we speak with often feel a greater sense of relief that comes from the information and support that we provide during their claim and by taking over their dispute with OTIP, allowing them to focus on their treatment and recovery.

Help With Your OTIP LTD Application, Appeal and Litigation

We encourage you to contact us if your LTD claim has been denied or terminated by OTIP. We offer free consultations to help you decide whether to appeal the denial of your claim to OTIP or whether to proceed straight to litigation, suing OTIP and the insurance company. There is no requirement that you appeal or grieve the denial or termination of your OTIP LTD claim.

As an added support, during this pandemic only, we are offering Ontario Teachers free consultations at the sick leave/LTD application stage. If you are considering sick leave and/or applying for LTD, we encourage you to contact us to schedule a time for us to discuss the details of your LTD claim. We will discuss the claims process with you, provide you with direction with respect to what to include in your initial claim and review of your claims forms before you submit them. Every claim is different and it is important that you use wording and provide medical evidence that will be most supportive and persuasive to OTIP and result in the approval of your claim.

We appreciate that there are a number of resources available to help you in your LTD claim application and appeal. Unlike many other resources provided by OTIP (such as your school board and your union), we have the unique perspective that comes only from seeing and litigating countless OTIP LTD claims that have been denied or terminated and we can use that insight and experience to help you avoid those outcomes. One of our partners, Courtney Mulqueen, also has the added insight that only comes from having defended OTIP LTD claims.

If you have specific questions about LTD, please contact us to schedule a free individual consultation. We also invite you to visit our website www.mkdisabilitylawyers.com, where you will find an extensive collection of blog articles about LTD, including our most recent article for teachers “Preparing for the Unknown” and our “Guide to LTD for Union Representatives”, as well as information related to applying LTD during COVID-19.

Part 2: Struggling to be Seen & Believed

Making an OTIP LTD Claim for an “Invisible Condition”

https://www.pexels.com/photo/orange-and-white-shoes-2422896/

You are exhausted. You are in pain. You can hardly concentrate. Your memory is shot and you are feeling depressed and anxious. You may still not (and may never) know what is causing you to feel the way that you do. The one thing you do know is that there is no way that you will be able to do what is required of you as a teacher.

“Invisible Conditions” Are Difficult to Prove

Your family, your colleagues, your school administrators, the school board–they try to be supportive, but you wonder whether they believe you. You do not want to be perceived as malingering or exaggerating. You want to be believed and supported. Unfortunately, while you may be very good at explaining to your doctors and others how you feel and how your symptoms prevent you from functioning in your daily life, including teaching, some people will still not be convinced that you are ill or as severely ill, as you describe yourself to be.

This skepticism may be extremely hurtful or at the very least aggravating, if it comes from those you love and from those who you thought you could count on to believe and support you. However, when the skepticism comes from OTIP in the form of a denial or termination of your LTD benefits, it can be downright devastating.

OTIP Denied Your LTD Claim for an “Invisible Condition”

Financially, you were relying on OTIP to provide you with a percentage of your income and to protect your pension while you remain disabled. Without this income from OTIP LTD benefits, it will be impossible for you to meet your personal and family’s financial obligations and the risk to your pension could have serious consequences, down the road. The stress of having no income and not being able to work can also have serious and long-lasting effects on your mental health and serve to aggravate your existing physical symptoms.

You provided your OTIP LTD claims forms to OTIP. You were sure that OTIP would approve your claim. You went to great lengths to describe your symptoms and treatment and explain why you are not able to teach. Your doctor, she detailed your symptoms, described your treatment and set out a long list of functional restrictions and limitations. She even attached consultation reports from all the specialists you have seen and indicated upcoming referrals to other specialists and treatment providers. She stated, right on the form, that you are disabled from work and that your prognosis for return to work is unknown. Surely, this will be sufficient medical evidence to support your OTIP LTD claim.

Not so. You receive a detailed 3-page letter from OTIP. The bottom line is that your OTIP LTD claim has been denied. What are you to do? Was there anything you could have done differently to have had your OTIP LTD claim approved? Is there a way to now appeal or litigate the denial/termination by proving to OTIP that your illness is truly preventing you from returning to teaching?

No “Objective” Evidence of Disability for “Invisible Conditions”

The fact is that OTIP (as do all LTD administrators and insurers) likes “objective” evidence of disability. Objective evidence of disability makes it far simpler for OTIP to determine the nature and severity of a teacher’s disabling condition and assess whether a teacher is not functionally able to work and therefore, eligible for LTD benefits.

For example, it is easy for someone to rely on x-rays and MRI’s to prove that walking, sitting, and standing are not possible due to visible evidence of damage to the person’s back. If these functional abilities are necessary for a teacher to complete “the significant duties of that teacher’s specific assignment,” then the teacher’s LTD claim will likely be approved by OTIP without much more investigation.

Unfortunately, many types of serious disabilities do not lend themselves to being identified by “objective” measures, such as x-rays, CT-scans, blood tests, and other measurable diagnostic testing. For example, chronic pain and chronic fatigue conditions are very common disabilities that do not lend themselves to diagnosis by way of the usual objective tools or measures. A teacher may claim to not be able to work due to pain or fatigue, but how does OTIP know that these “self-reported” restrictions and limitations truly exist or are truly as severe as the teacher claims?

Why Does OTIP Deny LTD Claims for “Invisible Conditions”?

Insurance companies and LTD plan administrators, like OTIP, are in a tricky spot when it comes to “invisible conditions” or conditions for which “objective findings” are not possible to provide. On one hand, OTIP self-insures teachers for the very purpose of paying LTD claims to teachers who are not medically able to work. OTIP’s mandate is to support dedicated, hardworking teachers who have been paying their own premiums for LTD coverage since they began teaching in order to protect their incomes and pensions, in the event that they are not able to work due to any type of illness or injury.

On the other hand, OTIP must also be mindful of its financial obligations to its members; particularly, with respect to maintaining or reserving sufficient assets in its trust to ensure that benefits are available to pay all legitimate LTD claims and other financial obligations to any and all of it’s plan members. OTIP (like all LTD insurers) have a duty to its members to carefully assess all LTD claims to ensure that only those members who satisfy the definition of disability in the plan are paid benefits and only for so long as they continue to meet the terms and conditions of the plan.

Since January 1, 2020, OTIP administers and pays Teachers’ LTD claims. Prior to that date, LTD benefits were administered by OTIP but insured by Manulife. Meaning, Manulife, as an insurance company, was responsible for paying claims approved by OTIP. For LTD claims arising on or after January 1, 2020, OTIP assesses claims and then pays claims out of its trust. OTIP also offers members help appealing OTIP’s own decision to deny/terminate a member’s claim. (More about this service can be found on the OTIP website. More about our services, providing “outside” perspectives and assistance to teacher in their OTIP LTD claims can be found on our website)

Sick Leave – The First Step Toward Claiming OTIP LTD for an “Invisible Condition”

If you are experiencing disabling symptoms, such as pain, fatigue, depression, anxiety, and these symptoms are impacting your ability to function in your normal daily activities, including in your work as a teacher, then you will need to consider your options.

Assuming that your condition is so severe that no accommodations will allow you to do the “significant duties of your specific assignment”, then you will need to apply for Sick Leave to your school board. The information you provide from your doctor might have been sufficient for the board to grant you Sick Leave. Remember that your board is not entitled to know your diagnosis; only the nature of your condition and your functional restrictions and limitations and your prognosis. Sick Leave could be easier to get, since you do not need to provide a diagnosis; which you might not have at this point. Further, there can be no prejudice against “invisible condition diagnoses” like chronic pain or chronic fatigue or multiple-chemical sensitivity, if the board does not have that information.

If, for whatever reason, your board did not approve your Sick Leave claim, you may seek assistance from your union steward to advocate on your behalf. A grievance and arbitration might even be necessary to dispute the denial of your Sick Leave. It is important to take these steps, even if you do not feel up for the fight. Your long-term financial and emotional health are at greater risk, if you do not have an income and are not able to work. We can consult with you and your union steward, if you feel that our expertise might help you in proving your Sick Leave claim to your school board.

While on Sick Leave or going through the process of disputing the denial of your Sick Leave application, it is critical to remember that you will still need to submit an application for LTD benefits to OTIP, within the required timeframe; usually a within a few months of the end of the Sick Leave period and before the start of your OTIP LTD period. OTIP will need to do its own assessment of whether you have been continuously disabled throughout the Sick Leave period and into the LTD period. If you do not apply for OTIP LTD because your Sick Leave was denied or terminated by your board, you may prejudice your OTIP LTD claim. We encourage you to contact us if your Sick Leave has been denied by your board. We can work with you and your union steward to help you with your Sick Leave dispute and also with your OTIP LTD application.

Tips for Applying for OTIP LTD for an “Invisible Condition”

Applying for OTIP LTD for an “invisible condition” is a difficult task, at the best of times, and even more so when you are struggling with the symptoms of your disability. It is important that you get help where you can to ensure that your application is complete, accurate and most of all, persuasive to OTIP, to increase the likelihood that your claim will be approved and to avoid the stress of appealing or litigating a denial.

From decades of experience litigating OTIP LTD claims from both sides (as in-house counsel for Manulife defending OTIP LTD claims and as plaintiff’s counsel, representing Teachers in their LTD disputes with OTIP/Manulife), we know that LTD claims for “invisible conditions” are the most common types of claims that are denied or later, terminated. We understand why these claims were not successful and how to persuade OTIP of their legitimacy and resolve these disputes for our teacher clients.

Together, our three law partners have over 50 years of LTD litigation experience, including representing teachers, many with “invisible conditions”. Based on that experience, we have put together a list of the Three Most Important Tips for teachers applying for or appealing their OTIP LTD claims for “invisible conditions. It is our hope that our suggestions will increase the likelihood of these claims being approved early on, so that teachers can focus on their recovery without worrying as much about their income and pension.

The Three Most Important Tips for Applying/Appealing an OTIP LTD Claim for “Invisible Conditions”

  • Functionality is key. Always focus your answers and remind your doctor(s) to focus answers to questions on forms and in telephone calls, on your functioning; that is what you can and can not do, as a result of your symptoms. This is what OTIP should be most concerned with in assessing your claim under the plan.

Many people believe that a diagnosis is necessary to be successful in an LTD claim. Often with “invisible conditions” it takes a long-time to get a diagnosis and sometimes, the cause of your symptoms might never be determined. Approval for OTIP LTD does not hinge on a specific diagnosis; it’s all about whether you meet the definition of disability under the plan.

In terms of meeting the definition of disability, it will help your OTIP claims representative to know what the “significant duties of your specific assignment” are and what specifically prevents you from doing those duties. For example, pain and fatigue may prevent you from standing, walking, sitting, concentration, memory, communication, emotional regulation, etc. These are all functions you might need for your job. Therefore, OTIP needs to understand that your symptoms prevent you from making and executing lesson plans; from keeping awake for the day, let alone an entire period; from controlling your emotions in front of your class, etc.

  • Treatment is critical. Yes, treatment is extremely important for you, medically, but it is also important for proving your OTIP LTD claim. This holds true for all LTD claims, but especially so for claims for “invisible conditions”. The nature and extent of your treatment tells OTIP a lot about the severity of your condition, about your self-reported restrictions and limitations, and about your credibility. When all you have to rely on is what you are telling your doctors, you need another means to support your claim. Treatment is one of the best ways to prove to OTIP that you are not able to do your job and that you are not malingering or exaggerating your condition.

Follow your doctor’s orders; meaning you should be filling prescriptions, attending specialists’ appointments, getting investigations done (such as x-rays, blood tests, MRI’s, medical assessments, etc.), regularly attending therapies that are recommended or prescribed (such as physical therapy, massage, acupuncture, cognitive behavioural therapy, group therapies, etc.), and following your doctors’ recommendations regarding your functional limitations and restrictions (such as, trying to go on walks, not overdoing it, rest as needed, limiting bending, walking, sitting, etc.). Do not be afraid to advocate for yourself by researching your condition and talking to your doctor about possible referrals or treatments.

OTIP will be more likely to be convinced of the severity of your “invisible condition” and of your self-reported functional restrictions and limitations if there are medical records that document consistent self-reporting that is consistent with what your doctors observe (and which might be observed in OTIP’s surveillance). If your family doctor has referred you for countless tests and investigations and to various specialists, that would suggest that your doctor believes you and believes that your condition is so severe as to warrant these investigations and referrals. Specialist reports will lend additional credibility and validity to your self-reports, as they will also be consistent with what your family doctor and you are reporting.

It should be clear to OTIP, from all the testing and appointments and treatments that you are not choosing to be disabled. Who would opt to spend their days going from doctor to doctor and being poked and prodded and undergoing often painful (emotionally and physically) treatments, if they could work and earn their full salary?

  • Credibility can make or break a claim for “invisible conditions”. When completing forms or speaking with the OTIP representative who is assessing your claim, remember to be open and honest. You should also be careful not to be overly optimistic about your return to work or overstate your actual functional abilities.

Remember, it is not unreasonable to assume that OTIP wants to pay legitimate claims. Since you are legitimately struggling with your functioning, be clear about what you can not do, but also be clear on what you can do. You do not need to be bedridden everyday or in hospital to be eligible for LTD benefits. You must only satisfy OTIP that you are not able to do the “significant duties of your specific assignment”.

If OTIP finds a medical record or conducts surveillance and finds inconsistencies in what you have reported to them versus what you are doing in the “real world” or what you have reported to your doctors, your credibility comes into question and your claim becomes that much more difficult to prove.

Overstating your abilities or optimism for your recovery can be relied on OTIP to deny or terminate your claim. Some of us tend to be “Type A” and find it difficult to admit to ourselves and others that we are not doing well and we are not coping as well as we would like. While optimism and positivity may be key to recovery or key to living with a disabling condition, OTIP could easily misconstrue these sentiments and use them as a basis for denying/terminating your claim or initiating rehabilitation and return to work efforts, well before you are ready.

You May Still Need Outside Help to Prove Your “Invisible Condition” to OTIP

OTIP LTD Claims are extremely difficult claims for teachers to prove. That is why a vast majority of LTD litigation, including OTIP LTD cases, are based on these types of conditions.

We know that you have your unions and OTIP to assist you with your disability related claims. However, if you ever need an outside perspective, our experience with teacher OTIP LTD claims and with “invisible condition” LTD claims is extensive. We are available to teachers for free confidential consultations at any stage of your disability. Please do not hesitate to reach out to us.

Help With Your OTIP LTD Application, Appeal and Litigation

We encourage you to contact us if your LTD claim has been denied or terminated by OTIP. We offer free consultations to help you decide whether to appeal the denial of your claim to OTIP or whether to proceed straight to litigation, suing OTIP and the insurance company. There is no requirement that you appeal or grieve the denial or termination of your OTIP LTD claim.

As an added support, during this pandemic only, we are offering Ontario Teachers free consultations at the sick leave/LTD application stage. If you are considering sick leave and/or applying for LTD, we encourage you to contact us to schedule a time for us to discuss the details of your LTD claim. We will discuss the claims process with you, provide you with direction with respect to what to include in your initial claim and review of your claims forms before you submit them. Every claim is different and it is important that you use wording and provide medical evidence that will be most supportive and persuasive to OTIP and result in the approval of your claim.

We appreciate that there are a number of resources available to help you in your LTD claim application and appeal. Unlike many other resources provided by OTIP (such as your school board and your union), we have the unique perspective that comes only from seeing and litigating countless OTIP LTD claims that have been denied or terminated and we can use that insight and experience to help you avoid those outcomes. One of our partners, Courtney Mulqueen, also has the added insight that only comes from having defended OTIP LTD claims.

If you have specific questions about LTD, please contact us to schedule a free individual consultation. We also invite you to visit our website www.mkdisabilitylawyers.com, where you will find an extensive collection of blog articles about LTD, including our most recent article for teachers “Preparing for the Unknown” and our “Guide to LTD for Union Representatives”, as well as information related to applying LTD during COVID-19.

Part 3: Guidance for Teachers & Parents

Tips for Making an LTD Claim During COVID-19

https://www.pexels.com/photo/shabby-teddy-bear-in-medical-mask-sitting-on-pavement-against-blurred-mom-and-kid-in-park-4000604/

Teachers, in recent weeks we have spent a great deal of time with you, focused on the “what ifs” around becoming disabled during COVID-19. In this blog article, we a

Help With Your OTIP LTD Application, Appeal and Litigation

We encourage you to contact us if your LTD claim has been denied or terminated by OTIP. We offer free consultations to help you decide whether to appeal the denial of your claim to OTIP or whether to proceed straight to litigation, suing OTIP and the insurance company. There is no requirement that you appeal or grieve the denial or termination of your OTIP LTD claim.

As an added support, during this pandemic only, we are offering Ontario Teachers free consultations at the sick leave/LTD application stage. If you are considering sick leave and/or applying for LTD, we encourage you to contact us to schedule a time for us to discuss the details of your LTD claim. We will discuss the claims process with you, provide you with direction with respect to what to include in your initial claim and review of your claims forms before you submit them. Every claim is different and it is important that you use wording and provide medical evidence that will be most supportive and persuasive to OTIP and result in the approval of your claim.

We appreciate that there are a number of resources available to help you in your LTD claim application and appeal. Unlike many other resources provided by OTIP (such as your school board and your union), we have the unique perspective that comes only from seeing and litigating countless OTIP LTD claims that have been denied or terminated and we can use that insight and experience to help you avoid those outcomes. One of our partners, Courtney Mulqueen, also has the added insight that only comes from having defended OTIP LTD claims.

If you have specific questions about LTD, please contact us to schedule a free individual consultation. We also invite you to visit our website www.mkdisabilitylawyers.com, where you will find an extensive collection of blog articles about LTD, including our most recent article for teachers “Preparing for the Unknown” and our “Guide to LTD for Union Representatives”, as well as information related to applying LTD during COVID-19.

Teachers Battling Back-to-School Blues

Making an OTIP LTD Claim for a Mental Health Condition

https://www.pexels.com/photo/adult-back-view-beautiful-bench-316889/

Over the course of the pandemic, I have heard from many teachers experiencing serious and debilitating stress and anxiety. Last year, many teachers were forced to pivot from face-to-face to online and then back to face-to-face. This school year has come with its own challenges–health and safety concerns and juggling in-person and online teaching, concurrently.

In addition to the unique challenges of educating and supporting students in this pandemic, teachers must also manage their own personal stress and worries around the pandemic as it relates to their own and their families’ health and well-being. Combined, these various constant and long-term stressors can take their toll.

For some teachers, the demands of teaching and living through the pandemic has been difficult but manageable. However, for others, the stress of returning to school this year and teaching either in-person or online has been a harrowing undertaking and not all teachers will be successful in their return to the classroom.

This article is for teachers who are struggling with mental health conditions and are not able to return to work after a period of sick leave and may need some guidance with respect to submitting an OTIP LTD claim for mental health conditions.

Mental Health Conditions Resulting in OTIP LTD Claims

It may be that the accumulated stress of these past several months and recent weeks has caused an aggravation of a pre-existing mental health related condition or it could be that all this stress has triggered a new mental illness. In either case, you may find that your mental health is suffering. For some of you, your mental health may be severely limiting your ability to perform your duties as a teacher, let alone perform your regular daily activities (such as parenting, socializing, self-care, housekeeping, recreation, reading, communication, etc.).

As you probably know, some of the most common mental health conditions are: depression, anxiety, personality disorders and bi-polar disorder. These conditions can severely limit your ability to work and may form the basis for an OTIP long-term disability claim.

Of those conditions, over the past several months, we have seen a surge of claims based on depression and anxiety. According to the World Health Organization, depression is a leading cause of disability, affecting approximately 300 million people worldwide and can lead to long-term disability. According to WebMD, the most common types of depression are: major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder (SAD), psychotic depression, peripartum (postpartum) depression, premenstrual dysphoric disorder (PMDD), “situational” depression, and atypical depression.

Teachers Struggling with Depression

While you may feel “off” or “not like yourself”, you might not realize that you could be experiencing symptoms of depression and anxiety. Some symptoms for you to look out for now, in the coming weeks and in the coming months, include:

  • Persistent sad, anxious, or “empty” moods
  • Feelings of hopelessness or pessimism
  • Fatigue
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Insomnia, early-morning wakefulness, or sleeping too much
  • Appetite or weight changes
  • Thoughts of death or suicide, suicide attempts
  • Aches, pains, headaches, or cramps and digestive problems without a clear physical cause and that do not ease even with treatment

Teachers Struggling with Anxiety

In addition to depression, we see many teachers and other professionals suffering with anxiety and panic disorders. There are several types of anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, phobias, agoraphobia, separation anxiety, selective mutism and medication-induced anxiety disorder. These conditions alone or combined with depression, can be difficult to manage and often requires intensive treatment to improve functioning to the extent that returning to work is possible.

According to WebMD, the main symptom of anxiety disorders is excessive fear or worry. Anxiety disorders can also make it hard to breathe, sleep, stay still, and concentrate. Your specific symptoms depend on the type of anxiety disorder you have. Many of the teachers we have spoken with in recent weeks are experiencing many of these and other symptoms of anxiety. Some teachers will be able to manage and overcome their anxiety, while others may struggle to function or return to or continue to teach.

Some of the most common symptoms of anxiety to look out for are:

  • Panic, fear, and uneasiness
  • Feelings of panic, doom, or danger
  • Sleep problems
  • Not being able to stay calm and still
  • Cold, sweaty, numb, or tingling hands or feet
  • Shortness of breath
  • Breathing faster and more quickly than normal (hyperventilation)
  • Heart palpitations
  • Dry mouth
  • Nausea
  • Tense muscles
  • Dizziness
  • Thinking about a problem over and over again and unable to stop (rumination)
  • Inability to concentrate
  • Intensely or obsessively avoiding feared objects or places

Unable to Perform Duties of Your Regular Assignment

Symptoms of mental illness, and most commonly symptoms of depression and anxiety can impede your ability to perform the “duties of your regular assignment” and make it impossible for you to work, let alone perform many of your other responsibilities.

You might find it difficult or impossible to plan and prepare lessons, engage and teach students, complete marking, evaluate student performance, attend and participate in meetings, be on time for classes, be mentally present while teaching, promote a positive learning environment, learn and adapt to teaching online, and to enforce and comply with the countless health and safety protocols that are expected to be in place.

However, if you are struggling, it is important you seek medical attention and possibly help from your union or a lawyer, as soon as possible to ensure that your LTD claim is approved in the first instance and if not, to be prepared to dispute any potential denial.

Knowing your limits and knowing when and if to stop working and apply for Sick Leave is critical. Stopping work while you are still functioning fairly well and completing your duties, may not be a good idea and could lead to the denial of your sick leave and LTD claims. Continuing to work while you are not well could strain your relationship with your colleagues, students, administrators and your board. Sick leave could be a way to take some time to recover while preserving your relationships with your employer.

You may also wish to consider accommodations to allow you to continue to work. It is important that you do not agree to accommodations that essentially change your regular assignment to the extent that you are no longer doing your regular duties nor earning your regular income. Working part-time could jeopardize a future OTIP LTD claim.

If you are considering going on sick leave or applying for LTD or considering accommodations, it is important to speak to your union or to a lawyer to ensure that your rights under your plan and your employment rights are protected.

OTIP Definition of Disability

Under the OTIP LTD plan, to be eligible for benefits, for the first part of your claim (the qualifying sick leave period and the following 24 months) you are considered disabled if, because of illness or injury, you are unable to perform the significant duties of your regular assignment. After this period, you are considered disabled if, because of illness or injury, you are unable to be gainfully employed.

The OTIP LTD definition of disability is all about functioning. As with other types of “invisible” conditions (conditions for which there is no objective testing, like x-rays or blood tests, etc.), you will need to be able to prove to OTIP that your mental health condition is so severe that it limits your ability to do your duties as a teacher (either in the classroom or online).

Proving Your Mental Health LTD Claim to OTIP

Mental health based LTD claims can be very difficult to prove and often result in litigation, when OTIP or some other insurance company denies the claim on the basis that the person’s symptoms are “self-reported” or that there is “no objective medical support” for the claim or that treatment is “not indicative a of a severe disabling condition” or that there is simply “insufficient evidence” to support disability.

Despite the challenges of supporting these claims, mental health disabilities are real and can be serious and long-term. These are legitimate claims that may need the assistance of your union or a lawyer to help you persuade OTIP of your inability to work. It is important to have an extensive medical record of your condition. When you see your doctor there will be a record of what you said and about the nature and severity of your condition and the treatment prescribed and the effectiveness of treatment. Be open and honest with your doctor, to ensure that the records are a true reflection of your condition because OTIP, like other insurers, may misinterpret something written in your medical records and rely on that information to deny or terminate your LTD benefits.

Comply With Treatment Recommendations to Support your OTIP LTD Claim

In terms of treatment, OTIP can deny or terminate your claim, if you are not receiving appropriate treatment. Since depression and anxiety, like many other mental health conditions, are treatable, OTIP will expect that your condition will improve with treatment. While OTIP and you will want a quick resolution of your symptoms and a quick return to your functioning and teaching, this is not always the outcome.

It is helpful to argue you have a severe condition if you attended regularly for treatment, sought the assistance of specialists (such as psychologists, psychotherapists, social workers, psychiatrists, group therapies) and followed doctors orders with respect to medication and other recommendations such as exercise. OTIP may then be better able to extract the nature and severity of your condition based on the recommendations of your doctors and the type of treatment you have been prescribed.

Include Physical Conditions in Your Mental Health OTIP LTD Claim

In addition, any physical symptoms that your depression or anxiety may present will likely help your case because physical limitations are more objective and more easily assessed and understood to be debilitating.

You and your doctors may find it simpler to document and record symptoms such as fatigue, aches, and digestive problems than irritability, sadness, dark feelings, and anxiety. If you have physical symptoms resulting from your mental health conditions or if you have other physical symptoms (such as pain or sleep disorder) which have been aggravated by your mental health condition, it is critical to include these conditions, at the outset and in your initial claim form for benefits. You can also remind your doctor to include these conditions in the form he/she will submit on your behalf.

The Importance of Disputing a Denial of Your OTIP LTD Claim

Sometimes it takes many months and even years to return to normal functioning. It is therefore critical to dispute any denial or termination of your benefits. A lack of income during recovery from a mental illness can have serious consequences, not only for your financial future (impacting your pension, as well) and also for your long-term prognosis for recovery.

We know how incredibly difficult it can be for people with severe depression and anxiety to seek proper treatment, let alone contact their union or a lawyer to help with the denial or termination of their OTIP LTD claim. However, the teachers who we speak with often feel a greater sense of relief that comes from the information and support that we provide during their claim and by taking over their dispute with OTIP, allowing them to focus on their treatment and recovery.

Help With Your OTIP LTD Application, Appeal and Litigation

We encourage you to contact us if your LTD claim has been denied or terminated by OTIP. We offer free consultations to help you decide whether to appeal the denial of your claim to OTIP or whether to proceed straight to litigation, suing OTIP and the insurance company. There is no requirement that you appeal or grieve the denial or termination of your OTIP LTD claim.

As an added support, during this pandemic only, we are offering Ontario Teachers free consultations at the sick leave/LTD application stage. If you are considering sick leave and/or applying for LTD, we encourage you to contact us to schedule a time for us to discuss the details of your LTD claim. We will discuss the claims process with you, provide you with direction with respect to what to include in your initial claim and review of your claims forms before you submit them. Every claim is different and it is important that you use wording and provide medical evidence that will be most supportive and persuasive to OTIP and result in the approval of your claim.

We appreciate that there are a number of resources available to help you in your LTD claim application and appeal. Unlike many other resources provided by OTIP (such as your school board and your union), we have the unique perspective that comes only from seeing and litigating countless OTIP LTD claims that have been denied or terminated and we can use that insight and experience to help you avoid those outcomes. One of our partners, Courtney Mulqueen, also has the added insight that only comes from having defended OTIP LTD claims.

If you have specific questions about LTD, please contact us to schedule a free individual consultation. We also invite you to visit our website www.mkdisabilitylawyers.com, where you will find an extensive collection of blog articles about LTD, including our most recent article for teachers “Preparing for the Unknown” and our “Guide to LTD for Union Representatives”, as well as information related to applying LTD during COVID-19.

Part 2: Struggling to be Seen & Believed

Making an OTIP LTD Claim for an “Invisible Condition”

https://www.pexels.com/photo/orange-and-white-shoes-2422896/

You are exhausted. You are in pain. You can hardly concentrate. Your memory is shot and you are feeling depressed and anxious. You may still not (and may never) know what is causing you to feel the way that you do. The one thing you do know is that there is no way that you will be able to do what is required of you as a teacher.

“Invisible Conditions” Are Difficult to Prove

Your family, your colleagues, your school administrators, the school board–they try to be supportive, but you wonder whether they believe you. You do not want to be perceived as malingering or exaggerating. You want to be believed and supported. Unfortunately, while you may be very good at explaining to your doctors and others how you feel and how your symptoms prevent you from functioning in your daily life, including teaching, some people will still not be convinced that you are ill or as severely ill, as you describe yourself to be.

This skepticism may be extremely hurtful or at the very least aggravating, if it comes from those you love and from those who you thought you could count on to believe and support you. However, when the skepticism comes from OTIP in the form of a denial or termination of your LTD benefits, it can be downright devastating.

OTIP Denied Your LTD Claim for an “Invisible Condition”

Financially, you were relying on OTIP to provide you with a percentage of your income and to protect your pension while you remain disabled. Without this income from OTIP LTD benefits, it will be impossible for you to meet your personal and family’s financial obligations and the risk to your pension could have serious consequences, down the road. The stress of having no income and not being able to work can also have serious and long-lasting effects on your mental health and serve to aggravate your existing physical symptoms.

You provided your OTIP LTD claims forms to OTIP. You were sure that OTIP would approve your claim. You went to great lengths to describe your symptoms and treatment and explain why you are not able to teach. Your doctor, she detailed your symptoms, described your treatment and set out a long list of functional restrictions and limitations. She even attached consultation reports from all the specialists you have seen and indicated upcoming referrals to other specialists and treatment providers. She stated, right on the form, that you are disabled from work and that your prognosis for return to work is unknown. Surely, this will be sufficient medical evidence to support your OTIP LTD claim.

Not so. You receive a detailed 3-page letter from OTIP. The bottom line is that your OTIP LTD claim has been denied. What are you to do? Was there anything you could have done differently to have had your OTIP LTD claim approved? Is there a way to now appeal or litigate the denial/termination by proving to OTIP that your illness is truly preventing you from returning to teaching?

No “Objective” Evidence of Disability for “Invisible Conditions”

The fact is that OTIP (as do all LTD administrators and insurers) likes “objective” evidence of disability. Objective evidence of disability makes it far simpler for OTIP to determine the nature and severity of a teacher’s disabling condition and assess whether a teacher is not functionally able to work and therefore, eligible for LTD benefits.

For example, it is easy for someone to rely on x-rays and MRI’s to prove that walking, sitting, and standing are not possible due to visible evidence of damage to the person’s back. If these functional abilities are necessary for a teacher to complete “the significant duties of that teacher’s specific assignment,” then the teacher’s LTD claim will likely be approved by OTIP without much more investigation.

Unfortunately, many types of serious disabilities do not lend themselves to being identified by “objective” measures, such as x-rays, CT-scans, blood tests, and other measurable diagnostic testing. For example, chronic pain and chronic fatigue conditions are very common disabilities that do not lend themselves to diagnosis by way of the usual objective tools or measures. A teacher may claim to not be able to work due to pain or fatigue, but how does OTIP know that these “self-reported” restrictions and limitations truly exist or are truly as severe as the teacher claims?

Why Does OTIP Deny LTD Claims for “Invisible Conditions”?

Insurance companies and LTD plan administrators, like OTIP, are in a tricky spot when it comes to “invisible conditions” or conditions for which “objective findings” are not possible to provide. On one hand, OTIP self-insures teachers for the very purpose of paying LTD claims to teachers who are not medically able to work. OTIP’s mandate is to support dedicated, hardworking teachers who have been paying their own premiums for LTD coverage since they began teaching in order to protect their incomes and pensions, in the event that they are not able to work due to any type of illness or injury.

On the other hand, OTIP must also be mindful of its financial obligations to its members; particularly, with respect to maintaining or reserving sufficient assets in its trust to ensure that benefits are available to pay all legitimate LTD claims and other financial obligations to any and all of it’s plan members. OTIP (like all LTD insurers) have a duty to its members to carefully assess all LTD claims to ensure that only those members who satisfy the definition of disability in the plan are paid benefits and only for so long as they continue to meet the terms and conditions of the plan.

Since January 1, 2020, OTIP administers and pays Teachers’ LTD claims. Prior to that date, LTD benefits were administered by OTIP but insured by Manulife. Meaning, Manulife, as an insurance company, was responsible for paying claims approved by OTIP. For LTD claims arising on or after January 1, 2020, OTIP assesses claims and then pays claims out of its trust. OTIP also offers members help appealing OTIP’s own decision to deny/terminate a member’s claim. (More about this service can be found on the OTIP website. More about our services, providing “outside” perspectives and assistance to teacher in their OTIP LTD claims can be found on our website)

Sick Leave – The First Step Toward Claiming OTIP LTD for an “Invisible Condition”

If you are experiencing disabling symptoms, such as pain, fatigue, depression, anxiety, and these symptoms are impacting your ability to function in your normal daily activities, including in your work as a teacher, then you will need to consider your options.

Assuming that your condition is so severe that no accommodations will allow you to do the “significant duties of your specific assignment”, then you will need to apply for Sick Leave to your school board. The information you provide from your doctor might have been sufficient for the board to grant you Sick Leave. Remember that your board is not entitled to know your diagnosis; only the nature of your condition and your functional restrictions and limitations and your prognosis. Sick Leave could be easier to get, since you do not need to provide a diagnosis; which you might not have at this point. Further, there can be no prejudice against “invisible condition diagnoses” like chronic pain or chronic fatigue or multiple-chemical sensitivity, if the board does not have that information.

If, for whatever reason, your board did not approve your Sick Leave claim, you may seek assistance from your union steward to advocate on your behalf. A grievance and arbitration might even be necessary to dispute the denial of your Sick Leave. It is important to take these steps, even if you do not feel up for the fight. Your long-term financial and emotional health are at greater risk, if you do not have an income and are not able to work. We can consult with you and your union steward, if you feel that our expertise might help you in proving your Sick Leave claim to your school board.

While on Sick Leave or going through the process of disputing the denial of your Sick Leave application, it is critical to remember that you will still need to submit an application for LTD benefits to OTIP, within the required timeframe; usually a within a few months of the end of the Sick Leave period and before the start of your OTIP LTD period. OTIP will need to do its own assessment of whether you have been continuously disabled throughout the Sick Leave period and into the LTD period. If you do not apply for OTIP LTD because your Sick Leave was denied or terminated by your board, you may prejudice your OTIP LTD claim. We encourage you to contact us if your Sick Leave has been denied by your board. We can work with you and your union steward to help you with your Sick Leave dispute and also with your OTIP LTD application.

Tips for Applying for OTIP LTD for an “Invisible Condition”

Applying for OTIP LTD for an “invisible condition” is a difficult task, at the best of times, and even more so when you are struggling with the symptoms of your disability. It is important that you get help where you can to ensure that your application is complete, accurate and most of all, persuasive to OTIP, to increase the likelihood that your claim will be approved and to avoid the stress of appealing or litigating a denial.

From decades of experience litigating OTIP LTD claims from both sides (as in-house counsel for Manulife defending OTIP LTD claims and as plaintiff’s counsel, representing Teachers in their LTD disputes with OTIP/Manulife), we know that LTD claims for “invisible conditions” are the most common types of claims that are denied or later, terminated. We understand why these claims were not successful and how to persuade OTIP of their legitimacy and resolve these disputes for our teacher clients.

Together, our three law partners have over 50 years of LTD litigation experience, including representing teachers, many with “invisible conditions”. Based on that experience, we have put together a list of the Three Most Important Tips for teachers applying for or appealing their OTIP LTD claims for “invisible conditions. It is our hope that our suggestions will increase the likelihood of these claims being approved early on, so that teachers can focus on their recovery without worrying as much about their income and pension.

The Three Most Important Tips for Applying/Appealing an OTIP LTD Claim for “Invisible Conditions”

  • Functionality is key. Always focus your answers and remind your doctor(s) to focus answers to questions on forms and in telephone calls, on your functioning; that is what you can and can not do, as a result of your symptoms. This is what OTIP should be most concerned with in assessing your claim under the plan.

Many people believe that a diagnosis is necessary to be successful in an LTD claim. Often with “invisible conditions” it takes a long-time to get a diagnosis and sometimes, the cause of your symptoms might never be determined. Approval for OTIP LTD does not hinge on a specific diagnosis; it’s all about whether you meet the definition of disability under the plan.

In terms of meeting the definition of disability, it will help your OTIP claims representative to know what the “significant duties of your specific assignment” are and what specifically prevents you from doing those duties. For example, pain and fatigue may prevent you from standing, walking, sitting, concentration, memory, communication, emotional regulation, etc. These are all functions you might need for your job. Therefore, OTIP needs to understand that your symptoms prevent you from making and executing lesson plans; from keeping awake for the day, let alone an entire period; from controlling your emotions in front of your class, etc.

  • Treatment is critical. Yes, treatment is extremely important for you, medically, but it is also important for proving your OTIP LTD claim. This holds true for all LTD claims, but especially so for claims for “invisible conditions”. The nature and extent of your treatment tells OTIP a lot about the severity of your condition, about your self-reported restrictions and limitations, and about your credibility. When all you have to rely on is what you are telling your doctors, you need another means to support your claim. Treatment is one of the best ways to prove to OTIP that you are not able to do your job and that you are not malingering or exaggerating your condition.

Follow your doctor’s orders; meaning you should be filling prescriptions, attending specialists’ appointments, getting investigations done (such as x-rays, blood tests, MRI’s, medical assessments, etc.), regularly attending therapies that are recommended or prescribed (such as physical therapy, massage, acupuncture, cognitive behavioural therapy, group therapies, etc.), and following your doctors’ recommendations regarding your functional limitations and restrictions (such as, trying to go on walks, not overdoing it, rest as needed, limiting bending, walking, sitting, etc.). Do not be afraid to advocate for yourself by researching your condition and talking to your doctor about possible referrals or treatments.

OTIP will be more likely to be convinced of the severity of your “invisible condition” and of your self-reported functional restrictions and limitations if there are medical records that document consistent self-reporting that is consistent with what your doctors observe (and which might be observed in OTIP’s surveillance). If your family doctor has referred you for countless tests and investigations and to various specialists, that would suggest that your doctor believes you and believes that your condition is so severe as to warrant these investigations and referrals. Specialist reports will lend additional credibility and validity to your self-reports, as they will also be consistent with what your family doctor and you are reporting.

It should be clear to OTIP, from all the testing and appointments and treatments that you are not choosing to be disabled. Who would opt to spend their days going from doctor to doctor and being poked and prodded and undergoing often painful (emotionally and physically) treatments, if they could work and earn their full salary?

  • Credibility can make or break a claim for “invisible conditions”. When completing forms or speaking with the OTIP representative who is assessing your claim, remember to be open and honest. You should also be careful not to be overly optimistic about your return to work or overstate your actual functional abilities.

Remember, it is not unreasonable to assume that OTIP wants to pay legitimate claims. Since you are legitimately struggling with your functioning, be clear about what you can not do, but also be clear on what you can do. You do not need to be bedridden everyday or in hospital to be eligible for LTD benefits. You must only satisfy OTIP that you are not able to do the “significant duties of your specific assignment”.

If OTIP finds a medical record or conducts surveillance and finds inconsistencies in what you have reported to them versus what you are doing in the “real world” or what you have reported to your doctors, your credibility comes into question and your claim becomes that much more difficult to prove.

Overstating your abilities or optimism for your recovery can be relied on OTIP to deny or terminate your claim. Some of us tend to be “Type A” and find it difficult to admit to ourselves and others that we are not doing well and we are not coping as well as we would like. While optimism and positivity may be key to recovery or key to living with a disabling condition, OTIP could easily misconstrue these sentiments and use them as a basis for denying/terminating your claim or initiating rehabilitation and return to work efforts, well before you are ready.

You May Still Need Outside Help to Prove Your “Invisible Condition” to OTIP

OTIP LTD Claims are extremely difficult claims for teachers to prove. That is why a vast majority of LTD litigation, including OTIP LTD cases, are based on these types of conditions.

We know that you have your unions and OTIP to assist you with your disability related claims. However, if you ever need an outside perspective, our experience with teacher OTIP LTD claims and with “invisible condition” LTD claims is extensive. We are available to teachers for free confidential consultations at any stage of your disability. Please do not hesitate to reach out to us.

Help With Your OTIP LTD Application, Appeal and Litigation

We encourage you to contact us if your LTD claim has been denied or terminated by OTIP. We offer free consultations to help you decide whether to appeal the denial of your claim to OTIP or whether to proceed straight to litigation, suing OTIP and the insurance company. There is no requirement that you appeal or grieve the denial or termination of your OTIP LTD claim.

As an added support, during this pandemic only, we are offering Ontario Teachers free consultations at the sick leave/LTD application stage. If you are considering sick leave and/or applying for LTD, we encourage you to contact us to schedule a time for us to discuss the details of your LTD claim. We will discuss the claims process with you, provide you with direction with respect to what to include in your initial claim and review of your claims forms before you submit them. Every claim is different and it is important that you use wording and provide medical evidence that will be most supportive and persuasive to OTIP and result in the approval of your claim.

We appreciate that there are a number of resources available to help you in your LTD claim application and appeal. Unlike many other resources provided by OTIP (such as your school board and your union), we have the unique perspective that comes only from seeing and litigating countless OTIP LTD claims that have been denied or terminated and we can use that insight and experience to help you avoid those outcomes. One of our partners, Courtney Mulqueen, also has the added insight that only comes from having defended OTIP LTD claims.

If you have specific questions about LTD, please contact us to schedule a free individual consultation. We also invite you to visit our website www.mkdisabilitylawyers.com, where you will find an extensive collection of blog articles about LTD, including our most recent article for teachers “Preparing for the Unknown” and our “Guide to LTD for Union Representatives”, as well as information related to applying LTD during COVID-19.

Part 3: Guidance for Teachers & Parents

Tips for Making an LTD Claim During COVID-19

https://www.pexels.com/photo/shabby-teddy-bear-in-medical-mask-sitting-on-pavement-against-blurred-mom-and-kid-in-park-4000604/

Teachers, in recent weeks we have spent a great deal of time with you, focused on the “what ifs” around becoming disabled during COVID-19. In this blog article, we a

Help With Your OTIP LTD Application, Appeal and Litigation

We encourage you to contact us if your LTD claim has been denied or terminated by OTIP. We offer free consultations to help you decide whether to appeal the denial of your claim to OTIP or whether to proceed straight to litigation, suing OTIP and the insurance company. There is no requirement that you appeal or grieve the denial or termination of your OTIP LTD claim.

As an added support, during this pandemic only, we are offering Ontario Teachers free consultations at the sick leave/LTD application stage. If you are considering sick leave and/or applying for LTD, we encourage you to contact us to schedule a time for us to discuss the details of your LTD claim. We will discuss the claims process with you, provide you with direction with respect to what to include in your initial claim and review of your claims forms before you submit them. Every claim is different and it is important that you use wording and provide medical evidence that will be most supportive and persuasive to OTIP and result in the approval of your claim.

We appreciate that there are a number of resources available to help you in your LTD claim application and appeal. Unlike many other resources provided by OTIP (such as your school board and your union), we have the unique perspective that comes only from seeing and litigating countless OTIP LTD claims that have been denied or terminated and we can use that insight and experience to help you avoid those outcomes. One of our partners, Courtney Mulqueen, also has the added insight that only comes from having defended OTIP LTD claims.

If you have specific questions about LTD, please contact us to schedule a free individual consultation. We also invite you to visit our website www.mkdisabilitylawyers.com, where you will find an extensive collection of blog articles about LTD, including our most recent article for teachers “Preparing for the Unknown” and our “Guide to LTD for Union Representatives”, as well as information related to applying LTD during COVID-19.