Why Do Clients Reach Out at the End of Summer?

Having been litigating exclusively Short-Term and Long-Term Disability insurance claims for over 20 years now, I’ve come to notice a trend. I like to call it the “End of Summer Conundrum”. 

Typically, starting around now, the end of August, I get an onslaught of inquiries from two different types of clients: those who are either on Short-Term or Long-Term disability or who are still working and are considering applying for disability benefits. What they have in common is that they are contemplating returning to work in the Fall. My general advice in both scenarios is the same but for the sake of clarity let’s first unpack both of these types of clients’ situations. 

How Should I Approach the Decision to Return to Work?

First there are the clients that are still working. They’ve been pushing themselves to continue to work for some time. These “Hopeful Fighters” as I like to call them, thought that with good weather and some vacation time off, they would feel better and be able to continue to work come the Fall. While I appreciate and respect their optimism and determination, in many cases, these folks find that the summer has not resulted in a drastic improvement in their condition. If they do go back to work following a vacation, their symptoms have come back in full force and sometimes, even worse than before. (As you would expect, we see a lot of Teachers who fall within this category.)

What If I’m Already on Medical Leave and Facing Pressure to Return to Work?

We have the clients that are already on an approved medical leave, receiving either Short-Term or Long-Term disability benefits. While some might be just as optimistic and determined as my “Hopeful Fighters”, most are not.  They are usually feeling significant internal and external pressures to return to work. Their insurance company might be pushing them to get back to work before they are ready, under threat of termination of their benefits. They may have even been given a return to work date in the Fall. 

These clients are struggling financially and psychologically. Work gives purpose and of course, a greater income than disability benefits. I often hear these clients tell me that they “can’t afford” not to work. They are incredibly anxious about what will happen if they are not successful in their return to work or what the insurance company will do if they do not try.  I like to call these clients my “Rock & Hard Place” clients. They feel they have no choice but to return to work.

Keep in mind that I don’t hear from people whose medical conditions have improved to the extent that they are in fact able to return to work. The people who do reach out to us are the ones that are not well enough to return to work and desperately need some guidance on how to navigate their disability claims. 

What Should Be My Primary Concern?

The first thing I tell clients is “Your health comes first”. It’s that simple. The fact is that if you are functionally not able to work, then you should not be working and you are likely entitled to disability benefits. The last thing you want to do is to return to work prematurely, aggravate your health and suffer a setback in your recovery. 

Another go-to phrase I often hear myself saying to both of these types of clients is  “What’s good for your health, is good for your claim”. If you are not able to work, then your doctors and treatment providers will need to support your disability claim by providing an abundance of medical information about the severity of your condition, your functional restrictions and limitations and your treatment. More time off to focus on treatment is good for your health and medical evidence confirming this is good for your claim. 

What If My Healthcare Team Thinks I’m Ready to Return to Work?

If your health care team is of the opinion that you are ready to return to work or that work would be good for you or if they are not supporting your disability claim, then it is unlikely you will be successful in your disability claim and trying to return to work may be the way to go. If it goes sideways, then what better evidence of disability is there than trying to work and not being successful. (More later about situations where our clients are disabled but do not have a supportive medical team to back them up.)

As a lawyer, I must of course throw in the obligatory disclaimer, at this point in my article: Eligibility for disability benefits is determined by the disability plan or policy under which you are covered. Every claim is different and it is best to speak to a lawyer to review the particulars of your situation.

While my two go-to adages hold true whatever the situation and whichever type of client I am speaking with, inevitably, as we dive deeper into these clients’ individual circumstances, a flurry of questions and concerns pour out of them. Their anxiety is often palpable. 

What Are the Most Common Questions About Returning to Work?

Let’s go through and address the Top 10 most common and pressing questions and concerns I hear from my clients, as they relate to this End of Summer Conundrum of whether to work or not to work:

1. I need my full salary and I don’t want to jeopardize my reputation at work by going on medical leave. 

You have disability insurance for a reason. If you are not able to perform your duties up to your employer’s expectations, due to your medical condition, then you may jeopardize your job and your reputation. Also, by continuing to work, you might also be causing further harm to your health and prolonging your recovery and adding to the amount of time you will need to be off work.

2. Will my employer fire me if I do not go back to work?

Your employer is not able to fire because you are disabled. Doing so would be contrary to Human Rights and Employment laws. Employers offer employees disability benefits to allow them time to recover and return to work, while still having some income. You could be fired if you continue to work but you are not able to perform your job duties. You should also never resign from your job because you are disabled. This leads to the loss of your extended health coverage and other benefits. Remember that just because you have not heard from your employer while you have been on disability benefits, doesn’t mean you are not still employed. If an employer wants to terminate you, they will need to do so in writing.

3. I’m worried my disability claim won’t be approved. What happens then?

If your disability claim is not approved, you have options. You can return to work (only if you are well enough). Another option is you can submit more information as a part of an appeal to the insurance company. Finally, you can hire a lawyer to help you with your appeal or to sue the insurance company. So long as your employer is aware that you are disputing the denial of your disability claim, they should not be firing you. However, they may ask for general information about your functioning to determine if they can accommodate a return to work. You should not ignore your employer, while disputing your disability claim, as you do not want them to think you’ve abandoned your job.

4. I do not have a diagnosis yet, can I even apply for disability benefits?

Yes you can and should apply for disability benefits even if your condition has not yet been diagnosed. A diagnosis is not required for benefits to be approved. You need to only prove that your illness or injury is preventing you from working. You should continue to seek answers to what is causing your condition to ensure that you are able to find appropriate treatment to help you recover. 

5. My doctor says I should try to go back to work, but I don’t feel like I’m ready. What should I do?

Your family doctor is very important to your disability claim. It is important they have a good understanding of the job and what it is about your medical condition that limits your ability to work. They should also have a sense of what you need to prove to satisfy the eligibility requirements to receive disability benefits. Some doctors may believe you need to be far more severely impaired than the definition of disability in your insurance policy requires. In some instances, you may need to rely on the opinion of some other specialist who knows you well and is able to support your claim. If you do not have a family doctor, emergency and walk-in clinic doctors may be your only option.

6. The insurance company is threatening to terminate my benefits if I don’t return to work. What are my options?

In this case, you need to see your doctor and treatment providers right away. The threat of termination of benefits can cause a great deal of stress which can further aggravate your disabling conditions. Your doctors and others need to step in to write very strongly worded letters/reports explaining the nature and severity of your condition, your treatment, your functional limitations and restrictions. It would be helpful for them to provide the opinion that a premature return to work will cause you harm and delay your recovery. Alternatively, you could attempt to return to work and again, the best proof of not being able to work, is trying yoru best and failing. Be sure that you continue with regular treatment and visits to your doctor during any period of returning to work.

7. My employer says they will accommodate my disability, but I’m not sure they will and I’m not sure those accommodations are going to be enough for me to do my job.

Your employer has a legal duty to accommodate your disability, pursuant to the Human Rights Code. Unfortunately, accommodations do not have to be perfect; they must only be reasonable.  They also do not need to go so far as providing accommodations that cause them “undue hardship”. Again, it is best to consult with your doctor and treatment providers to determine if what is being proposed by way of accommodations will allow you to work without causing an aggravation in your medical conditions.

8. What if I return to work and I am not successful and need to stop working again?

If you do return to work, you may be entitled to Rehabilitation Benefits, where the insurance company continues to pay your benefit while also earning an income from your employer. Typically, as you gradually return to more hours, your income from work will increase and your disability benefit will decrease and eventually end. If you do need to stop working again, most insurance policies have a Recurrent Disability Provision which allows you to resume your claim if you become disabled again within a set period (usually six months) from the same or related conditions. However, if you become disabled from a new condition, you can submit new short- and long-term disability claims. 

For instances where you are returning to work for new employer, you should be aware that most policies have a Pre-existing Condition Exclusion, which means that if you become disabled within 12 months of being covered under your new plan, the insurance company will deny your claim if your disability is related to a condition you had before your disability insurance started with your new employer. It is very important that you keep this in mind if you are concerned that you may not be able to continue to work for at least a year (often a year and three months, if you had to wait for your coverage to kick in). 

9. How do I ensure that my disability claim is approved or continues to be approved, if I am not able to return to work?

The best way to ensure your claim is approved or continues to be approved is to see your doctor regularly and pursue all treatment recommendations. This will demonstrate that you are not well but focused on getting better. There will also be an ongoing record of medical evidence to provide to the insurance company and your symptoms and treatment will be well documented. It also allows you to draw on your doctors for support should the insurance company push you to return to work or participate in their rehab program before you are ready.

10. When do I need a lawyer?

If you are considering returning to work or you are feeling pressure to return to work before you are ready or if you are considering applying for disability benefits, now would be a good time to reach out to us for a free confidential consultation. 

We welcome inquiries at every step and stage of the process–-from when someone is considering going off work, to when a person is considering returning to work. We help with the initial claims forms and appeals and provide guidance when clients are asked to attend the insurance company’s medical assessments or participate in their rehab programs. 

Of course, what we do best is sue insurance companies when our clients’ disability benefits have been denied or terminated. Sometimes, if involved early enough, we can help a claim not be terminated. But if that does happen then we are here to help determine whether an appeal might be successful or whether it is a waste of time and better to push on to litigation. 

Contact Mulqueen Disability Law in Markham for Trusted Guidance on Appealing a Long-Term Disability Claim Denial

Mulqueen Disability Law is a boutique litigation law firm focused on representing clients in their Disability Insurance cases. We specialize in disability claims for Invisible Conditions such as mental illness, chronic pain, immunological and neurological conditions, concussion, long COVID, and others. The team at Mulqueen Disability Law is Trauma Informed Certified and we offer free consultations. Contact us for a free confidential consultation.

The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, contact a lawyer specializing in disability law.