At Mulqueen Disability Law, we know how difficult it can be to navigate your way through a long term disability claim. It’s unfamiliar territory for most people and it can be especially challenging when you are experiencing a health crisis. Having an understanding of certain key elements of a claim will help you gain a sense of control and have you feeling more empowered on your journey towards recovery.

What does rehabilitation mean?

In most insurance policies, there is a clause in the disability claim provisions that talks about rehabilitation. What does that term mean? Rehabilitation can actually mean a few different things. It can mean a program that is designed to assist you with your recovery, providing you with treatments such as physiotherapy or counselling to help you regain your prior level of function. Additionally, it might refer to educational programs, vocational training or job search assistance to help you become more work ready. It can also mean a return to work plan designed to gradually increase your duties and your hours of work, allowing you to build towards a return to full-time employment. Whichever way the term is being used, an important thing to know is that the insurance company can require you participate in a rehabilitation program at their sole discretion and might even threaten to terminate your claim if you do not.

Who needs to be involved?

It is important to make sure that your doctor is aware of any rehabilitation plan that comes up during the course of your disability claim. Tell them about any discussions you have had with the insurance company. Provide them with an understanding of the types of tasks you are required to do in your job. Your doctor is the one that knows your medical condition best, and knows what you are medically restricted from doing. Their participation in deciding what a suitable rehabilitation plan might look like for you is a vital part of the process. The insurer should not implement a rehabilitation program without direct input from some or all of your treatment providers. 

Your employer plays a key role in the rehabilitation plan if the goal is to have you return to your pre-disability job. The insurance company should have a copy of your job description on file along with information about the physical and cognitive demands of your job. The insurer must be able to provide your employer with the details and expected duration of any restrictions and limitations that you have, in order for your employer to be able to determine how best to accommodate you. A meeting with your employer, the insurance company and you prior to the start of any return to work is a key step in the process, as this will help to set expectations for everyone involved. 

Are you staying involved in the process?

Of course, you are a vital part of any rehabilitation program. Rehabilitation is supposed to help you recover and return to the workforce. You should feel supported in your efforts every step of the way. If you are feeling apprehensive or worried about any part of the plan, it is important that you speak your mind. Make sure you understand what timelines are involved and what milestones should be completed as the plan progresses. Ask questions! Insist on a steady flow of communication with the insurance company while the plan is being drafted and while it is being implemented. The insurer should know how you are doing throughout the rehabilitation process so that, if changes need to be made, they can happen in a timely manner. 

Will I still receive LTD benefits when I’m in a rehabilitation program?

Yes, most disability policies allow you to remain in receipt of long term disability benefits while you are earning an income through an approved rehabilitation program.  While it is not likely that you will be allowed to earn more than 100% of your pre-disability salary between receipt of both disability benefits and income, there should be some financial incentive for you while you are engaged in a return to work program.  The rehabilitation clause in the policy will outline how your earnings are used to calculate your benefit on a monthly basis. 

What do I do if I need to stop working after rehabilitation?

Many of our clients have gone through rehabilitation programs with their insurance company. Some of them were even able to return to work on a full time basis. Unfortunately, not all of them were able to remain at work. If you do need to stop working again, you have some options. 

Most insurance policies have a recurrent disability provision which allows you to resume your claim if you become disabled again within a certain period of time (usually 6 months) from the same or related medical condition. This means that you do not have to satisfy another qualifying period before your benefits become payable. If you have stopped working because of a new or unrelated condition, you would have to submit a new disability claim to your insurer. 

Additionally, if you have returned to work but with a new employer, you should be aware that most policies contain a pre-existing condition exclusion. Moreover, if you become disabled within 12 months of being covered under a new policy, the insurance company will deny your claim if your condition is related to a condition you had before your insurance coverage started.

What happens if I can’t participate in a rehabilitation plan?

We know that being unable to work because of illness is upsetting and difficult. We also know that most people in receipt of disability benefits remain optimistic about returning to work, even when their medical condition prevents it. Insurance companies sometimes use that optimism as a means to say that a person is “ready” to participate in a rehabilitation program. But what should you do if you are not physically and mentally ready? What happens when pressure from the insurance company has actually aggravated your condition? If that’s the case, you will most likely need to obtain a detailed report from your doctor outlining the medical reasons that prevent you from participating in a rehabilitation program.  If the insurance company then terminates your long term disability claim on the basis of non-compliance with rehabilitation, you should contact us right away

Contact Mulqueen Disability Law for Experienced LTD Litigation Advice in Markham, York Region & Toronto

Mulqueen Disability Law is a boutique law firm, focused on litigating long-term disability insurance benefit claims. Courtney Mulqueen and her team of legal professionals are Trauma-Informed Certified and have over two decades of experience exclusively in the area of long-term disability law. She and her team draw on their “insider” experience working for the insurance companies (including OTIP), that they now sue for their clients.  

Mulqueen Disability Law specializes in hard-to-prove long-term disability claims for “Invisible Conditions” such as mental illness (depression, anxiety, PTSD) and chronic conditions (pain, neurological, immunological, concussion, post-COVID)  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, please contact a lawyer specializing in disability law.