The insurer cut off his benefits. Then his lawyer reviewed his medical assessment

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A successful case for long-term disability benefits requires strong medical evidence of a disability. But medical evidence is not always the critical factor in determining the final result of a case. 

A recent matter involving a client of the disability law practice at Samfiru Tumarkin LLP illustrates how an insurance company tried to avoid paying out a long-term disability claim. The incident resulted in a successful negotiation with the insurance company and full compensation for the client.

My client, Jerry, a southern Ontario man whose name has been changed to protect his privacy, was a successful executive with a large company. One day, a serious workplace issue caused him to become depressed and anxious. Eventually, his afflictions became so severe that he had to stop working. 

His insurance provider conducted a psychiatric assessment and confirmed that Jerry’s mental health issues prevented him from being able to work — not just with his employer, but anywhere. After that assessment, Jerry was initially approved for long-term disability benefits.

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A little more than a year later, however, the insurance provider sent Jerry for a second assessment. This time, he saw a different psychiatrist. After the second assessment, the insurance company told Jerry that, based on this latest information, they no longer deemed him to be disabled. They cut off his disability benefits.

READ MORE: Tips on handling independent medical assessments

Not long after his benefits were cut off, Jerry contacted Samfiru Tumarkin LLP for a free consultation. After reviewing his situation, we started a legal claim against the insurance company and scheduled a mediation to resolve the matter.

I asked the insurance company for Jerry’s complete medical file. It had both psychiatric assessments, including the one the insurer used as the basis to deny Jerry’s long-term disability benefits. In the denial letter, the insurer told him the second assessment indicated he was not disabled.

READ MORE: 5 reasons why disability claims are rejected

After reviewing the psychiatrist’s notes, our team of disability lawyers realized that the insurer had lied. The second psychiatric assessment explicitly confirmed that Jerry was not able to work for his employer or any other employer, in any occupation.

Given this new information, the focus of the mediation was on the insurance company’s conduct. It was obvious to me that if the case ever went to court, a judge would find that Jerry’s insurance provider had acted in bad faith and would likely order the company to pay punitive damages in addition to the disability benefits owed to Jerry.

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READ MORE: How a lawyer can help with long-term disability denials

The insurance company wound up having to pay my client a total settlement that was over $100,000 more than what he would have received had his claim been based solely on his disability. Because our firm identified the insurer’s mistake and held the company accountable for it, Jerry was able to receive the financial support to which he was entitled.

This is why, when hosting radio and television shows about disability law, I always emphasize the importance of contacting Samfiru Tumarkin LLP when insurers deny claims. We can analyze the facts of your case and determine the best course of action.

Have your long-term disability benefits been cut off? Is your insurance provider asking you to submit to an independent medical assessment?

Contact the firm or call 1-855-821-5900 to secure assistance from a disability lawyer in Ontario, British Columbia or Alberta. Get the advice you need — and the compensation you deserve.

James Fireman is a disability lawyer at Samfiru Tumarkin LLP, one of Canada’s leading law firms specializing in employment law and disability claims. He provides free advice as a host of Canada’s only Disability Law Show on TV and radio.

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