The Hidden Traps in Long-Term Disability Applications: What Insurance Companies Don’t Want You to Know

The first step in applying for long-term disability benefits in Ontario, Canada involves contacting your insurer to get the forms you need for filing a claim. There will be a Claimant’s Statement and an Attending Physician’s Statement, both of which will need to be submitted along with copies of your medical records and information about your employment.

Your Long Term Disability insurance coverage may have been provided through:

• your employer
• a professional association to which you belong
• an individual policy you purchased directly

Whichever is the case, you’re going to be dealing, directly or indirectly, with an insurance company.

Uncomfortable truths about long-term disability insurance companies:

 While your disability insurance company is going to be asking you to help them by filling out mountains of detailed paperwork, it is important for you to understand one thing: it is generally not in the insurance company’s best interest to help you. 

Facing two realities:

• Long term disability insurance providers are in business to make a profit. While they must honor the policy contracts they’ve issued by paying legitimate claims, they are in business. Like all business owners, their goal is to minimize payouts and increase their own bottom line.
  
  
• Your involvement with the insurance company is just beginning. The need to submit information is not going to be over just because you’ve completed and turned in all the forms. Even after you have been approved to receive certain long-term disability benefits, you will continue to have a duty to keep the insurance company informed of any and all changes in your situation – any new treatments, any travel, any change in family situation, any improvement in your abilities or any worsening of your symptoms.

What Are the Hidden Traps in LTD Applications?

In filing a long-term disability claim in Ontario, it’s important to “navigate” your way around certain “traps” set by your insurance company. Beware of any of these tactics:

Trap #1: The Form That Doesn’t Give You Enough Space

“Crowding” – An insurance claim form may pose a question, about your disability or about your former job duties, yet provide only a line or two on the form – hardly enough to accommodate a complete answer. The company then claims you haven’t “proved” that your disability qualifies you to receive benefits!

How to avoid it: Attach pages to the file, (either on paper or online) giving a thorough answer to each question about your symptoms and the effect those symptoms are having on your day-to-day life.

Trap #2: Monitoring Your Social Media

“Friending” and “connecting” – You may not have invited them to connect or “friend”, but your insurance company is sure to be monitoring your presence on LinkedIn, Facebook, TikTok, Instagram, X, etc. looking for any pic, video, or post portraying you as a lot more “abled” (less disabled) than you had described on your claim form.

How to avoid it: Be cautious with social media. Assume anything you post could be used against you.

Trap #3: Missing Deadlines or Appointments 

“Watching the clock” – To have any chance at getting the disability benefits you need, pay attention to every deadline, because the insurance company is keeping track. It is important for you to keep every doctor or therapy appointment and to be on time. Take every medication your doctors prescribe. Never forget – your insurance company will be “watching the clock”, looking for any reason to deny your claim for benefits.

How to avoid it: Keep a calendar of every deadline, appointment, and medication. Document everything.

Trap #4: Playing With Definitions

“Definition chiseling” – Insurance policies tend to be very, very specific when it comes to precisely what is covered — and what is excluded — from coverage.

For example, many policies exclude conditions that existed before you were even enrolled in the company’s plan. It could be that, before your symptoms worsened, you were able to work full-time.

Even though you may now be unable to perform your job, your application may be rejected on the grounds that your condition is “pre-existing”. What’s more, the contract may have one definition of “unable to work” for the first year or two (meaning you cannot do the type of work for which you’ve been trained) — and then require that you be unable to work at any job in order to be considered eligible for benefits going forward.

How to avoid it: Review your policy carefully, or have a lawyer explain it to you before filing.

Surviving surveillance while applying for disability benefits in Canada

While, as a disabled Canadian citizen, your equality and human rights are guaranteed by law, you need to be aware that, in their efforts to avoid paying fraudulent claims, companies are allowed to conduct ongoing, legitimate “surveillance” activities of those who’ve filed claims. In Ontario, disability surveillance is governed by Canada’s Personal Information Protection and Electronic Documents Act, stipulating that insurance companies can collect only personal information that is necessary for their stated purpose.

Problem is, far too often, insurers carry that practice too deep and too far, performing intrusive surveillance on all claimants, in an effort to raise doubt about your credibility and find reasons for denying benefits.

On the original Activities of Daily Living questionnaire, you are asked about how your condition affects you on a typical day in your life. Do you need help with personal care? Standing? Sitting? Getting dressed? Going to the bathroom? Are you able to do household chores such as cleaning and cooking? Are you able to drive? Shop for necessities? Manage your own finances? What are your sleep patterns? Are you able to pursue any hobbies? Periodically, you will be sent update requests.

(The purpose of surveillance is showing that the answers you’ve provided overstate the reality of your situation.)

While your insurance company cannot record you inside your home, their representatives (or even a private investigator they’ve hired) might be tailing your car, compiling video or photos of you, even talking to:

• your neighbors
• your friends
• your co-workers past or present
• your doctors or therapists
• owners of businesses you visit – hairdresser/barber, dry cleaner, laundromat, etc.