Desjardins LTD Claims: What to Do if Your Benefits are Cut or Denied (Ontario)

You’ve just received notice from your Long-Term Disability insurance company, Desjardins, that in just a few weeks, the benefit checks you’ve been receiving are going to be cut off. You’ve been given an option to file an appeal with the company, but that would need to be done very quickly, and meanwhile, the financial support on which you’ve been relying will have stopped. Beyond disheartened, you feel trapped, not knowing how to respond.

You’ve read the letter over and over. It seems the reasoning for Desjardins’ decision are that “surveillance footage” suggests that, while your condition has improved sufficiently to allow you to work, you’ve not taken any steps to find a job.  What’s more, the implication is that there is insufficient medical documentation proving you are still totally disabled. While no specifics are given in the letter, the company is implying that you’ve not faithfully followed all the prescribed medical treatments. 

You’re finding it very difficult to focus on next steps to take; despite what the letter implies — and your own efforts to overcome your physical and emotional challenges, , you know you are far from being able to return to the work force. Frightened about how you’ll support yourself without those monthly checks, your thoughts go round and round, even as you realize you must embark – and quickly – on some course of action…

If Desjardins denies or stops your Ontario long-term disability benefits, act fast. Save the denial letter, write down every deadline, and get your policy and job description. Ask your doctor for notes that link your condition to work limits. Then choose a path: an internal appeal or a lawsuit, based on timing and evidence.

What is the 20-month change in long-term disability coverage with Desjardins LTD Insurance Company in Ontario, Canada?

• First two years:

Covered: any state of continuous disability resulting from an accident, illness, complication of pregnancy or organ donation that prevents the member from performing the main duties of their regular occupation (own occupation) during  the long-term disability insurance waiting period and the 20 months following this same period of disability.

• Years following the first two:

If this condition lasts for more than 20 months, in order to be covered by insurance, the disability must prevent the plan member from performing any paid occupation or from doing any work that  might provide them with wages or profit of any kind (occupation or work they are reasonably prepared for by education, training or experience (regardless of the availability of employment). 

Take comfort while taking steps to restore benefits

It’s important not to allow your fear of supporting yourself to paralyze you. While working to restore your Long-Term Disability insurance benefits, you can explore alternative financial resources:

• CPP-D benefits
• food banks
• Ontario Disability Support

Where to start after receiving a denial letter

5 steps to take:

1. Get a grip on timelines and medical records

When dealing with a long term disability denial letter, having comprehensive and organized records is critical.  Match up all correspondence recommending  treatments with records of your having received those very treatments:

• Proof of each visit to specialists and therapists (Go back to each Provider, asking them to provide additional details about your limitations).
• Gather and organize receipts showing that you filled every prescription for medication.
• Test results from doctors, therapists, or hospitals.
• Records of your correspondence with the insurer.

2. Arrange for an examination or consultation from a new specialist.

3. Consult a vocational advisor, asking for a letter explaining why you are (as of right now) unable to work at any occupation.

4. Follow up on any Independent Medical Examinations mentioned in the denial letter.  

5. Create a “typical day” description (telling how you spend your time now, including what portion of your day involves medical visits or self-treatment).

Think “work-related limits” not symptoms.

Remember, in deciding whether to continue paying you disability benefits, the Desjardins people are not weighing your symptoms. What they are measuring is your mental and  physical ability to perform job duties, including your likely:

• reliability
• stamina
• pace
• concentration
• absenteeism

Explain why, even though you have a history of good  work performance prior to your disability, pain and inability to maintain concentration do not now allow to perform consistently even in a less demanding job.