Empire Life Long-Term Disability Claims: What Ontario Residents Should Watch For

The monthly long-term disability benefit check you’ve come to rely on is likely to be cut off just weeks from now, you’ve been informed in a letter from Empire Life. Struggling to remain calm, you reread the letter several times, realizing you’ve been given the option to appeal the company’s decision.

However, that would need to be done very quickly and you’re feeling totally lost as to how to begin.  What’s so absolutely frightening is that, even if you appeal, before a decision is likely reached, your financial support will have been cut off. 

Empire Life is claiming that your latest medical reports, in addition to their “surveillance” (of your social media and interviews with neighbors) show that your condition has improved to the extent that you could work, even if not at your former occupation. The letter highlights the paragraph in your policy that talks about the “24-month change of definition”.

It’s very difficult to focus on what next steps to take. You only wish that what they are saying were true, but it remains a daily challenge to overcome your own physical and emotional challenges.  Yes, you try to put on a good front in social media posts, trying to be cheerful in brief encounters with other people. But you know you’re far from being able to return to the workforce, putting in an entire day outside of your own space.

You feel paralyzed, yet you know some kind of decision must be made — and quickly.

If Empire Life denies or cuts your LTD benefits in Ontario, act quickly. Review the denial letter, note every deadline, gather your policy and medical records, and build evidence that shows how your condition limits reliable work. Depending on timing and evidence, an internal appeal or a lawsuit may be the stronger option.

What is the 24-month change in long-term disability coverage with Empire Life in Ontario, Canada?

Most Canadian LTD policies, including Empire Life, use two different definitions of disability,

• During the first two years (starting from the month benefit payments have begun, you qualify to receive benefits if it has been verified that you have been unable to perform the duties of your own occupation..

• Beginning in the 25^th month, the insurance company usually changes the standard to any occupation, meaning that you are entitled to benefits only if it is proven that you are unable to work at any occupation for which you qualify based on your level of education and training, and your work experience.

What this all means is that the key to receiving benefits from  Empire Life is proving, not what your condition is or what the symptoms are, but proving that your condition impacts your ability to perform the duties of a job.

Responding to insurance company surveillance findings

Private investigators are often employed by insurance companies, both to uncover fraud and to deny claims. This might include social media monitoring and interviews with neighbors or vendors who interact with the insured person.

Honesty is key in claiming Long-Term Disability insurance benefits. It is also important to be mindful of your activities — and how you present yourself and those activities on social media. While you may be trying to “put on a good face” despite your struggles, your postscan be misinterpreted.  It might be wise to limit, or even totally avoid, social media use.

In responding to the Empire Life 24-month letter, “think functional”

Precisely because the insurance company is concerned with the impact your condition has on your ability to perform job duties, you, too, should think in terms of functional limitations. In gathering medical evidence from your medical providers, insist that the report show the impact your condition might have on your ability to function in a work environment.

• Organize a file of all the medical appointments you’ve had.
• In reading over each report, see whether there is mention of how your condition prevents you from maintaining regular attendance at work and from concentrating on tasks. 
• Particularly in more recent reports, request from that provider a comment on specific functional effects of your condition.
• Organize a log of medications prescribed and taken and their side effects you’ve experienced (complete with dates).
• Prepare a description of a “typical day in your life”. (What activities did you do? How often did you need to rest? Did you “crash” after a certain kind of activity?

Get ready for the in-between time

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

Other can-do actions to consider

• arrange for an examination or consultation from a new specialist.
• consult a vocational advisor, asking for a letter explaining why you are (as of right now) unable to work at any occupation.
• follow up on any Independent Medical Examinations mentioned in the denial letter.  

Should I appeal to Empire Life or sue in Ontario? That is the question…

Internal appeal:  

An appeal is faster, less formal and confrontational than turning  to the courts, but you are leaving the decision up to Empire Life’s employees and hired consultants. (Remember, it is not in the company’s best interests to help you.) You might also risk the deadline for filing a lawsuit.

Lawsuit:

You are turning to a third party, letting the court system decide whether or not you qualify for continued benefits.  There will be both court costs and increased lawyer’s fees involved.

Read more: Should You File a Legal Claim or Internal Appeal for Long-Term Disability in Ontario?