Being cut off after you were approved is a different problem from being denied at the start, and in some ways a worse one. You have organised your life around a benefit that has stopped, and the insurer has already accepted that you were disabled.
Why this is a stronger starting position than you think
The insurer approved the claim once. That means it reviewed the medical evidence and the policy and concluded you met the definition. To stop paying, something has to have changed. Either the medical picture, or the definition that applies to you, or the insurer’s view of the same facts.
Working out which of those three it is, is the whole case.
The most common reason is not medical
It is the policy. Many group policies apply one definition of disability for an initial period, and then switch to a stricter definition. The stricter definition is commonly referred to as the any occupation period, which usually tests whether you can return to any occupation for which you are reasonably suited by education, training or experience. Income components can also apply to that test, which depend to some extent on the wording of your policy. People are frequently cut off at that changeover without their condition having changed at all.
If that is what happened to you, see our page on the change from own occupation to any occupation.
The other reasons we see
- An independent medical examination arranged and paid for by the insurer reached a different conclusion from your own doctors.
- A file review by a consultant who never met you.
- A gap in treatment. If you stopped going to appointments because they were not helping, or because you could not afford them, that gap gets used against you.
- Surveillance or social media. A photograph of you at a family wedding is not evidence that you can work, but it gets treated as though it is.
What to do in the first two weeks
- Keep going to your appointments, even if the benefit has stopped. The treatment record is the evidence.
- Ask for the file in writing, including every medical opinion the insurer relied on.
- Do not sign a new authorisation or a settlement document without having someone read it.
- Write down what you can and cannot do on an ordinary day. Contemporaneous notes are worth far more than a memory reconstructed two years later.
On deadlines
A cut off starts a clock, and the deadline depends on the wording of your policy and on the date the benefit stopped. It is the first thing we check, and it is not something you should have to work out on your own. Exceptions may apply – legal advice is strongly recommended for your particular situation.
Read more
- Long term disability: the main page
- Your claim was denied: what to do first
- Long term disability denial
Speak to a lawyer about benefits that have been cut off
Initial consultations are free. Our fee schedule is published in full, by stage of the case, on our Fair Fees page. Call 905-409-2438, send a text, message us on WhatsApp, or use the contact form.
Steven Polak is licensed as a lawyer in Ontario and practises with Lerners LLP at 123 Athol Street, Whitby.