As discussed many times in this blog, your relationship with your insurance company is one based on contract. Your insurance policy lays out the responsibilities and obligations of the insured and the insurer.  The basic provisions of all insurance policies are that you pay insurance premiums to your insurance company, and they agree to pay out insurance benefits should an agreed upon event occur triggering coverage under the policy. That’s the broad strokes. However, every type of insurance policy has fine print as well and more often than not it’s the fine print that is the most important part of the policy when a claim for benefits is made.

A common provision in long-term disability insurance policies is that the insured is obligated to participate in a program designed to get them back to work and that if the insured fails to participate in the program the insurance company can deny further long-term disability benefits.

What your return-to-work program will look like depends on the nature of your disability.

Physical Disabilities

If your long-term disability is the result of an illness or injury that manifests with physical symptoms and restrictions your return to work will likely be overseen by an occupational therapist who will coordinate a return to work with your treating professionals such as physiotherapists and treating medical doctor.  They will attempt a gradual return to your workplace, seeking accommodations from your employer and look at ergonomic changes to your workplace to assist your return to work.

While there is no one size fits all return-to-work schedule, generally speaking they start off with the disabled worker returning to work for a few hours a day a couple times a week, increasing the length of and number of days as the program progresses with a view to getting you back to work full time.

Psychological or Emotional Disabilities

If your disability is psychological or emotional in nature the insurance company will hire a psychiatrist or psychologist to assist you in an attempted return to work.

Unlike physical disabilities, almost all individuals on long-term disability for psychological or emotional issues have already had professional intervention whether it be from a psychiatrist, psychologist, or registered clinical counsellor.  It is important that the treating medical professional have their opinion involved in any return-to-work program dealing with psychological or emotional disabilities as they will have a better understanding of the nuances of your specific circumstances.

If a Return-to-Work Program Fails

If your return-to-work program for your previous employment fails, the insurance company may hire a vocational rehabilitation specialist to look at your medical records and determine a new area of employment you might be better suited for keeping your disabilities in mind.

The insurance company will be motivated by only one consideration, will the newly identified area of employment generate enough income to reach the percentage threshold of your previous income (usually 65-70%) that disentitles you to further long-term disability benefits.

The Inherent Conflict of your Rehabilitation Specialists

With insurance companies hiring all these medical and therapeutic specialists, it leads to the question: what will the insurance company’s professionals be able to do that an individual’s treating professionals couldn’t or didn’t do?

The answer is likely nothing, other than provide the insurance company with the answer they’re looking for, that you can return to work, regardless of whether or not you actually can.

Insurance companies do not simply choose any occupational therapist or any psychologist to assist in their return-to-work programs.  They have a roster they choose from, and these professionals earn their living by being hired time and again by the insurance companies. Why? Because the insurance companies know which professionals they can hire to get the opinion they want, that you can return to work.  These professionals know that if they continually support ongoing disabilities that the insurance companies won’t hire them again. So, they give the insurance companies the results they want to hear.

This is why it is important to have your testing professionals involved in any return-to-work program. They will be better suited to give an opinion because they have been treating you for longer than the insurance company’s hired guns and they have no inherent bias in their position.

The Reality of Return-to-Work Programs

The unfortunate reality is that once an insurance company demands you attempt a return-to-work program, whether or not your doctor supports such a program, and whether or not you participate successfully or not, chances are your insurer has already decided to deny further ongoing long-term disability benefits.

Insurance Denial Lawyers

If you believe your long-term disability benefits have been wrongfully denied, contact our experienced insurance denial lawyers at Taylor & Blair LLP. We will give you a free case assessment and work hard to make sure you get a fair deal.

Contact the lawyers at Taylor & Blair LLP today as strict timelines apply to long-term disability claims.