One Claimant’s Story Fighting a Long-Term Disability Insurance Claim Denial

This is an excerpt from a recent claimant testimonial. They provide an overview of their journey fighting their benefits insurance provider. Names and specific details were removed to protect the privacy of all individuals and companies.

Our insurance claim problem 

I experienced a life-threatening medical issue which if left untreated would have been terminal. I also suffered severe pain from the medical issue, as well as physical, neurological, and psychological issues resulting from the diagnosis and treatments. My doctors and nurses were very nice and caring. The LTD insurance company was not helpful.

While working at a major Canadian (FI) financial institution, and paying for many years into LTD (long term disability) insurance, I believed when I experienced a life-threatening medical issue followed by debilitating treatments that the insurance company, their subsidiaries, and outsourced business partners would be honest, truthful, and at the very least compassionate. Instead, they lied about everything, including how long I was allowed to be off work to recover while on LTD. They also convinced me to return to work one year too early. This resulted in my inability to handle the pressures and stresses of my workplace. I ended up having to be off work again. 

The Insurer denied my claim

My employer understood and agreed with my taking time off for short-term and long-term disability. However, the LTD insurance company denied my claim three times over a two-month period. The insurance company consistently bullied and harassed me to get me to return to work. Don’t be fooled! I felt the insurance company was not interested in my health or my wellbeing. This is contrary to what’s in their LTD marketing brochures. The insurance provider caused me much pain and suffering from their harassing and threatening phone calls. The insurer gave me and my husband false information about what they needed to prove I was unable to return to work. Each time I had to relive my trauma with our physician, fill out more forms, get poked and prodded, which compounded my neurological stress which increased to an intolerable level.

Having spent 18 months dealing with terminal diagnosis, treatments, recovery, then 20 months of trying to handle my workplace stresses when I was clearly not ready for, my body and mind gave up. I also sustained a physical injury at work, but I toughed through the pain. My employer saw I was struggling physically and mentally, but my supervisor had little to no compassion either. When I could no longer handle the stresses of my workplace I had to stop work (hoping it was temporary) because I hoped to work for several more years before retirement. I had no choice but to go on STD (short-term disability) in order to save what little sanity I had left. When my situation did not improve enough to return to work after 6 months while on STD, I could not return to work yet. The LTD insurer failed to provide me with a safe return to work plan or processes, and they bullied me at every turn. When my LTD claim was denied several times, I did not know what to do?

I was unsure how to go about advocating this

When all attempts failed for me and my husband to work with the LTD insurer, I was left with few options. The insurer had us go back and forth to our family physician several times, each time, the insurer declined/rejected my claim, until they finally told us that our doctor was not qualified to provide the details needed for our claim. The important thing here is that the insurer also refused to confirm exactly which type of medical specialist was needed to fill in the paperwork, and provide a diagnosis. This lack of “return to work” support left me with no options, so I thought. The only option I believed I had was to be forced to retire prematurely from a job I enjoyed doing for many years. My husband felt there was something not right, so he reached out to David who is a lawyer who advised us in the past. David referred our issue immediately to Joey Pollock who specializes in dealing with insurance companies.

I felt lost and did not know what to do 

Not knowing what to do, where to go, or who to turn to was adding to my already stressful situation. I was feeling depressed, my husband had felt frustrated with the lack of support and compassion from these supposed “return to work” supporters.

I called Joey Pollock

Very soon after reaching out to David, Joey called us even though he was away on vacation. He had read through the details my husband had sent to David regarding my situation. Joey was kind and understanding. Joey advised us that the insurer’s mandate was to have claimants return to work as soon as possible, regardless of whether the claimant was ready and able to return to work. That was disturbing to hear, but it explained why the insurer pushed me so hard to return to work, even though I was not ready mentally or physically. We also learned that insurers often outsourced to front-line agents who specialize in getting people to return to work. Little did we know or understand that it included harassing and bullying tactics. My husband and I did not understand why an insurance company that is supposed to advocate on your behalf to return to work in a safe and healthy manner was instead making a bad situation worse.

Joey eased my concerns

Joey made me feel at ease. He is very knowledgeable in dealing with insurance companies. We learned that Joey was in-house counsel for a major insurance company, so he has first-hand knowledge of how insurers operate. He advised us that the next step is to see a specialist who he knew the insurance company could not refuse or deny. Further doctor’s appointments for more assessments and having to explain/relive everything that is causing my suffering, was something I needed to avoid in order for a successful recovery. Joey assured me this would be the last doctor’s assessment I would need related to my LTD claim.

Joey took my case

Joey took on our case and provided us with the guidance we needed. First up was making an appointment with the correct specialist, for the types of issues I was dealing with. This meant having to relive the trauma of diagnosis, treatments, life changes, fears, etc, but Joey reassured us it would be the last one needed to get the insurance company to accept my claim. I went to the specialist, he and his nurse assessed my situation, and the specialist provided Joey with the report confirming that I was unable to return to work.

Joey was able to resolve the case to my satisfaction

We sat down with Joey to discuss that he received the specialist’s report and forwarded it to the insurer. Joey then confirmed that the insurer accepted my LTD claim. However, there was one caveat. The insurer would continue to call us every month. The insurer had already caused much of the stress and anxiety, with their harassing phone calls which made my suffering worse. After experiencing several months of harassing and threatening phone calls, my husband who is very concerned for my wellbeing told Joey that having the insurer call us was no longer an option. Our goal was to focus on my recovery, while the insurer’s goal/plan was for me to return to work as soon as possible. You can see already, that our goals and plans did not match, therefore my husband and I knew this constant contact with them would cause more friction, anxiety, and potentially prevent me from recovering altogether. This is when Joey suggested seeking a settlement with the insurer instead of having us in continuous contact with them. Joey negotiated a settlement with the insurer, which allowed us to focus solely on my recovery.

We’re happy with his services

We are very pleased with Joey’s support and services. He helped us through a traumatic time in our lives, which we are very appreciative of. When dealing with so much emotional upheaval during a very traumatic time, Joey’s assistance was much-needed relief and provided us with peace of mind we needed to move forward.

We’re more than happy to recommend others to do the same

We are so pleased with Joey’s assistance, that when we heard of a friend’s son and daughter-in-law were experiencing serious issues with a different disability insurer, I referred our friend to have their son and daughter-in-law contact Joey. We heard soon after they contacted Joey, that they needed to find one specific piece of information for Joey to succeed in helping them. Joey advised them what info he needed in order to resolve their issue. Knowing what to look for, making it much easier for the young couple to find info. The insurer was not sharing that they knew they were wrong. The insurer tried to bluff their way through, even though the insurer had already received proof via email of the disputed claim info. The couple had already told the insurer of their situation via email, during the initial claim process. The insurer was not about to divulge that they had previously given incorrect information, or that they had already received the patient’s details. The friend’s son and daughter-in-law were very pleased with Joey’s successful resolution of their issue with the insurer.

Joey’s advice helped another family in need! You have a problem with an insurer, who are you going to call? We called Joey, and are very happy to share our experience!

With all of the information available to us at our fingertips on the internet, we still needed to reach out to someone who specialized in their field and could help us deal with complex issues. This could be consultants, contractors, doctors, accountants, lawyers, etc. In our case, and in our friend’s family’s case, Joey is that specialist. We needed someone who specialized in navigating the insurance world and Joey knows and understands that world. We were very lucky to have Joey on our side when we needed him most. His knowledge and insight, and most of all his compassion, helped us resolve a very difficult situation and allowed us to move forward with our lives.

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joseph Pollock, Winnipeg Disability Lawyer

About Joseph A. Pollock

Joseph (Joey) Pollock is a Winnipeg-based attorney with over 35 years of legal experience – 25 of those years dealing with disability and life insurance claims.