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Insurance Disputes FAQs

** The information in this document is not intended to replace the advice of a lawyer or accountant and should not be relied upon as such.

My Insurance Company Wants Me to See Their Doctor. Do I Have to Go?

Most long-term disability policies allow the insurance company to have your medical condition reviewed by a doctor of their choosing to determine if you are unfit to work. The doctor must be qualified to give an opinion regarding the nature of your disability. The assessment date and time must be reasonable. If you refuse to attend (without good reason) you will be in violation of your responsibilities as set out in the insurance policy and your insurance company will have grounds to deny your claim. If you have been advised by your insurance company that they want to send you for a medical assessment it is in your best interest to consult a lawyer before the assessment appointment.

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Is It Legal for My Insurance Company to Have Me Watched?

Surveillance of persons making claims for disability wage loss benefits is common and legal. Insurance companies often hire an outside company to follow, photograph and record your movements to confirm that you are in fact disabled. They do this to ensure that claims fraud is not occurring. It is iamportant that you are open and honest with your lawyer about what you are able, or not, to do so that any surveillance will not harm, but in fact help your claim. Most investigation companies follow the laws regarding trespassing, however if you feel threatened you should call the police.

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Can My Insurance Company Force Me to Apply for CPP Disability Benefits?

Many policies allow long term disability insurers to require you to apply for benefits from another source, like CPP. If you receive these benefits it is normal that they will be deducted from the benefits you receive. Ask for the specific section of the insurance policy that requires you to apply for benefits as it may also include a provision that if you choose not to apply for benefits from another source as requested by the insurer, they may be able to deduct the amount you would have received, regardless if benefits are actually obtained. If you apply for CPP disability benefits and are denied, you may be required to appeal. If you have not already obtained legal advice, when your insurance company requests that you apply for benefits from CPP or WSIB, it would be a good time to obtain legal advice.

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