Misconception #4: LTD Benefits Are Guaranteed Once Approved

Fictional Conversation (overheard at a park)

Person A: “I thought once you’re approved for LTD, you’re set for life.”

Person B: “Yeah, I always thought the same thing. If the insurance company gives you benefits, that’s it, they’ll keep sending you money until you get better.”

Person A: “That’s what I figured! They can’t just stop paying you, can they?”

How to Overcome:

LTD benefits are not guaranteed indefinitely, and insurers have the right to reassess a claimant's condition after a certain period. Many policies have built-in "review" periods, where the insurance company can request updated medical records or an independent medical evaluation (IME) to determine whether the claimant is still eligible for benefits. If the insurer deems that the person’s condition has improved enough for them to return to work, they may terminate the benefits early.

To overcome this, it's important to maintain a consistent treatment plan, attend all medical appointments, and document any changes in your condition. It’s also wise to consult with a lawyer if you receive notice that your benefits may be terminated to ensure that the insurer is not wrongfully cutting off your payments.

Technicalities:

In Zerafa v. Manulife Financial (2016), the Ontario court ruled that long-term disability benefits could be terminated after the insurer conducted a reassessment and determined that the claimant’s condition no longer met the criteria for total disability. This case demonstrates that insurers are within their rights to review and modify claims, but the decision must be based on substantial medical evidence. If a person feels their benefits were wrongly terminated, they can challenge this through an appeal or legal action.