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Long Term Disability

Can my LTD insurance company force me back to work?

Many people are understandably scared to try to return to work.

Person changing tire at work

Applying for and finally being approved for long-term disability benefits (LTD) is sometimes a long and arduous struggle. Often people feel like they can finally focus on treatment and getting better once they are approved. So, what happens when an LTD insurance company wants them to try to return to work?

Many people are – understandably – scared to try to return to work. Often they are worried that if they try and are not successful, the insurance company might terminate their benefits anyway and then they will be left without work they can do and will have lost their benefits.

Sometimes an insurance company will ask a person receiving LTD benefits to participate in a “work hardening” program prior to attempting a “gradual return to work” (GRTW). A work hardening program is intended to focus on what tasks a person might be required to do at their job and on helping the person improve their functional capacity through individually tailored conditioning.

A work hardening program or a GRTW is generally done in consultation with a rehabilitation specialist or occupational therapist. An insured person’s own medical provider should also be involved in these decisions and should sign off on their return-to-work plan before any such plan is attempted.

In Greig v. Desjardins Financial Security Life Assurance Company, 2019 BCSC 1758, a case out of British Columbia, an insured person was sent to a “work hardening” program and, despite the fact that the rehabilitation specialist there had noted that he had struggled and reported ongoing pain and soreness, the health centre that ran the work hardening program determined “that [he] did not present with physical findings that would preclude him from attempting a GRTW.”

None of his treating physician, however, were willing to sign off on a GRTW program. Despite these facts, the insurance company representative determined that there was no objective evidence to support his ongoing disability and terminated his benefits.

In that case, however, the Court determined that the insurance company representative, in deciding to terminate the insured person’s benefits, ignored relevant evidence available to her and that it was, in fact, improper to rely on the work hardening program discharge report, which recommended the GRTW, when no treating physician ever endorsed that plan.

The Court ultimately awarded $200,000 in punitive damages for what it found was “an egregious breach of the [insurance company’s] duty of good faith to [the insured]” and $50,000 in aggravated damages for the plaintiff’s mental distress caused by the termination of his benefits.

Making a good faith effort to participate in a work hardening program and, if it is signed off on by a treating physician, to attempt a GRTW, is generally a good idea. If you attempt a work hardening program or a GRTW and that attempt does not succeed, that may be further evidence of your disability. In the BC case reviewed in this article, the Court found that there was evidence that the union president and the insured person’s employer stated that “they had no concerns about [his] motivation and that they were eager to have him back at work.” The evidence showed that he put in the maximum effort towards his rehabilitation. This evidence helped to establish that the duty of good faith was breached when determining that the insured person no longer qualified for benefits.

Ideally, an LTD insurer will not force an insured person to return to work before they are ready to do so, and will not terminate benefits when a treating physician will not sign off on even a GRTW. But these issues do arise, and an insured person may need help navigating them. While the insured person in the case referenced in this article was ultimately awarded damages, he was put under undue stress and financial pressure at a time that he should have been able to focus on his health.

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