Have you had your Manulife disability benefits cut off? You are not alone. Many disabled Canadians have had their disability benefits cut off or threatened at the two-year mark. This is oftentimes when Manulife will assume a lack of evidence or request more evidence that the recipient is continuing to suffer from a long-term disability.
Whether it’s an individual or employee long-term disability policy, the responsibility falls on the recipient to provide evidence that they continue to suffer from a total disability during the qualifying period. If Manulife deems that evidence insufficient, the next step is to stop providing benefits.
Why Manulife Could Cut Off Your Benefits After 24 Months
How this is all done is through understanding the definition of what Manulife considers disability.
‘Total disability’ is usually seen as a chronic illness or injury that prevents you from performing the majority of your duties at work. This is the bar you have to meet within the first 24 months, however, the definition changes at the two-year mark. Insurance companies like Manulife don’t often explain this change and so for someone to have their benefits cut off out of nowhere, it’s not unexpected and often traces back to this switch at 24 months.
After two years, the change in definition of ‘total disability’ requires the recipient to prove they cannot perform any occupation to which they are reasonably suited – not just limited to their own duties. This often extends to what a person is qualified for, i.e. their training, education, and their work experience.
Manulife takes in over $40 billion in premiums every year. Like any insurance company, they’re focused on profits rather than paying out claims. If they can certify a reason to cut off your benefits, they will. At the two-year mark, when that disability standard becomes harder to successfully qualify for, that’s an excuse to terminate your benefits package.
How Manulife Will Argue You Do Not Qualify For Disability Benefits
When it becomes tougher to qualify for disability benefits at Manulife at the two-year point, you no longer can rely on the relaxed standards that your policy maintained in the time prior. As the rules have changed, you have to prove your disability prevents you from participating in any version of work at your current place of employment, no matter how simple it is.
Manulife’s goal is going to be to get you back to work so that they do not have to cover the benefits you are rightfully owed. To this degree, let’s say you work in a retail store. Your disability might prevent you from walking around or putting things on the shelf but perhaps you can stand near the front of the store and act as a greeter. Even if you would normally be very active while working, if you’re able to do sedentary work that’s available, Manulife will use this as an opportunity to conclude you no longer qualify for benefits.
To put it simply, they do not care what your personal situation might be. If you are able to work, their perspective is in finding a way to get you back to work. Manulife does not care about what you think your limitations are or what you could do. They do not care about whether you’d be happy working a specific job or not. They do not care about your wants and needs as it relates to employment. Whatever challenges you are facing, the bottom line is if you are able to work, Manulife believes that at the two-year mark, you should be working.
What Definition of ‘Total Disability’ Do You Use: Manulife Or Supreme Court of Canada?
Insurance companies like Manulife have a very restricted definition of what total disability is. According to the Supreme Court of Canada, the exact definition of ‘total disability’ is a little different. You do not need to be unable to do anything to meet the legal definition. The Supreme Court of Canada structured ‘total disability’ to include people from a wide array of different injuries, allowing these people to receive the benefits they are owed.
Total disability does not require a person to be totally unable to work in any circumstances, according to the Supreme Court of Canada.
This contrasts with what Manulife might state as to how total disability is defined. Fortunately, this is where an opening exists that many legal claims have been fought on. It’s on you to persuade them to think differently than what their own policy states, to put it simply.
How to Prove You Have A Total Disability With Evidence
Although you can argue with Manulife that you have a total disability, they won’t accept an argument without supporting evidence. You have to affirmatively demonstrate that you meet Manulife’s definition for what total disability means. To do this, doctor consultations and medical exams will be needed.
Manulife likely has already sent you to at least one doctor at this time for a medical evaluation. That doctor may have their own conclusion on whether you pass the total disability test or not. Insurance companies may take matters even further, conducting surveillance such as capturing pictures and posts off your social media accounts. This is all evidence they can use to disprove a claim and get them out of paying.
To combat this, you should speak with a long-term disability lawyer who knows how to prepare you for an independent medical exam and help strengthen your case in order to put you in the right direction towards being defined under a total disability.
Common Reasons Manulife Will Try to Cut Off Your Benefits
There are three common arguments, among others, that Manulife will use to permanently terminate your benefits.
The first is they will claim there is insufficient medical evidence to prove you are disabled. The counterclaim you can make and what you can argue is to bring in the medical evidence supporting a disability claim. This can be done through doctor’s notes and independent medical assessments.
The second is that Manulife will argue there is a lack of objective medical evidence supporting your claim.
The third is that an insurance company may come to the table sharing evidence of behaviour and/or social media posts that contradict claims you are making. If they can present clear evidence that there could be dishonesty at play, it is a strategic way for an insurance company like Manulife to defend itself. This is why a key recommendation most experienced disability lawyers will give to a claimant is to avoid posting on social media. If you make it public, Manulife can use it against you.
There are a range of legal strategies and evidence a disability lawyer can present to help you overcome these tactics.
What About A Disability That Does Not Show Up In Testing?
There are various disabilities that will not show up in any sort of test. You can’t take an MRI or CT scan to prove it. They’re not necessarily going to be seen on any sort of objective testing. Fibromyalgia and chronic pain are great examples of this. There are millions of people suffering from chronic pain on a daily basis and for a portion of these, this pain does not show up in any testing.
For these types of disabilities, it presents more of a challenge. As painful and as debilitating as chronic pain or similar conditions can be, it takes more evidence and stronger arguments to successfully qualify someone as a total disability.
Another set of unseen disabilities that can be difficult to prove are mental health conditions, including anxiety and depression. For these, there may not be anything physically wrong yet they’re potentially equally painful and debilitating. Something like post-traumatic stress disorder can impact functioning just like a physical disability can.
Hopefully, with conditions like these, the more documentation there is the better. You can submit your own physician’s documented opinion and notes to help with a claim. It will help, however, Manulife has their own doctors. They often refer unseen disability cases like these to their own doctors and it’s the evidence presented by them that they use as opposed to what you may provide.
Speak With A Disability Lawyer Before Launching An Appeal Through Manulife
Manulife deals with claims and appeals every day. They are very experienced at getting their way when it comes to putting an end to continued benefits. If you approach the appeals process without a lawyer, you are immediately being put at a disadvantage. Manulife has a team of lawyers to protect their interests. Before launching an appeal, speak with a disability lawyer first.
In handling a disability benefits claim like this, you have two options. The first is to make an internal appeal through Manulife. In this scenario, Manulife is the judge and most likely to act in their interests. The second option is to take your case to court. With that, you have an independent decision-maker.
Before you decide for sure to head to court, let’s take a look at what would happen if you go through the appeals process. The first part of an appeal is Manulife explaining their decision to terminate your benefits. They may have already done so. In some cases, it may come down to a simple misunderstanding. If that’s the case, it’s fully possible Manulife may reverse their decision right then and there. It’s rare but it has happened. If this doesn’t happen, you can deal with a customer service manager going forward and it is through this manager that the formal appeal will begin and be escalated to the right parties. You can submit documents and evidence alongside an appeal and make a formal case that you deserve to continue receiving benefits.
If the customer service manager denies your claim, the next step is to reach out to Manulife’s ombudsman. This office is there to review denied claims and benefit terminations. The ombudsman will look at how your claim was reviewed and filed to ensure rules and policies were followed.
An ombudsman will also conduct their own review of your file. Although this can sound promising, sadly, there is a limit to how far you can get pursuing an internal appeal. Manulife is open to listening, reviewing, and considering the possibility that you may still qualify; however, doing so without legal representation advising you could result in them acquiring information that will only strengthen their case in denying you benefits.
A disability lawyer could, for example, request that another ombudsman examine your case file. They may refer you to the OmbudService for Life and Health Insurance. This non-profit organization provides alternative dispute resolution for disagreements between policyholders and insurance companies. Although this service isn’t available to everyone, and they can reject some cases outright offering no assistance, it may be worth asking them if they can intervene in resolving your dispute.
Assuming none of this has worked and you still do not have a satisfactory resolution, the last move to make is to take your appeal to the courts.
Should I Go to Court To Appeal A Disability Benefits Termination?
Although going to court can sound like a good path towards resolving a dispute, it can be tough to get there.
In general, it is less costly to exhaust Manulife’s appeals process first. This way, you pursue every available avenue pre-court to arrive at the decision you want. That said, if you or your legal representation prefers, you may be advised to go straight to court. A disability lawyer can provide an accurate view of your case as it relates to appeals and the courts, and advise accordingly on where time and effort are best spent.
When you come before the courts, they are there to review the record and facts. The courts will reach their own decision relating to whether you are entitled to benefits or not. Meeting the definition of ‘total disability’ is not necessarily easy. You are going to be hit with a lot of arguments from Manulife arguing the contrary and that you should not qualify. If you do not have fairly persuasive evidence, you could end up with the same result as you did with internal appeals. A disability lawyer is an absolute necessity in preparing you for what’s ahead and ensuring the medical evidence is there, the investigations are done, and that you are presenting your best argument.
In court, there are lots of ways Manulife may try to make it difficult for you to receive your benefits.
- Manulife may outright refute medical evidence, even arguing with expert opinion and physicians who are very familiar with your condition. They are likely to rely on their own doctors’ opinions and assessments to make a conclusion on your condition.
- You may encounter the argument that you are not following the recommendations of treatment providers and that you are not interested in getting better. This is where evidence that you are following the treatment plan provided can aid you in navigating this argument.
- Manulife will argue what you can do more than you are arguing you can. They might complete an analysis of your skills and abilities, without even meeting you, and state that someone with your condition should be able to do X, Y, and Z. They can use these assessment tools and general information about your condition to paint the picture that there’s no reason your benefits shouldn’t be cut off and that you should be returned to work.
- If it’s a mental health condition you are dealing with, Manulife may not recognize the limitations it is putting on you and argue that you shouldn’t be using it as an excuse to continue to receive benefits.
As Manulife deals with so many of these cases on a daily basis, they often use boilerplate suggestions, borderline automated replies and strategies, and make conclusions that can sometimes not even apply to your unique circumstances. They aren’t treating you like a human being. As it relates to their benefits policy, you are a number. A disability lawyer is there to ensure you’re being seen as the human being you are, to humanize what’s being said, and to make connections to reality as it relates to your ability to work. Even when your insurance company is denying you the right to share your story, a disability lawyer before the courts will make sure you are heard.
What You Can Do If Manulife Cuts Your Benefits
If you and your doctor believe that you still cannot work after two years, call a disability lawyer. They can aid in preparing your initial appeal, filing court documents, and speaking directly with Manulife to resolve the dispute in the most timely fashion.
If you have been receiving disability payments under a Manulife policy and you have learned your benefits are ending, remember that you do not have to accept the decision. You can appeal. You have legal rights. Consult with a disability lawyer experienced in the claims process at Manulife.