If you’re unable to work due to a serious medical condition or injury, applying for disability leave may be your next step. Many group benefits plans include coverage for short term disability (STD) and long-term disability (LTD), which provide income replacement during your recovery. LTD benefits are meant to offer peace of mind by covering a portion of your salary. Most people’s plans typically cover between 50% and 80% of your salary while you’re unable to work.
But what happens when your insurance company says you’re “well enough” to return to work, even when you don’t feel ready? One of the most common pressure points in a long-term disability claim is when an insurer recommends a Gradual Return to Work Program (GRTW). While a gradual return to work program for long term disability is often positioned as supportive, they can be used to justify cutting off benefits.
In this blog, we’ll explain how a GRTW program works, the risks of refusing to participate, your legal rights, and how to protect your LTD benefits if your case manager is pushing you to go back to work too soon.
What are Long Term Disability Benefits?
LTD benefits is an income replacement benefit which is typically part of your benefits from work. It is intended to provide a portion of your income should you become disabled from working. Your LTD insurance policy will provide the particular benefit amount. It could range from 50% to 80% of your income, depending on your plan.
The LTD policy is meant to be a “peace of mind” agreement, meaning the insurance is supposed to help provide a monthly income if you’re unable to work due to an illness or injury.
I’m on LTD But My Case Manager is Trying to Get me to Try A “Gradual Return to Work Program”
If you’ve applied for LTD and have been approved, you will be assigned a case manager from the insurance company. The case manager is responsible for evaluating your claim and making any ongoing decisions on your claim. If you or your doctor indicate improvement in your condition, your case manager might put together a Gradual Return to Work Program for you to try to return to work. Before accepting and attempting any GRTW program, consider the following:
- Are you medically capable of returning to work in any capacity?
If you’re on LTD, you might not be sure of when you’ll be able to return to the workplace. If you feel uncomfortable with a GRTW plan provided you by your case worker or are skeptical of the pace or components of the GRTW, you can have your case manager revise the plan or you can propose a different schedule that may work better with your limitations.
- Ask your case manager to consult with your doctor
If your case manager has proposed a GRTW plan, it’s important to check with your doctor to ensure it is something that is safe for you to attempt. If you suffer from a condition that has a strong likelihood of relapse, ask your case manager to obtain approval from your treating practitioner before attempting a GRTW plan.
What are the implications of refusing a gradual return to work program?
Under your disability policy and the law, you have a duty to work towards recovery and listen to reasonable treatment recommendations as provided by your medical practitioners. If you refuse to take part in a gradual return to work program for long term disability, the insurer will likely hold this against you and deny your ongoing entitlements to LTD benefits. Again, it’s important for your insurer to work with your medical practitioners or it could cost them dearly.
Pushing an improper GRTW program will cost your insurer
In Greig v Desjardins Financial Security Life Assurance Company, the court punished the insurer by awarding $50,000 in aggravated damages for (in part) terminating Mr. Greig’s LTD benefits for not partaking in the Gradual Return to Work Program that was not endorsed by his physicians, ignoring overwhelming objective medical evidence supporting his ailments and for his significantly worsening his psychological condition directly due to the insurers adjudication of his claim. The court also noted that the insurer relied on Mr. Greig not being motivated to return to work as a factor in denying his benefits, despite there being no evidence to support that allegation.
What are an employee’s rights when it comes to gradual return to work program?
In any GRTW program, your case manager should be working with your doctor and employer in ensuring accommodations can be met. A GRTW can restrict either the number of hours you work per day, slowly increasing every week or restrict the duties you are to perform at work, or a combination of both.
If your doctor has recommended a medical accommodation, your insurer should ask your employer if the accommodation is possible if you are attempting a GRTW plan.
An easy example: if you worked as an office receptionist and suffer from migraines and a medical restriction requires you to have no exposure to fluorescent lighting, it may be impossible for your employer to accommodate you. In such a case, a GRTW program would be improper if you cannot withstand any exposure to fluorescent lighting or risk a debilitating migraine.
The above scenario would be different if your job could be completed remotely and you could control the lighting in the environment and take breaks as needed.
Each person’s situation is unique, so it’s important to know what you are capable of and not capable of.
How to ensure you take the right approach to a gradual return to work program?
If your case manager is implementing a GRTW Program, it’s important to consider the following:
- Am I able to return to work at all?
- Did my case manager work with my doctor in approving this GRTW Program?
- Does the GRTW Program go against my doctor’s recommendations?
- Is my employer able to accommodate me?
When should you call a disability lawyer?
If you’re on an approved short or long term disability leave, getting in touch with a lawyer early could impact the ongoing approval or denial of your benefits. In fact, you can hire a lawyer at Whitten & Lublin to help you navigate a Gradual Return to Work Program and any other questions related to your STD or LTD claim. We offer a free consultation for short and long term disability claims. Contact us online or call 416 640 2667.
Author – Aman Chaggar
