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Trying to get LTD back and/or CPP

I have been out of work since March 2010 and had insurance benefits through my work insurance until Feb. 2011 At that time I attempted an ease-back to work but it didn't work out. My work insurance cut me off at that time and started requesting reports from my doctors and physiotherapists. It took a few months but I got them all the reports they asked for. Then they said they didn't have enough physical evidence to justify the pain I 'claim' to be in. They wanted me to get a new MRI. It was less than a year since my last one when they first asked and I said I'd talk to my doctor when I saw him again. When I saw him he said he didn't see any clinical evidence that I needed a new MRI and he refused to order one. I understand that and had no problem with his decision. He said if insurance didn't like his decision he'd be happy to talk to them and explain why he said no.

I told them what he said and they weren't happy with it. Long story short, my doctor contacted them and made it clear that he would not be ordering an MRI as my condition had not changed in the last year since I had one. Anyway, they denied my claim but then I spent 2 more months chasing them to get their decision in writing so I can appeal. My pm doc said he'd help me. The last I spoke to my insurance agent she sent the letter last week so it should be here this week some time. I'm not sure how the appeal process works. I've never been through this before and my doctor is away until the end of November so that kinda sucks. If anyone has experience with this in Canada I'd appreciate any advice or suggestions. I'd love to talk to some other clients of Desjardin Financial Securities but no one else in my office has had to deal with LTD through them.

I've had to go to Social Assistance to get financial aid since I've had no income since Feb. They required me to file for CPP disability as well. My doctor just finished filling out the paperwork he has to do for it and I've done my paperwork too. I just need to make copies of all the paperwork and reports then I'll drop it off at the office in the next couple of days. I would also appreciate any advice on CPP disability as this is all new to me. What are they looking for? What will help or hurt my case?

I look forward to some feedback on this issue though I know most of the members here are probably in the US.



  • babyruthbbabyruth Posts: 260
    edited 11/09/2012 - 11:21 AM
    hello lisa. i qualified for cpp on my first attempt. i was told that you have a better case the more "systems" are affected by the pain; for example, sleeping, activities of daily living (i.e., housework, laundry), bathing, concentration, mood, medication side effects (i.e., drowsiness), sitting, standing, walking, social activities pain levels.

    for me pain would effect sleep, and because i was in pain i'd take narcotics in the middle of the night, then i would wake up with a hangover from the narcotics because they hadn't cleared my system, lack of sleep led to an inability to focus at work. so for me the major arguement was pain--sleep dysregualation--medication side effects--extreme fatigue. on top of this i had all those other diffiiculties, but they were secondary to the revolving cycle of pain-sleep-fatigue. each thing is affected by the other, pain and sleep as well as the inverse lack of sleep leads to more pain...more pain leads to more meds, more meds leads to fatigue, fatigue leads to lack of concentration ....i hope this helps.
  • Hi there... I also am in Canada. Fighting the LTD still, through a lawyer. Won my CPP appeal after a few years... two denials then a tribunal I had to go to. Lots of paper! Lots of dr's. LTD... what a nightmare headache. They just don't want to pay.. and also try to snowball ya with "we need this proof" crapola.
    I am really tired right now.. back on fire, so can't sit too long right now. I do want to share with you more stuff.
    CPP website... good info there. They do want specific... prolonged and severe... proof.
    Gotta go right now... will check in tomorrow~!
  • Thanks for the responses. I am trying to prepare myself for a long ugly battle. Hopefully if that's what I'm prepared for it will work out faster and easier (hahaha). I have a good support system behind me so I'm just hoping for the best. I know I can't work, everyone around me knows it, now I just need to prove it to the powers that be.

  • I was talking to my insurance worker last night. After sending in an appeal letter of my own and my pm doc sent in one on my behalf as well I got the results. They are going to reinstate my benefits and back-pay to last march on one condition - I HAVE to get another MRI. They are really being insistent about this one and its driving me insane. I talked to the nurse at my pm clinic today and she said I can't get an MRI and no one will be able to order one for me because the pm doc already stated I have had no changes in 18 months so there is no clinical reason to have an MRI. I don't know if that is true or not but I'm sure my new family doctor will help me. She can't order an MRI, it has to be a specialist but she should know someone she could refer me to who might be willing to do it. Otherwise I'm going to have to get a lawyer and fight; I'd rather not do that. What other kinds of specialist do people see for back problems and sciatica? I see my gp on Friday so we'll see what she has to say. Any input would be welcome.

  • I know in Canada there are some places that offer pay MRIs. I think they are not incredibly expensive, but I know they take you right away. It may be an option but I don't know if a referral is needed or not. To me its rather odd that a insurance company can dictate the type of tests you get, I was wondering if you could have the PM doc write exactly what you said... you are 18months unchanging and do not require an MRI like on a prescription... that would be another approach. If they are willing to pay for an independent MRI tell them you will go :)
  • I knew there were differences between the US and Canada. I have had MRI's ordered by Primary care and ortho drs. Recently went in for a lumbar ESI and because my lumbar MRI was over 18 months old I had to get a new mri before they would do the injections. Insurance has never questioned the need for an MRI. I did have Insurance turn down a knee replacement due to not treating rhuematoid arthritis agressive enough and the OS called them and it was approved 2 weeks later.
    Good luck to you, let us know what happens.
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
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