ASK A LAWYER: Back Conditions and Long-Term Disability

My co-workers have told me that back conditions do not qualify as disabilities under our long-term disability benefit plan with Manulife. Is this true?

Never rely on what a co-worker or what you have heard when it comes to disability benefits. Some policies do have restrictions regarding what types of disabilities or medical conditions are covered or excluded, however, most group policies do not specifically exclude "back conditions" from coverage for disability benefits. If in doubt, submit the claim and let the insurance company process your claim. Rest assured if they intend to deny your claim because such conditions are not covered under their policy, they will tell you that but do not simply accept what someone tells you without getting written proof.

Standard Life cut off my disability benefits because my MRI does not show a progression in disc degeneration, yet I am still experiencing the same symptoms—pain and numbness—that prevented me from working. Is this decision fair, or better yet, legal??

The decision may not be fair as only relying upon what an MRI states does not provide the full picture. It is not illegal for an insurance company, such as Standard Life to deny or terminate your claim based on their interpretation of the medical evidence that has been provided, but you can challenge this decision by having your case reviewed by a disability lawyer who can assess your chances of success in not accepting this decision.

My sciatic pain makes it difficult to work a regular eight-hour day. I should only work two hours a day according to my doctor's recommendations. Will my LTD benefits cover the deficit these reduced hours will cause in my pay?

This question can only be answered by a thorough review of the policy wording that applies to your case. Many LTD plans require you to be totally disabled before you can make a claim for LTD benefits. Working two hours a day may not be something that your employer is prepared to accommodate, so such significant restrictions may not make it possible for you to continue working and you may have to claim total disability. You should review the terms of your coverage to see if there is any provision for partial disability, as some plans do allow a claim for a top-up, but many do not. SP


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Back Pain

Most people will experience the pain of a back injury at some point in their lives. This problem is usually caused by sudden damage or stress to the back or by gradual wear over years. Most back injuries occur between the ages of 20 and 50. Back pain that starts over the age of 50 is more likely to have a serious underlying cause.