24 Feb 2023

What You Should Know Before Agreeing To A Rehabilitation Program

If your disability claim has been approved you might assume that the insurance company will continue to pay you until you have fully recovered and are ready to return to work. However, LTD insurance companies are highly motivated to stop paying disability benefits as quickly as possible and thus they will often force disabled claimants to participate in a rehabilitation program to speed up the return to work. Your case manager will usually threaten that failure to participate in the program will result in the immediate termination of your benefits. The reality is that once the LTD company has decided to initiate a rehabilitation program, your disability benefits will likely soon be terminated – whether or not you agree to participate.

Counselling Sessions/Psychotherapy

Disability rehabilitation programs can take a number of different forms. If you suffer from a psychiatric illness such as depression or anxiety, it will often take the form of counselling or psychotherapy sessions with a psychologist chosen by the insurance company. This psychologist is paid by the insurance company and provides regular updates to your disability case manager as to your progress.

You should be highly skeptical that the psychologist chosen by the insurance company is on your side. The psychologist may heavily rely on the insurance company for referrals and have every financial incentive to keep the insurance company happy by declaring that you are now improved and ready to return to work – even if that is not true.

I always recommend that you only attend psychological counselling sessions with a medical provider of your own choice and one that has been recommended by your family doctor. This way you can be assured that the psychologist or counsellor will only be loyal to you – not the insurance company. Remember, the LTD policy does NOT give the insurance company the right to dictate who provides you with medical treatment and advice.

Work Hardening Program/PGAP

If you suffer from chronic pain, fibromyalgia or chronic fatigue syndrome, a rehabilitation program will sometimes take the form of a “work-hardening program” or a Progressive Goal Attainment Program (PGAP). Most of the time the disability insurance company will outsource this program to a third party vendor. These rehabilitation companies are paid by the LTD company and provide your case manager with regular updates about your progress.

Work hardening and PGAP rehabilitation programs vary between companies. Typically, the program involves regular meetings with rehabilitation professionals, including career counsellors, kinesiologists, physiotherapists and vocational retraining personnel. These meetings normally take place in a facility where you will be required to perform various activities such as stretching, exercises, talk-therapy, and retraining activities such as working with a computer. Their goal is to push you to gradually increase your activities and improve your pain or fatigue tolerance every week so that by the end of program you can return to work. In between sessions they will often demand that you do “homework” such as performing household chores, going for walks, or otherwise increasing your activity levels.

Given these companies often rely upon insurance companies for referrals, they are under tremendous pressure to successfully return you to work. Unfortunately, that often means they will try and bully you into doing more than you are capable of which can result in a setback to your recovery. If you protest and push back due to extreme fatigue or pain they may accuse you of “not trying hard enough”. Then your disability insurance company may declare that you are refusing to comply with the rehabilitation plan and use that as an excuse to terminate your disability benefits.

Once you have completed the program, the third party rehabilitation companies are highly incentivized to report that you are fully recovered and ready to return to work – even if that declaration is untrue. The LTD insurance company will congratulate you on the successful completion of the program and advise that your disability benefits are now being terminated as you are no longer disabled.

Know Your Rights

Before you agree to any rehabilitation program, it is essential that you first have a discussion with your own medical providers. Ask your LTD case manager for a full written description of what the program involves and what is expected of you. Then, have a detailed discussion with your doctor about whether they believe it would be appropriate for you to participate and if you are capable of doing so. If your doctor disagrees with the rehabilitation program, ask for a letter to that effect and provide it to the insurance company as a reasonable basis to refuse.

Even if your doctor approves of your participation, it is very important to make sure they know about any struggles that you experience during the program or any complaints that you have. Doing so creates a paper trail of your difficulties which can counter any false narrative by the rehabilitation provider that you are now fully healed and ready to return to work.

If you do participate in the rehabilitation program, do not let them bully you into doing more than you are capable of. Only you know how much pain, fatigue, and anxiety that you are experiencing and what your limits are. Make sure you document any bullying or harassment so that there is a record of such behavior.

If you are being unfairly pressured or harassed by a rehabilitation company or if the insurance company is threatening to cut off your benefits, give me a call to get legal advice about your rights.

Likewise, if the insurance company wrongly terminates your long-term disability benefits following your participation in a rehabilitation plan, or because you have reasonably refused to participate, call me for a free confidential discussion. We will discuss your legal options, including filing an appeal or commencing a lawsuit to get your benefits restored.

Mark Yazdani
Disability Lawyer