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THE QUESTION

I recently applied for disability benefits as I was unable to function at work because of anxiety. I prefer to use homeopathic remedies that my homeopath prescribes. The insurer denied my claim because they do not recognize natural medicine as a prescribed treatment. What are my options with my claim as natural medicine works for me and is my preferred treatment?

THE FIRST ANSWER

Nainesh Kotak, founder, Kotak Personal Injury & Disability Law, Mississauga

We have seen a growing trend of our clients turning to natural medicine or alternative therapies as their choice of care in dealing with injuries and illnesses. Disability insurers frequently deny claims on the basis that there is insufficient medical evidence or that the claimant isn’t seeking appropriate treatment. If your family doctor is aware of the homeopathic treatment and has not told you to switch, this will help. In Ontario, there is case law that provides that a failure to follow physician-prescribed treatment is just one factor to consider when adjudicating a claim, but is not the only one. Sometimes people have tried conventional treatment including pharmaceuticals and have had adverse reactions.

Disability insurers often cut off or deny legitimate claims. You can challenge the decision. You may be offered to appeal using the insurer’s internal appeal process but our experience shows that this is not worth the effort. These internal appeals can drag on for a long time and are rarely successful.

The better approach is to retain a disability lawyer to file a Statement of Claim and gather evidence in support of your case. The insurer will refer the handling of the case to a senior specialist and a lawyer. Often, the case will then be settled through a mediation process in a timely manner.

THE SECOND ANSWER

Susanna Quail, partner, Allevato Quail & Roy, Vancouver

Your question seems to conflate two different types of insurance benefits: disability insurance, which replaces your income if you are unable to work due to a disability, and extended health benefits, which cover the cost of various medical treatments that are not publicly funded like prescription medication, medical devices, physiotherapy, psychologist services and so on.

If you can stay on your disability insurance (which you should be careful not to jeopardize) but change your extended health benefits insurance, you could explore that option. Your insurer does not have any obligation to cover whatever you want to be covered, only to cover what you have purchased insurance to cover.

If your extended health benefits are provided by your employer, you could approach your employer to ask whether they will expand this coverage, but they have no obligation to do so. If you work in a unionized workplace, your union could pursue this issue in collective bargaining but again there is no obligation for your employer to agree to expand coverage in this way.

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