Advice for disability claimants who want to take a holiday

With warmer weather on the horizon, employees’ minds may be turning to vacation plans. For most, taking a holiday is as simple as booking the time off, with your boss’ approval. For those on disability insurance leave, vacations are still permitted — after all, it’s an opportunity to rest, recharge and recover from what ails you. However, not consulting your insurer first could be a costly mistake, one that might jeopardize your benefits.

In exchange for disability payments, you have agreed to report your condition and work status to your insurer regularly or upon request. This allows the insurer to assess whether you remain eligible for benefits. Insurers are very interested in any changes to your routine, condition, symptoms, medication and treatment because these inform your ability to return to work. And the sooner the insurer gets you back to work, the less you cost that insurer. While insurers are technically expected to prioritize your best interests, they are ultimately profit-driven, creating a clear conflict of interest.

So why should you check with your disability benefits provider before taking that much needed getaway?

First, your policy may limit the amount of time you are permitted to be out of the country. While some policies are silent, others expressly stipulate a time limit.

Take, for example, the recent case of Saloomeh Nazary Nasab v. Sun Life Assurance Company of Canada. Ms. Nasab suffered from chronic back pain. She was eligible for 26 weeks of short-term disability (STD) benefits. Sun Life approved her claim for 11 weeks. For the remainder of the 15 weeks the STD policy potentially permitted, she was in Iran for a family emergency. The policy expressly stated benefits would not be paid if she was “absent from Canada longer than four weeks due to any reason, unless Sun Life agrees in writing in advance to pay benefits during the period.” Before departing, she did not get Sun Life’s approval.

At the motion, Ms. Nasab unsuccessfully argued that STD benefits should be suspended for the time she was away and resume for the remaining 15 weeks after she returned. “The STD period is a maximum period of 26 weeks of payment, and for any period the claimant is out of country without pre-approval from Sun Life during that 26 weeks the benefits will not be paid,” wrote Justice Jane Dietrich, dismissing Ms. Nasab’s STD claim.

The court also dismissed her much larger long-term disability (LTD) claim because she had a pre-existing disability — an entirely different topic for another column.

To avoid a similar fate, be sure to read the fine print in your benefits booklet and the entire insurance policy (yes, this is a separate document) and look for any language concerning trips abroad. If you are unsure, check with your insurer or a disability lawyer.

Second, virtually all disability policies require you to follow a reasonable treatment plan while receiving benefits. So, even if your policy says nothing about spending time outside of Canada, you will still be expected to continue appropriate treatment no matter where you go. This includes, say, regular sessions with your physiotherapist or psychotherapist and, of course, taking medication as prescribed. Not adhering to a plan could lead to discontinuance of benefits.

Third, insurers may view your vacation as a sign that you are healthy enough to work — a message you do not want to send if you are, indeed, not ready to return. Depending on the nature of your disability, taking a trip could contradict your medical restrictions. For example, if you are receiving LTD benefits for a back injury and your doctor has recommended limited physical activity, a vacation ziplining across the Costa Rican treetop will almost certainly result in cancelling your benefits.

Be transparent with your insurer about the length, nature and location of your trip. Discuss potential modifications to your treatment plan. A few weeks of home-exercises, meditation or virtual therapy should be fine. You could also arrange for follow-up appointments upon your return. If you face resistance from your insurer, ask your healthcare provider about creating a modified treatment plan that accommodates both your restrictions and vacation activities. If your doctor, as part of your treatment plan, recommends the vacation — for the sake of taking a vacation — even better. An insurer would be hard-pressed to deny coverage in the face of such a medical note.

Fourth, you do not want unexpected requests for phone meetings, updated records or medical evaluations to disrupt your trip. If your insurer is aware of your absence, it likely will not contact you while you are away.