Long Term Disability Claims

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Long Term Disability Claims

Has Your Disability Claim Been Denied? Know Your Rights!

Employer Group Disability Insurance Policies are meant to help you and your family in a time of need. Unfortunately, at one time or another, you will suffer from an illness, injury, or disease that will inhibit your ability to work. The protection provided to you by these policies is very important to the health and well-being of you and your family.

What Are Short-term Disability Benefits?

Most employers do not provide this benefit or do so in combination with a sick plan. In general, short-term disability is an income replacement that typically provides you with up to 80% of your gross salary (there is a monthly limit) for up to 6 months.


If you do not have short-term disability benefits from your employer, you may be eligible for Government of Canada Employment Insurance (EI) sickness benefits. The government offers 26 weeks of benefits.

To be eligible for EI sickness benefits, you must:

– Have used up all of your sick leave
– Have worked enough insurable hours


What Are Long-term Disability Benefits?

Most employers provide some form of long-term disability insurance benefits. LTD is an income replacement benefit that provides up to 60% of your gross salary (there is a monthly limit) for the time you cannot work. It is available after exhausting the following benefits:

– Short-term disability insurance
– Sick leave benefits from your employer
– EI benefits

Benefits usually continue until you reach age 65.


Understanding Your Disability Claim

The definition of a “disability” varies between insurance companies and can even vary between different insurance plans from the same company. It is common that the group policy has “regular or own occupation” test for a period of time which later changes to an “any occupation” test.

Obtaining a copy of the master policy is of vital importance. Policies can have different “time limits” and “exclusions”. All must be carefully reviewed in order to protect your interests.
For example, Insurers can require you to:

– take part in a rehabilitation program if it may help you get back to work;
– obligate you to attend upon a Doctor of it’s choosing to determine whether your disability continues to preclude you from working; and,
– continuously provide medical evidence that supports your claim.

1. The “Regular or Own Occupation” Test:

The definition of “regular or own occupation” means you’ll receive benefits if you’re unable to perform the main duties of the job you had at the time the disability started. You’ll receive benefits even if you can work in a different job from the one you had before your disability, based on your training, experience, and education. Most professionals purchase this type of policy. For example, a medical surgeon who can no longer perform surgery would be able to claim the benefit irrespective of the fact that he can continue working as a doctor.

2. The “Any Occupation” Test:

The “any occupation” test is a determination of whether or not you’re able to work at all. This means your illness, injury or disease, prevents you from performing the duties and/or job for which you’re reasonably suited. Insurers use this determination to decide whether you can work in a different job from the one you had before your disability, based on your training, experience, and education.


Do You Have Other Sources of Disability Benefits?

Canada Disability Pension Plan: you may also be eligible to receive benefits from the Canada Pension Plan (CPP). The CPP disability benefit is available if you have contributed to the plan and are not able to work regularly at any job because of your disability.

Workers Safety Insurance Board Benefits: if you were injured while in the course of your employment, you are likely eligible to receive WSIB. It is a complicated process. Employers readily have the forms available which you will need to complete.


Was Your Disability Claim Denied?

If your benefits have been denied, it’s very important that you get yourself a long-term disability lawyer.

Long-term disability insurance is meant to provide financial assistance to you in your time of need. When an insurance company wrongfully denies your claim, you need to seek competent legal advice as quickly as possible. Your best choice is to hire an experienced long-term disability lawyer to review your rights and remedies. They need to work with you to make sure your benefits are re-instated.

Why Choose De Rose Lawyers?

At De Rose Lawyers, we have 40 years of combined experience working for innocent victims who have been wrongfully denied their benefits. We are here to help you get the long-term disability compensation you deserve and to make sure the maximum benefits owed are paid to you and your family.


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