Long Term Disability Claims

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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.

Long-Term Disability FAQs

How Do I Qualify for Long-Term Disability Benefits?

It depends. Many illnesses or injuries that prevent you from working for a prolonged period of time may qualify, but it depends on the plan you have in place. Physical illness or injury such as cardiovascular disorders, bodily injury, acquired brain injuries or cancer can leave you unable to work at your current job or any job. Mental illnesses such as major depression, PTSD, severe OCD or many others also qualify for long-term disability benefits.

The bottom line is, you must meet the definition of your policy.

When Do I Qualify for Long-Term Disability Benefits?

It depends. Long-term disability benefits come into effect once you’ve already used up your short-term benefits. For instance, a short-term disability insurance plan or more commonly, Employment Insurance (EI) which you pay into every paycheque and is paid out by the government. After you’ve become disabled, there is typically a 90 to 120-day period which is called the elimination, waiting, or qualifying period before your long-term benefits come into effect.

Not many private policies exist. The percentages vary, and qualification dates vary. There is no standardized formula for this type of benefit. That’s why it’s very important to talk to a lawyer to properly understand your policy and what these different terms mean.

How Do I Check My Long-Term Disability Insurance Policy?

Fortunately, many employees have access to long-term disability insurance. Sometimes this insurance is automatically included through your employer via payroll, but other times it’s up to the individual to privately purchase their own long-term disability insurance from an insurance company or broker. This is especially important as more and more Canadians opt for freelance or self-employed jobs. While no one plans to fall ill for an extended period of time, long-term disability insurance is a crucial thing to have.

How easy is it to secure depression benefits?

Firstly, it’s true that all disability benefit providers in Canada recognize depression as a disability. It’s a condition that can qualify for benefits. However, a diagnosis alone won’t qualify you. Ultimately, proving that depression or a mental health issue is keeping you from work can be difficult. Most providers focus on the severity of your symptoms and will consider previous, present and future medical treatment plans. They will also scrutinize how your symptoms affect your work and how hard you tried to keep working.

Keeping your documents in order and recording all necessary paperwork to assist your claim can go a long way in recovering long-term disability benefits. Nevertheless, a lot of individuals fear speaking out against their employer because they feel they will get fired – especially for depression. However, Canada’s human rights laws state that employers have a duty to help employees with medical conditions that affect their ability to work.

What are some challenges for people applying for long-term disability?

1. Inaccessible health records

Being able to access your medical records, as mentioned, is critical to successfully processing your long-term disability claim. If you’re somehow unable to get accurate, up-to-date records from your doctor and/or medical professional, insurance companies will either delay making a decision on your claim or they could flat out deny your claim or appeal based on a lack of evidence. At De Rose Lawyers, we advise our clients to make copies of all documents received and keep a log of dates in which they’ve visited their care provider.

2. Adequate employment options

It’s not uncommon for an insurance company to deny a disability claim or stop payments of benefits because they feel that you should be able to find work. Insurance companies can outsource rehabilitation experts or occupational therapists to determine if you’re capable of going back to work. They can also encourage you to go back to work on a part-time, or gradual basis. At times and in specific cases, we advise our clients to do that, even if unsuccessful. Saying you tried is better than saying you did nothing.

Moreover, another hurdle arises in situations where people are being laid off and have no job to return to. Lack of opportunity isn’t likely to help you become eligible for long-term disability or depression benefits. Again, this is where your doctor and medical records will come into play. Performing some sort of activity until a final diagnosis is reached can be beneficial in the final outcome of your claim.

3. Attending treatment sessions

In our experience, accessibility issues and transportation costs are one of the main reasons that clients are unable to meet their treatment goals. Even still, some offer videoconferences. Do your best to find medical professionals that offer more than in-person sessions — especially during COVID-19.

What types of depression benefits are available?

If you’re unable to work due to depression or disability, there are several types of depression benefits available.

  1. Employment Insurance (EI) Sickness Benefits
  2. Short-Term Disability Insurance
  3. Long-Term Disability Insurance
  4. Veterans Affairs Canada
  5. Provincial Disability Benefits
  6. Disability Tax Credit
  7. CPP Disability
  8. Workers’ Compensation

How Do I Apply for Long-term Benefits?

This is a form doctors don’t fully understand – MVA forms are standard and most doctors understand those. The first LTB application is incredibly important, and the medical report is critical. It must immediately meet the contractual obligations.

You have to contact your insurance and they will send you a form that must be filled out by a medical professional. It is EXTREMELY important that your medical professional understands why you cannot work. If the details aren’t filled out with specific details about why you can’t work, your claim may be denied.

That’s where we come into play. It’s important you contact us before you speak with your doctor. We can help you understand what obligations need to be met for your specific contract and how to properly talk to your doctor to get your forms filled out the way they need to be, before you submit them. If this is done improperly, you may be denied and will have to restart the process from the beginning or file an appeal.

You can’t afford to have a denial, and then contact a long-term disability lawyer. This will delay you from getting your coverage and leave you without income and higher medical expenses for much longer.

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 You Should Choose De Rose Personal Injury Lawyers For Your Long-Term Disability Lawyers Needs

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.

Looking For A Long-Term Disability Lawyer In Toronto?

If you or a loved one has been denied long-term disability, De Rose’s long-term disability lawyers can help. Give us a call today to schedule a consultation with a member of our experienced personal injury team. We will be there with you, and for you, throughout the appeals process.


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