A Guide to Claiming Long Term Disability

Long-term disability may be the result of an injury sustained on the job or in an automobile accident; it may occur following a sporting mishap or because of a chronic illness. Recovery from surgery that requires ongoing rehabilitation or continuing medical treatment can limit the ability to perform normal duties at work, resulting in loss of earning power and a claim for long term. No one is totally protected against such loss, and even employees of companies with quality insurance programs would be wise to check on the benefits of private long term disability insurance.

Long term disability coverage is anyone’s best protection against serious financial difficulties that result from loss of income, no matter what your age or income level may be. Despite the reputation that surrounds some insurance, and the perceived difficulties involved in filing claims and receiving benefits, there are valid reasons to consider such insurance.

This guide is designed to answer some of the common questions you may have about disability insurance, filing a disability claim, and assuring that your long term disability claim is honoured. It should be used to broaden your understanding of the terms, limitations, benefits and types of various long term disability plans, including the various policies and claims procedures of different insurance companies. There are also differences in specific legal policies and procedures from one province to another.

What Is Long Term Disability?

Defined simply, long term disability refers to an illness or injury severe enough to limit or curtail a person’s earning ability for an extended period of time. The disability may be the result of a job-related injury, a chronic medical condition, cancer or another illness that leads to extensive and long term treatment, or any accident or occurrence, including a mental condition, that requires medical intervention and an extended recovery period. For insurance coverage and benefit purposes, it is important to understand that the difference between short and long term disability is simply one of duration. In some cases, that duration may be as short as 10 weeks; in other cases, a condition is only considered a long term disability if it lasts for six months or more.

What Is Long Term Disability Insurance?

Again, the simple answer is that long term disability insurance offers protection against the debilitating effects of long term loss of income due to illness, injury or a medical condition that inhibits one’s ability to work. It differs in important ways from Workers Compensation Insurance that reimburses employees for the costs of treating job-related injuries and time off caused by on-the-job accidents. And it differs also from illnesses and injuries that keep workers away from the job for shorter periods of time, including non-job-related conditions that may be covered by an employer’s sick leave policies. If an illness or surgery requires a lengthy period of ongoing recuperation or treatment that keeps you away from work, it may be classified as a long term disability, in which case you could file a claim for benefits until it’s possible to return to work.

Long term disability insurance is not usually an employer-provided benefit, although some Canadian firms offer the option to employees as part of a comprehensive benefit package.

The expense reimbursement and compensation rules differ substantially, however, between short term and long term disability. Typically, short term disability insurance will pay an amount equal to about 70 percent of an employee’s wages, and the cost of such coverage is generally borne by the employer. Long term payments, depending on the specific policy, may cover income replacement in addition to medical bills and/or rehabilitation. Benefits are often paid for up to two years, if a person cannot return to his or her regular job, and may extend until age 65 if a return to any kind of job is deemed impossible.

If, however, a person is eligible to receive any sort of government assistance for disability, the payments under a private plan will be reduced. In addition, long term disability insurance only becomes effective after short term disability benefits are exhausted. They cannot be claimed concurrently.

Coverage for long term disability is something that all workers should consider, weighing the cost of such insurance against the devastating effects of long-term loss of income due to inability to work.

What Does Disability Insurance Cover?

Essentially, private disability insurance coverage helps you manage your bills and sustain your family’s lifestyle should you become disabled. There are no universal rules governing long term disability benefits; in fact, there is no universal definition of disability. That’s one reason it pays to know about the terms that are used, to study your options carefully, and to shop for the coverage that best suits your needs. In Canada, even statutory definitions of disability can vary from one jurisdiction to another.

The World Health Organization takes the definition of disability a step further, noting that there are three basic types of disability:

• Impairments that define a bodily function or structure;
• An activity limitation; or
• A participation restriction.

But, even with that language, there can be disagreement among companies, or within the same firm, about what can and should be covered. The potentiality that a claim will be disallowed always exists, and that can be devastating to anyone who is unable to return to work because of a medical situation.

How Long Does Long Term Disability Last?

Typically, long term disability insurance payments may begin sometime after about 10 weeks of disability, but the period may be as long as 52 weeks in some circumstances. Compensation is not automatic, even when it is offered by an employer. An employee who receives payment from Workers Compensation insurance or an employer’s disability payment coverage may still be entitled to compensation from a private insurer. Some forms of disability have lifetime limits, while others may have caps on monthly payments. Some incorporate a form of cost of living increase into the policy language to mitigate the effects of inflation in cases of lifetiime disability; other policies will supplement payments received from other sources to bring income equal to the wages earned while the disabled person was working.

When a long term disability policy is activated, it is subject to the governing clauses of the policy, whether for a period of five or 10 years, or until age 65. If you are shopping for disability policies, consult with an attorney or trusted financial adviser to determine which limits may be most beneficial for your particular situation.

How to Apply for Long Term Disability Compensation

As noted previously, long term disability payments are not automatic. The application and verification process may be cumbersome and will definitely require attention to specific details, precise record-keeping and constant monitoring. It can be to your advantage to consult with an attorney who specializes in LTD Long Term Disability cases, claim filings and adjustments, and a firm with in-depth knowledge about both health concerns and legal requirements. Applying for long term disability financial assistance can be a lengthy and complicated process.

Disability claims are time-consuming and exacting. Allowing a professional representative to file your claim can mean the difference between peace of mind and continuing worries at a time when you have many more important concerns.

An initial claim denial does not mean that you have to give up hope of receiving long term disability benefits. It may simply require additional documentation or a revised filing. Claim denials can be reversed or set aside, and having a knowledgeable advocate to present your case can mean the difference between receiving proper benefits and being consumed by financial worries.

How to Get Long Term Disability from Work

Dealing with a disability is difficult enough without having the added stress of filing insurance claims, fielding questions from insurance companies, completing redundant forms, documenting treatment dates and procedures, and keeping track of medical expenses, notes, specific treatments and outstanding bills. The process can be exhausting and overwhelming at a time when all your energy should be concentrated on your physical well being and your health concerns. If a trained advocate is working on your behalf, it can mean the difference between healing and continuing stress.

Many employers are less than helpful when it comes to supplying information about coverage, individual rights and disability claims. If you are in doubt about your coverage, or you have questions related to a pending claim, a previous denial, a change of condition or situation, the cessation of disability payments, disability challenges, or recourse to any situation that affects your coverage and your benefits, representation from an attorney who specializes in personal injury cases is a must.

Diamond & Diamond has a reputation of fighting for clients’ rights — and winning. If you require a trained and dedicated personal injury attorney to fight on your behalf, our firm stands ready to help.

On the other hand, if you are simply interested in finding more information about the reasons for and potential benefits of disability insurance coverage, we can help you separate fact from fiction about current law and procedures throughout Canada. We will be happy to explain the terms and help you weigh the pros and cons of various available options. While we are not affiliated with a specific insurance company or agency, we are prepared to answer your questions, and we have the knowledge, experience and expertise to help you evaluate insurance options with an eye toward understanding the subject, evaluating your options, assessing your needs and deciding what is best for your individual situation.

Long Term Disability Canada FAQ

As a summary, these are some of the questions most frequently asked by Canadians regarding long term disability insurance:

• I’m young and healthy. Why should I consider long term disability insurance? Statistics show that about 1 in 4 citizens currently in their 20s will become disabled before they reach retirement age. Is it worth the gamble to wait?
• I am employed by the government. I am eligible for assistance through the Federal Employees Retirement System. Why would I need additional insurance? Government employees may be partially protected, but even federal employees should carefully check their plan and be aware of its limitations. Always consider the advisability of supplementary coverage. Government claim requirements are especially stringent, and a private policy can offer additional funding, not to mention additional peace of mind.
• Insurance companies will find a way to disallow benefits, so why bother? It may be common belief that insurance companies will do everything in their power to pay out the least amount possible in benefits, but that doesn’t mean that supplementary insurance is a bad idea. It simply means that you should enlist the best efforts of those who are trained to deal with the insurance companies and dedicated to securing the highest return in benefits for each individual client.
• I don’t want to pay for decades for insurance that I may never need. Can I buy coverage for a shorter term? Actually, yes. In fact, that may be the wisest thing you could do. Because there are additional safety nets in place for those who might become permanently disabled and unable to work at all, a policy that offers coverage for a specific limited period of time in case of a disability can be a smart move. Even though you might not be able to return to your previous position, you could possibly be retrained for a new position or an entirely new career. Disability insurance policies don’t have to be written to cover a person to age 65. Consider your options, your risk, your budget and your family needs carefully before making a final decision, but many professionals recommend a five-year policy, citing the fact that most claim-worthy disabilities have a span only three years. Paying for more might simply be a case of spending money unnecessarily.

Working on Your Behalf to Get You the Compensation You Deserve

In addition to a team of personal injury lawyers working for clients in Ontario, Alberta and British Columbia, Diamond & Diamond has a full-service staff of legal representatives to assist you with real estate dealings, corporate law matters, civil and commercial litigation, class action representation and a host of other legal matters.

We hope you find this long term disability guide helpful, and we are available to answer any specific questions. Please contact our firm at your convenience for additional information.