What is the Definition of Total Disability?

What is the Definition of Total Disability Featured Image

While every insurance policy uses the term “total disability” a little differently, it is usually defined as any illness or injury that keeps you from performing work for at least 17 weeks. The 17 week marker is also used to denote a “long-term” disability. 

These terms have meaning when attempting to collect insurance benefits, when attempting to collect public benefits, and when attempting to press a personal injury case.

Your Occupation in a Disability Claim

When you are first injured or when you first become ill, total disability is defined as an inability to pursue your “own occupation,” that is, the job that you were working at the time when the disability occurred.

After a certain period of time—usually 24 months—most insurance policies or public benefits will then require you to show that you can’t work in any occupation through a combination of your bodily ability, education, training, or experience. These policies want you to get some form of gainful employment, even if it’s at a much lower wage than you made prior to the accident.

Available Benefits and Coverages

In a personal injury case, you’ll receive compensation for past lost wages as part of your settlement. If your injuries are grievous enough to qualify for total disability then you can also receive a loss of earning capacity settlement. These settlements require the involvement of experts who make certain assumptions about your career trajectory. 

Unfortunately, nobody can predict the future, so these assumptions can be challenged. In the end the amount you receive for a loss of earning capacity comes down to the negotiation skills of your lawyer. Usually those who expect to live, at least in part, on their personal injury settlement are better off investing the settlement or taking it as a structured annuity monthly payout.

While you’re waiting for your personal injury claim to resolve you will have a few other places to look for monetary support. The first stop for many Albertans will be their Section B coverage. This is a routine coverage offered by all legal car insurance policies. 

Section B will pay up to 80% of your lost wages, or up to $600, whichever is smaller, for two years. If you were not employed at the time of the accident you can still get a total of $135.00 per week for a maximum of 26 weeks if you are unable to perform household duties.

If you have a disability benefit under your employer’s insurance policy you can also claim weekly living expenses from that policy, up to the limits outlined by the policy.

Sometimes you can receive both disability insurance payouts and Section B, but your Section B payments will be adjusted to reflect the fact that you are receiving money from another source.

There are also public benefits available. CPP is the federal program for people with a severe and prolonged disability that prevents you from doing “substantially gainful work,” defined as work that pays at least $17,000 per year. This program also requires you to have paid into the Canada Pension Plan. Most people have: it’s taken out of their taxes at work automatically. Depending on how much you paid in, this plan will pay between $510.85 and $1,414 per month until you reach the age of 65, at which point they revert to normal CPP payments.

AISH is the provincial program. It is a means-tested program that requires you to apply to all other benefits that are available to you. 

You can keep AISH benefits even if you receive a personal injury settlement, though you have to take steps to protect the settlement. CPP is not means tested, and will not be impacted by your personal injury settlement. 

On-the-Job Injuries

If you were injured on the job you cannot make a personal injury claim, but you can apply for no-fault workers compensation coverage through WCB instead. You will also be eligible to have your medical bills covered. 

Proving Total Disability

Proving total disability requires evidence. We use medical records, physician instructions, X-rays, MRIs, expert witnesses, psychological evaluations, prescriptions, and your own accounts of the ways that your injury has destroyed your quality of life. At times we might bring in family or friends to testify about the impact on your life.

We recommend documenting the effects of your injury on a daily basis. These journals can be a big help at providing a body of evidence as to the veracity of your disability claim.

Remember, any insurance company who is going to be asked to pay money because you can’t work, whether it’s your own insurance company or an at-fault party’s, does not want to pay you. They’re going to look for any weakness in your case to paint you as a malingerer who could go back to work if you really wanted to. You need a personal injury who is well-versed in the law to show that you have a bona fide claim. 

If your insurance claims have been denied unfairly, a long-term disability lawyer can help.

Disabled by an Accident? Need Help Getting Disability?

Our team of Red Deer personal injury and disability lawyers is here to help you hold the at-fault party accountable. The earlier you involve a lawyer, the better your claim is likely to go. We can even file claims on your behalf, reducing the amount of justification that an insurance company has to wriggle out of paying your claims. When you hire us, they know you mean business and that their normal dirty tricks aren’t going to work. 

Most of our lawyers have over 20 years of experience with personal injury and disability law. We’re known for being some of Alberta’s toughest negotiators and savviest litigators. We’re responsive and caring. Calling us is absolutely risk-free: we’ll evaluate your case without a retainer and without charging an exorbitant hourly rate. We don’t get paid unless we bring your case to a satisfactory conclusion. 

Don’t struggle through the process of making a personal injury claim or long-term disability claim alone. Don’t let insurance companies take advantage of you. Call (403) 269-7777 to claim a case evaluation today.

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