Long-term disability is a complex area of the law. Here are some of the most common questions we get from clients attempting to make long-term disability claims.
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What is long-term disability insurance?
Long-term disability insurance is an insurance policy designed to replace your wages when injury or illness prevents you from working.
What is the difference between short-term disability insurance and long-term disability insurance?
A short-term disability plan will generally cover you from 30 days to 6 months before requiring you to apply for a long-term disability plan. A short-term disability plan also tends to pay a smaller percentage of your income than a long-term disability plan.
What is the difference between individual disability insurance and group disability insurance?
Group disability insurance usually comes from your employer, union membership, or membership in a specific group, like an alumni association. It usually has lower premiums.
An individual plan is a plan that you select for yourself and is not tied to your employment in any way. Premiums can be higher, but the fact that your disability insurance is decoupled from your employer can become an advantage if there are problems later down the line.
What types of disability insurance are there?
In addition to long and short-term disability, you can buy specific disability insurance policies to cover particular situations.
Mortgage disability is a type of coverage purchased from your mortgage lender. If you can’t work due to injury or illness, it covers your mortgage payments.
Supplemental disability insurance serves as a gap plan. It covers the difference between your weekly payments and your expenses if your disability payments aren’t sufficient to meet your expenses.
Disability overhead expense insurance is a business-owner plan that will pay the overhead for your business if you can’t run your business.
Technically worker’s compensation is a form of disability insurance. You are only covered by it if you are injured at work.
Who pays for long-term disability coverage?
Your insurer pays your coverage.
What type of disability allows me to qualify for long-term disability benefits?
A wide variety of disabilities may qualify. These can include heart attacks, strokes, cancer, anxiety, depression, PTSD, major spinal, neck, or head injuries, arthritis or rheumatoid arthritis, seizures, multiple sclerosis, lupus, fibromyalgia, GI illnesses, injuries caused by accidents, and more. The main criterion is that the injury or illness prevents you from working.
Will I have to file a claim in order to receive long-term disability benefits?
Yes. Most policies will have a claims form that you will have to fill out. You can usually file a claim online. You may have to provide evidence for your claims, such as medical records and check stubs.
What information is required on my disability claims form?
Every form is different. We advise you to read your form carefully and answer each question thoroughly and truthfully.
Are there deadlines when claiming long-term disability insurance benefits?
Yes. The specific deadlines will depend on your policy, but it’s generally best to get your claim in as quickly as possible.
In order to receive disability benefits, is it required that I be confined to a hospital?
No. All required is to prove that you cannot work your profession for the first two years or any profession if your disability lasts longer than two years. Most people recover at home throughout most of the disability process.
Is it legal for insurance companies to hire someone to follow and videotape me?
Yes, and you should expect surveillance. Insurance companies are constantly on guard against fraud.
Be careful of even innocent, seemingly unavoidable activities that violate doctor’s orders. If your doctor says you can’t travel up a flight of stairs, then you need to avoid stairs, even if that means having someone else bring your groceries up to you and staying inside of your second-floor apartment. These companies will look for any reason to deny your claim. Please don’t give them a chance!
How long do I have to wait to collect long-term disability benefits?
You will usually start on short-term disability, and you’ll usually wait just five days or so for your benefits to start.
You will generally apply for long-term disability benefits while on short-term disability. You will usually have to wait anywhere from 90 to 180 days to start receiving benefits. It is essential to plan accordingly.
How much will I receive from long-term disability insurance benefits?
It depends on your policy. You could receive anywhere from 50% to 80% of your net pay. You may also be subject to a monthly maximum. Some private disability policies pre-determine the benefit and do not tie them to your salary.
How long do the long-term disability insurance benefits last? Are my benefits taxable?
Private benefits are not taxable. Employer benefits are.
Can other benefits be deducted from my long-term disability payment?
Yes. This can include WCB benefits, CPP benefits, AISH benefits, severance pay, and more. In general, you are not allowed to “double-dip” benefits, so all of these benefits will have complex calculations that they use to account for one another and determine how much they will send you every month.
Can my long-term disability insurance company force me to apply for the Canadian Pension Plan (CPP) Disability or other benefits?
It depends on your policy, though many do include such clauses.
What policy “riders” can you purchase with long-term disability policies?
Many policies allow you to purchase riders or modifications that improve or extend your policy. Examples include cost-of-living riders, which adjust benefits based on inflation, and the “own occupation to 65” riders, eliminating the “any occupation” test.
Your insurance company may offer other, more specific riders with different functions.
Does long-term disability provide extended medical and dental care as well?
No, disability is only a wage replacement policy. Some employers offer medical benefit continuation. In addition, you will continue to receive Medicare.
After being unable to work for two years, can my insurance company stop paying me benefits?
This generally means you have failed the “any occupation” test. Your disability plan will kick in for the first two years if you cannot work the occupation you performed before you became disabled.
After two years, the test is whether you can work any job at all. If you’re qualified for any position or reasonably could become qualified, you’re expected to get out there and go to work.
Why has my long-term disability claim been denied? Why have my long-term disability benefits been terminated?
Insurance companies look for just about any reason to terminate benefits. This could include:
- They are missing forms or evidence.
- They believe you have committed fraud.
- You missed a deadline.
- You had a pre-existing condition you failed to mention.
- You did not get medical care from an insurance company-approved doctor as required by your policy.
- You’ve failed any occupation test.
- You have failed to mitigate your losses in accordance with your policy.
- The insurance believes you are only partially disabled.
I just received a letter from my insurance company terminating my benefits. What should I do?
The letter should tell you exactly why your benefits were denied. In some cases, you can mitigate the problem yourself by sending additional information and documentation. In other cases, you’ll need help from a disability lawyer.
If you cannot mitigate these issues yourself, it is time to get a lawyer involved.
How much will it cost to sue my insurance company?
Disability lawyers work on contingency. We don’t get paid unless we bring your case to a successful conclusion.
How Long Does Long-Term Disability Last in Canada?
Every disability plan is unique. In some cases, if you cannot return to the work you held before becoming disabled, you may be eligible for disability benefits for up to two years. After two years, receiving benefits is only possible if you are unable to work at any employment.
Can You Work While on Long-Term Disability in Ontario?
You can work in another occupation while still meeting the Own Occupation criteria of impairment during your Own Occupation term. However, if the wages from another occupation equal or exceed 70% of your pre-disability earnings, you will no longer be considered disabled.
We have over 20 years of experience handling long-term disability claims like yours. Don’t try to go it alone. Call (403) 269-7777 to claim a case evaluation today.