Understanding Short-Term Disability in Alberta

Understanding Short-Term Disability in Alberta Featured Image

When you fall ill or are injured in an accident, you may need recovery time. During that time you won’t be able to work, but you’ll still have bills to pay.

Short-term disability insurance can help you cover your bills while you can’t work. It is usually available through your employer, though it is also possible to purchase private disability insurance.

If you do not have short-term insurance coverage, you might qualify for Employment Insurance for up to 15 weeks while an injury or illness keeps you unemployed. 

How Does Your Short-term Disability Coverage Work?

Payments usually happen bi-weekly and represent some percentage of your weekly income. These will usually be capped, and the amount of the cap will depend entirely upon the terms of your insurance policy.

You can usually get up to 6 months of benefits before you have to start talking about using long-term disability benefits instead, though some plans will only give you 30 days. Your doctor can tell you how long you should expect to be out of commission. 

How to Streamline Your Application Process

When you fill out a short-term disability application your number one goal is to reduce reasons to deny your claim. 

This means you need to fill out every part of the application form as accurately as you possibly can. It also means you need to have your doctor or specialist fill out the appropriate paperwork as well, and that they get it to your insurance company in a timely fashion. 

The application usually consists of a Notice of Claim, an Employer’s Report, and an Attending Doctor’s Report. You fill out the first one. Your supervisor fills out the second. The doctor who treated you for the specific disability that you’re making a claim on submits the third.

If your insurer requires copies of documents such as your driver’s license or your birth certificate make sure the copies are clear and included with your application.

What are the Rules for Short-term Disability Benefits?

Much will depend on your plan or policy. It’s important to read your policy in its entirety. 

Do be aware that if your benefits are approved almost all plans will require you to undergo continuing medical reviews to prove that you still need disability payments. You should also be aware that the insurance company might well put you under surveillance. If you disobey doctor’s orders or start doing strenuous leisure activities while you’re off work you’re going to find your benefits revoked relatively quickly.

You may also be required to participate in treatment or return-to-work programs you wouldn’t have necessarily chosen for yourself. If the insurance company is going to pay out at all, they want to make sure that they’re paying out for as little time as possible.

How Much are Short-term Disability Benefits?

You may be surprised to learn that your short-term disability benefits don’t cover your entire salary. Instead, they usually only pay out 50% to 60% of your weekly salary, and this amount is often capped. 

Can You Be Fired While on Short-term Disability?

Most of the time your job is protected while you’re on short-term disability. You can only be terminated or laid off if the employer suspends or discontinues the business. If your employer starts the business back up again within 52 weeks after your leave ends then they have to offer you your old job back.

Alberta law also prohibits employers from terminating employees simply because they have requested medical leave or disability. 

If you feel you have been terminated in violation of the law you can file an employment standards complaint.

What happens if my short-term disability claim is denied?

It happens, and it happens more than we might like. Insurance companies make profits when they can get people to pay premiums and then find legal reasons to avoid paying the benefits when the time comes.

There are a few reasons why you might be denied.

In some cases you genuinely don’t qualify for the benefits you’re asking for. 

In others, you absolutely qualify but the insurance company is taking a shot in the dark to see if they can get away with it, or they’ve found some nitpicky technical reason to deny your claim.

When that happens you can make an appeal. 

Read your denial letter carefully. Alberta law requires insurance companies to provide you with a denial in writing. The letter is supposed to explain why your claim was denied and exactly what your rights are. You’ll have a deadline that you can use to file your appeal.

In some cases you can read through each reason that has been provided to you, provide additional evidence to show why these reasons are spurious or incorrect, and then ask for a review. This is known as an “internal appeal.” Your claim will be reviewed by a different insurance claims representative. It may well get approved on the second time around.

If you can’t get approved through the internal appeals process you might need to go to an appeal hearing. These decisions are usually handled by arbitration and are final.

Is it time to get a lawyer yet? Maybe. Some plans specifically strip you of your right to launch a lawsuit when you purchase the plan. This is often true of employer-provided or union-based plans. If you have a private insurance plan you may be able to launch an appeals lawsuit. 

Is a short-term disability lawsuit actually worth it? Sometimes. By the time you launch a lawsuit you might be able to claim damages because the insurance company isn’t living up to its contractual obligations. These can include emotional distress and financial losses associated with being able to pay your bills for the months when you were fighting with your insurance provider.

You don’t have to do any guesswork on whether your case is worth pursuing. You can reach out to a disability lawyer and just ask. 

Need Help?

Our team of Red Deer disability lawyers is one of Alberta’s toughest and most experienced. We’ve got a long track record of successful cases.

Put us to work for you. Call (403) 269-7777 to get started today.

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