Long Term Disability

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Most people think that unless they are employed in a dangerous job or participate in a hazardous hobby, they have very little risk of becoming disabled. They view a long term disability policy as unnecessary and an expense that they can safely avoid.  Having access to disability benefits if you are unable to work is extremely important. Not many people can easily get by financially for a prolonged period of time without any income.

There are several types of disability benefit plans and programs in Ontario and each has its own eligibility requirements. Depending on your circumstances, you may qualify for more than one disability benefit.

Common sources of disability income include:

Sick Pay from your Employer

Many employers offer paid sick days as a non-wage benefit. Some employers let you “bank” unused sick leave and you may have accumulated a significant amount of sick pay.

Short-term Disability Benefits

Some employers offer short-term disability benefits or salary continuation benefits as a non-wage benefit. Short-term disability benefits usually provide income to employees who are off work for up to 3 months. You need to check to see if your employer offers short-term disability benefits and, if so, for what period of time.

Employment Insurance (EI) Sickness Benefits

If your employer does not provide short-term disability benefits, then you may qualify for Employment Insurance Sickness Benefits.

Long-term Disability Insurance Benefits

Some people are covered by a long-term disability policy. This could be a workplace group policy provided by your employer or union, or it could be an individual disability insurance policy that you bought.  These policies may pay disability benefits for several years, typically until the individual qualifies for a pension or to age 65. If your disability was caused by a workplace accident, then the long-term disability benefits may not be available or they may overlap with workers compensation benefits.

Canada Pension Plan Disability

Many Canadian workers can apply for disability benefits from the Canada Pension Plan. In order to be eligible to receive these benefits you have to be continuously disabled and off work for 4 months. You must be under age 65, unable to maintain gainful employment due to disability, and have made recent contributions to the Canada Pension Plan in order to qualify for Canada Pension Plan Disability benefits.

Workers Compensation Benefits

Many workers are covered by Provincial Workers Compensation Programs. Most businesses are required to participate in a workers compensation program, with some exceptions.  To be eligible for workers compensation benefits you must have a work-related injury that occurred while working for an employer enrolled in a workers compensation program.

Provincial Disability Benefits or Income Support Programs

There is a disability income program in each province for eligible residents. These provincial disability income programs are usually the last resort if you do not qualify for any other form of disability income.  These programs have both a disability and financial criteria. This means that you can only qualify for provincial disability support income if you are disabled and your income and assets fall below certain levels. Even if you are unable to work due to disability, you may not qualify for provincial disability support income if a family member has sufficient income, or if you have significant assets such as a home, or savings, etc.

Here are 8 practical things you can do to manage the long term disability claim process.

1.   Complete your application forms for your LTD claim in a timely manner.

There are many forms which need to be submitted for an LTD claim. They should be submitted as soon as possible. There are often limitation periods set out in LTD policies and a delay could result in a denial of your LTD claim.

2.   Make sure that you consult with your family doctor or specialist for your LTD application.

Your doctor or specialist will need to complete a medical questionnaire for your LTD application. Make sure that your doctors are aware of the problems you have had at work because of your symptoms and limitations.

3.   Be sure your application supports your claim of disability.

There may be a section in your LTD application which asks how you are feeling, or to describe your pain, injuries, physical and/or psychological limitations. Make sure to include a detailed description of how your medical condition prevents you from performing the requirements of your job.

4.   Let your medical records do the talking.

LTD insurers need to see medical evidence to corroborate your claim for disability benefits.  Your medical records, including those of your family physician, any specialist and other treatment providers, are needed to support your claim of disability.

5.   Follow the rules of the LTD provider.

In your policy, you will find rules and procedures.  Make sure you follow them.  If you fail to comply with your LTD policy, the insurer will use that as an excuse to deny your LTD claim.

6.   Be careful with what you say over the phone with the adjuster.

What you say during your phone calls with the adjuster may be recorded and used against you in the assessment of your LTD claim.

7.   Do not post to social media.

Social media posts of you engaging in physical activities and evidence of time spent online could give your insurer an excuse to deny your LTD application. It is advisable to reduce your activity on social media sites during the application period and while receiving disability benefits.

8.   Speak with a lawyer first.

You should not commit to any agreement or settlement without speaking with a lawyer first.

The personal injury team at Mann Lawyers is committed to ethics, integrity and results in its legal practice. In every case we take, we are sensitive to the experiences of our clients. Our professionalism and high standards of practice are a complement to our individual compassion.

You may reach us by phone at (613) 722-1500 or 1-888-420-0577 (toll-free) or by email at personalinjury@mannlawyers.com.

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Frequently Asked Questions

What are Employment Insurance (EI) benefits?

Employment Insurance (EI) benefits are typically reserved for situations such as layoffs beyond employee control – in other words, they function as a means of temporary income support. This is achieved through payments of premiums in the preceding year in addition to meeting eligibility criteria. If your employer does not provide such benefits for those with disabilities, then you could be eligible for EI Sickness Benefits. We can help you determine this eligibility.

Why do I need to be careful about my online activity?

When long-term disability claims are being examined, special precautions are taken by the insurance company that are meant to protect against fraud. Eliminating fraudulent claims ensures those truly in need receive the compensation they rightfully deserve. Disability insurance companies moderate social media sites to look for claimants whose activities are inconsistent with the limitations they say they are experiencing. Therefore, your online presence and even the way you behave over the phone in conversations with an adjuster are scrutinized and taken into consideration as part of the decision-making process. If your medical records and current condition do not align with long-term disability policies or application requirements, your claim may be denied. As noted, even posts on social media can be attributed to time spent online, which can actually be used against you. Honesty is important, but at the same time, you also need to ensure an adjuster does not come to incorrect conclusions based on a few social media posts.

How can I prove my claim is real?

In order to have a successful long-term disability claim, you need to establish the medical cause and the effect it has on your ability to work. You therefore need to prove how you are disabled in a long-term manner, how it has impacted your ability to work, and your income prospects.

Why work with a personal injury lawyer on my claim?

If your long-term disability benefits have been unjustly terminated, know that you do not need to face it alone. Feel free to ask us any questions or share concerns on your unique case. With over 80 years of collective legal experience and a passion for helping our clients reach ideal outcomes, we will work closely with you to determine an appropriate course of action. Never commit to a settlement or agreement before speaking to a lawyer; it could end up that you are entitled to more than what it states. Our team can ensure you check all the boxes on your claim and submit one that validates your side of the story.

Our Personal Injury Clients are People, not Paperwork.

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