Disability Insurance Claims

Some people who are receiving long term disability (LTD) benefits feel that they are able to return to some form of paid employment and that it would be better for them to be out working, even part-time, than sitting at home. But does returning to work put their entitlement to LTD benefits at risk?

If you are receiving LTD benefits and return to work, you may jeopardize your LTD benefits, especially if you earn as much as you were making before you became disabled. Even earning a substantial portion of your pre-disability income could result in the loss of your benefits.

The impact that returning to work will have on your LTD benefits depends on the wording of your policy and the amount of income you earn. It is therefore important to obtain a copy of the actual insurance policy and not rely on the contents of any “booklet” you may have received.

A blog on this topic can be found here.

Before you make a disability claim, you need to identify the disability benefits you may qualify for. There are several types of disability benefits 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.

This blog discusses the most common sources of disability income.

Most disability programs have 3 forms that need to be completed as part of the initial application. The claimant, the employer and the treating doctor each fill out a form.

The form from the employer will ask for information about your job. The employer should provide a very detailed job description, which itemizes the essential tasks or duties of your position, even if one is not required by the form.

Your doctor may only have a limited knowledge of your employment and not know the essential tasks of your job. The detailed job description should be shared with your treating doctor before he/she completes the medical questionnaire. It is important for the doctor to outline how your physical and / or cognitive limitations interfere with your ability to perform these tasks.

If your doctor simply indicates what your diagnosis is and does not outline how your medical condition prevents you from performing the essential tasks or duties of your position, it is unlikely that your application will be accepted.

If you are prevented from attending work, due to injury in or illness, you may have access to short-term and long-term disability benefits through your employer or your own private insurance policy.

Two-years after you first received disability benefits long-term disability coverage usually has a change in the definition of disability. The definition typically changes to an inability to perform the essential tasks of any job for which you are reasonably suited by virtue of education, training, and/or experience. It is not uncommon for an insurance company to terminate payment of benefits at the two-year mark even if the insured person is not yet able to return to work.

There are many deadlines and limitation periods that can end your right to dispute a termination.

Most policies give the insured a right to appeal, which often must be commenced in a very short period. In addition, there is a time limit for commencing a lawsuit for breach of the insurance policy caused by the inappropriate termination. The Insurance Act sets a one-year time limit, from the date of termination of benefits, to commence a lawsuit. An insured who has had their benefits improperly terminated may have less than one year, depending on the circumstances of the case.

A blog on this topic can be found here.