If you're unable to work for an extended period due to injury or disability, knowing you have insurance coverage can be very reassuring. Short-term and/or long-term disability (LTD) policies provide benefits (including income replacement) that ensure an employee can concentrate on their recovery without fear of having to choose between making a premature return to work or losing their job entirely.
That's how it's supposed to work - at least, in theory. Unfortunately, sometimes in practice things work out very differently.
In this blog, I'll briefly outline some important factors to remember if you are applying for disability benefits, if your application has been rejected, or if you've received notice that your benefits have been terminated.
What are Disability Benefits?
LTD policies can be purchased by individuals or included as a part of an employment package at your work. If you purchase an individual LTD policy, you'll pay a monthly or yearly premium. If you have a group policy through your work, the premiums will be paid by you, your employer, or shared between the two of you.
If you become too disabled or ill to continue to work (and the disability or illness is not compensable under a Workplace Safety Insurance Board claim) you may be able to start drawing LTD benefits after a qualifying period. Sometimes a short-term disability policy, employment insurance or government sickness benefits can cover lost wages during this time.
An LTD policy generally pays you a portion of your usual salary/income as a monthly benefit until you are either able to return to work, no longer meet the definition of being disabled or reach retirement age. However, some policies will only pay for a defined period.
What Should You Know About LTD, Your Plan, and Your Rights?
As a law firm that has worked on many LTD benefits cases, we tend to hear from clients when they've either been denied benefits or have lost access after previously receiving them. By consulting a law firm experienced in LTD benefits, clients can quickly learn if the facts suggest there has been an unfair denial of benefits.
There are some things to keep in mind before you make that call:
1: Always Read Your Policy and Communications From Your Employer or Insurance Company Carefully
If an employer or LTD plan insurer denies benefits outright, they should provide a written reason. It could be that the policy allegedly exempts a certain type of illness or pre-existing condition, but sometimes insurers argue there is insufficient documentation of disability. Make sure you understand why you have been denied.
Similarly, if you have been receiving LTD benefits and receive notice that they will end, it could be for several reasons. After a period, the definition of disability may change. Plans that considered you to be disabled if you are not able to work at your own occupation (usually within the first two years of LTD) initially may change the definition of disability after a period to insist you are only considered disabled if you cannot perform any occupation (generally after 2 years). Each policy can differ slightly and these definitions are not necessarily standard from one policy to another.
Since an employer or insurance company may stipulate that you must take certain actions to assist in your recovery and return to work or insist that you apply for other benefits (such as CPP-Disability Benefits) to offset what they pay, you must also be careful to monitor correspondence, keep appointments and file appropriate paperwork throughout the claims period.
2: Keep an Eye on the Calendar
Policies and legal statutes stipulate that applications and/or appeals or lawsuits must be filed within a specified period. If you don't appeal or issue proceedings within the specified limits, you may accidentally run out the clock and lose your ability to claim benefits that you otherwise deserve.
3: When in Doubt, Contact a Qualified Lawyer
Navigating disability benefits policies can be very challenging - especially if you're unfamiliar with the terms and language they use. While sometimes a problem with an LTD application can be solved with a simple phone call with the insurance company or your employer seeking clarification, in other cases you may benefit from having an independent party review your policy and medical records to ensure you're being treated fairly.
Gluckstein Lawyers have had many opportunities to represent clients who have found themselves in these types of unenviable positions. Fortunately, when you have an experienced team of advocates supporting you, a story involving unfair denials and hardship can still lead to a fair resolution.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.