When you buy long-term disability insurance, or when you have access to such insurance policies as part of your employment, you would expect that should you ever become disabled, you will be able to tap into your long-term disability (LTD) policy. In an ideal world, it would be as simple as that. Become disabled from work, you apply for benefits, and you get those benefits. Unfortunately, as most people eventually discover when they have to make an insurance claim, it is actually quite complicated. People find out that there are actually many reasons that insurance companies will have to deny long-term or short-term disability benefits.
It is important to note that any disability policies are contractual in nature. That means, the terms of your insurance policy are unique to the policy that you have agreed to with the insurance company.
The basics of most short and long term disability insurance policies are that they provide you with a monthly cash benefit to help you with everyday expenses should you be away from work for an extended period of time. Typically, your disability insurance policy will cover a percentage of your income. Depending on the policy, it's typically between 50 and 75% of your salary. Some policies may pay until age 65. Some policies will also cover you for any occupation or your own occupation. Your own occupation is a better definition, because it just means you cannot work at your current job. With any occupation, it means you cannot perform the duties of any job. That means, if you become disabled, but you could perform a less demanding job, you will not qualify under the any occupation test. Some plans offer own occupation coverage for the first two years and then switch to any occupation after that.
The best thing to do to protect yourself is to ensure that you have sufficient coverage. If your coverage comes from work, you should contact your company's human resources department to see what your benefit entitles you to. You should also find out if there are any caps to your benefits. If you find out your company benefits are insufficient, you may wish to consider purchasing a private disability plan to supplement your group benefits. This is an important insurance policy for you to have, to ensure that if you ever become disabled from working, you have a source of income to survive.
If you have been denied short- or long-term disability by the insurer, you have many options. A lawyer can explain to you what options you have. There are internal methods of appealing an insurer's decision. Typically, you may try to exhaust the internal appeals procedures first. This is especially the case if the insurer just lacks documentation. However, don't take too long to appeal. If you find out your appeal is not going anywhere, speak to a lawyer immediately. Long and short term disability lawyers typically also do personal injury work, and have expertise in fighting short and long term disability denials. If you have any medical evidence, it is best to collect it and keep it in a safe place. If you don't have medical documentation, a lawyer can help you get that documentation and fight any denials that you may get from the insurance company. Do not give up on your claim. A lawyer can proceed with litigation, if necessary, in order to fight for your entitlement to the benefits that you have rightly paid premiums for and should be entitled to.
That being said, there are other avenues for monetary assistance in case you are unable to work one day. If you have contributed to Canada Pension Plan, you may be entitled to Canada Pension Plan (CPP) disability benefits. However, the test to meet is a difficult one. There are also Employment Insurance Sickness Benefits to consider, for the shorter term.
Ready to get started? Key Legal has free of charge Ontario Long-Term Disability Lawyers ready to help you either through Zoom meetings or by telephone. You can either book an appointment or request a lawyer on-demand. Just use our booking page or our chat feature to get started!