All long-term disability benefits have a waiting period and do not start immediately.
Have you reached the end of your rope? Do you no longer know how you are going to make ends meet since you were injured? You may be eligible for long-term disability benefits. These benefits are income replacement payments that are made monthly to those who are unable to work due to a disability. To be eligible for disability, you must be covered under a plan, and the payment is based on your salary. Long-term disability can be paid for several years, or a set number of years or until you reach a specific age.
All long-term disability benefits have a waiting period and do not start immediately. In most situations, you have to be unable to work continuously for several months before you can qualify. Once you are eligible, you will then be required to make a claim, or file paperwork, for long-term disability benefits.
Our long-term disability lawyers can meet with you in Thunder Bay for a free initial consultation. Call (416) 364-2000
Long-Term Disability Benefit Types
It is important to understand that there are multiple types of long-term disability benefits available. Some of them are through workers’ compensation, some through veterans’ disability, others through Canada Pension Plan disability, and some are through insurance-based disability plans.
Insurance-Based Long-Term Disability
Insurance companies in Canada fall under the authority of each Province. Even though they are national, and sometimes even international, they have to follow the rules and policies of the Province that they serve. When considering the obligations of your insurance company, you need to take into consideration the requirements of your province. It is also important to understand that there is not a “standard” disability policy. There are thousands of variations of policies even among the same company. Buying insurance is similar to buying a car. There is a base model and then you add all the bells and whistles for extra fees. If your long-term disability insurance is through your employer, they likely chose which bells and whistles you would receive.
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Eligibility for Long-Term Disability Benefits
Most Canadians will not be eligible for long-term disability benefits. In order to be eligible, you have to buy an insurance policy or be covered through a group insurance policy. All of these benefits will be based on the concept of complete disability, partial disability, or both. What constitutes any of these is based on the plan and the wording of the policy.
Some plans, for example, define total disability as the inability to do the regular work that you used to do. This means that you may be eligible for benefits under your own job, but that you could still do other jobs. Other plans define complete disability as the inability to do any kind of work. This means you would only qualify for benefits if you could not do any kind of work. Most plans fall somewhere between the two.
In addition, many plans will have a pre-existing condition clause which means they will limit your claims for medical conditions that you had before purchasing or enrolling in the plan. Some of the plans will have full exclusion, which means they will not cover you for any disability caused by this medical condition. Others may have limited exclusion, which means they will only exclude the pre-existing condition during the first one or two years that you are enrolled.
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What Conditions Qualify for Long-Term Disability Benefits?
The short and simple answer is almost any condition can qualify you for long-term disability if it results in you being totally disabled as your policy defines it. Long-term disability is based on how serious your symptoms are, and not the actual seriousness of the diagnosis. However, your medical diagnosis is still important because it will determine what types of treatment plans are available for you and what your prognosis is for recovery.
It is critical that you cooperate with any testing that is ordered to rule out some conditions because as a general rule, companies do not like it when there is not a clear diagnosis or plan of treatment. They may deny or stop payment of your benefits if they feel like you are not doing everything possible to work out your condition. The following medical conditions are some of the most commonly seen in disability claims:
- Back conditions and problems
- Bipolar disorder and depression
- Chronic fatigue syndrome and fibromyalgia
- Chronic pain
- Crohn’s disease
- Heart disease
- Headaches and migraines
- Knee disorders
- Multiple sclerosis
- Neck and cervical disorders
- Visual disorders
- Sleep disorders
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Applying for Long-Term Disability Benefits
In most situations, you will have a waiting period before you can apply for long-term disability benefits. The waiting period under most plans is 15-17 weeks but can go as long as 52 weeks. After your waiting period is over, then you will apply for benefits.
Applying for benefits is the same for everyone. You will need to be continuously unable to work for the term of the waiting period, get the forms to apply for long-term disability benefits, and send them in. Send in any medical documents to support your claim. Then wait for the insurance company to make a decision.
Keep in mind that it is illegal for your insurance company or employer to refuse to give you the forms to file for benefits. Even if they think you will be denied, they still have to allow you to file. It is also important that you do not miss any of the required deadlines for filing for long-term disability.
Appealing a Denial
If an insurance company refuses to pay you benefits, and it is justified, there is not much you can do. However, if you believe you qualify for benefits, you can start an appeals process. Depending on your plan, the deadline to appeal the decision can be soft or hard. A hard deadline is one in which if you fail to file in that time, you lose the right to appeal. Appeals only get you so far as the decision-making process lies with the insurance company’s internal team. In contrast, a lawsuit is often required when the internal appeal fails. An experienced Thunder Bay disability lawyer can help you if you have been denied benefits.
Contact an Experienced Thunder Bay Disability Lawyer Today
If you feel that you are entitled to long-term disability benefits and have been denied, contact the lawyers at Preszler Injury Lawyers today. We have years of experience helping our clients get the benefits that they are entitled to and we can help you, too.
Call or text (416) 364-2000 or complete a Free Case Evaluation form
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