In order to receive illness-related long-term disability benefits, you may be required to prove that your illness will prevent you from performing the duties of your job to qualify for an extended period of time. As such, being diagnosed with a number of different illnesses may make a policyholder eligible to submit a claim for benefits.
Eligibility requirements may vary between insurance companies. Consulting the details, conditions, and severity requirements of your insurance plan may help you determine if your illness qualifies you to receive long-term disability benefits.
Some long-term disability plans may bar coverage for illnesses related to pre-existing conditions, namely medical conditions diagnosed before the insurance policy was purchased. In some cases, these insurance plans may offer an exclusionary period, allowing policyholders with pre-existing conditions to access long-term disability benefits after paying into the policy for a set period of time, which is often a number of years.
If you are unsure if your illness qualifies you to claim benefits, a long-term disability lawyer may be able to help interpret your policy.
Illnesses that May Entitle Policyholders to Long-Term Disability Benefits
Being diagnosed with a serious physical illness that prevents you from returning to work may make you eligible to receive long-term disability benefits. Some examples of illnesses that may qualify you for benefits include:
- Chronic obstructive pulmonary disease (COPD)
- Crohn’s disease
- Heart disease
- Kidney disease
- Lyme disease
- Parkinson’s disease
- Chronic Pain
Additionally, policyholders who develop serious mental illnesses that prevent them from working may also be eligible to collect long-term disability benefits. Examples of mental conditions that may prohibit an individual from returning to work may include:
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
Whether your illness is physical or mental, in order to submit a claim for long-term disability benefits, you may require an official diagnosis from a medical professional, and exhaust other compensatory options available to you, such as paid sick leave, vacation time, and short-term disability benefits.
Receiving Long-Term Disability Benefits Payments
Long-term disability benefits are designed to provide eligible recipients with a portion of their normal wages while they are unable to earn a living due to their medical conditions. In Canada, long-term disability plans typically allow recipients to recover between 60-70% of their normal income.
Your insurance provider may require benefits recipients to apply for Canada Pension Plan (CPP) benefits, as well. CPP payments may help offset the amount of benefits you receive from your insurance company. In these cases, the payment amount issued to you each month by your insurer may be reduced.
Your policy may also have a rule that, after a certain amount of time, you can only continue receiving benefits if your illness prevents you from working in any occupation, even if it is unrelated to your current occupation. If at that time, your illness allows you to perform the duties of a different job than the one you had when you first filed your claim, you may no longer qualify for benefits.
Appealing Denied Claims for Long-Term Disability Benefits
If you’ve been diagnosed with a serious illness that prevents you from working for a lengthy period of time, but your insurance company denies your claim for benefits, a long-term disability claims lawyer may be able to help you appeal the insurance company’s decision.
Appeals may be made internally, through direct negotiations with your insurance company. You may also be able to file an external appeal, or lawsuit against the insurance company if you believe that they unfairly denied your claim for benefits. Doing so could result in a judge determining your eligibility for benefits instead of the insurance company.
Preszler Injury Lawyers May Be Able to Help You
If you have questions about what illnesses may entitle you to receive long-term disability benefits, or your claim for benefits was unfairly denied, Preszler Injury Lawyers may be able to provide useful advice and assistance. To discuss the details of your claim, call Preszler Injury Lawyers today at (416) 364-2000 for a free, initial consultation.