According to the Government of Canada, a common way to receive long term disability (LTD) insurance coverage is through standard group disability insurance available from an employer. In some cases, group disability coverage may be available through other occupational or professional groups as well.
Group disability insurance differs from the personal long-term disability policies that someone who is self-employed might purchase. Group benefits depend on your job or your participation in another group that allows you to obtain these benefits.
Disability Insurance Offers Additional Protections for Your Family
Disability insurance pays out when a worker sustains an injury or is diagnosed with an illness that prevents them from working their job and earning an income. This may ensure your family continues to receive a portion of your normal pay even if a medical condition keeps you home from work for several weeks or even months.
Long term disability benefits are generally payable to workers who miss several months because of a qualifying medical condition. After a waiting period, long term disability benefits may begin and pay about two-thirds of the worker’s normal gross earnings, depending on the specifications of the policy.
If your medical condition causes you to be temporarily unable to work or if you have a permanent injury or illness, you may qualify for short term disability benefits until your long-term benefits become payable. You may qualify no matter if your illness or injury is related to your occupation or not.
How Long-Term Disability Insurance Works for Sick or Injured Workers
Standard group long term disability insurance generally has a waiting period, also known as an elimination period. Your elimination period length may depend on the specific language or your policy.
If your employer’s standard group disability insurance plan also includes short-term disability coverage, it may provide benefits during the elimination period. If not, there may be other options for ensuring you receive a portion of your income during this challenging time.
The Qualifications for Receiving Benefits May Change
According to the Financial Consumer Agency of Canada, it is common for standard group disability insurance policies to change how they define “disability” after a certain period. For the first two to five years, they may pay benefits based on a “regular or own occupation plan.” This means you may continue to qualify during that time as long as your medical condition prevents you from working your own job or in your own occupation.
After this period ends, the insurance policy may change to an “any occupation” plan. This means you could lose coverage if your medical condition only prevents you from working in your occupation, not any occupation.
If your medical condition prevents you from working in any occupation, you may qualify to continue to draw these benefits until you reach the age of 65 years or until you reach another limit based on the rules in your policy.
You May Be Able to Fight an LTD Benefits Denial
Unfortunately, it is not unusual to run into problems when filing a claim and getting approval for long term disability benefits, either through standard group disability coverage or a personal policy. If this happens to you, you may be able to fight a benefits denial and get approved.
Long term disability insurance carriers must provide you with an option to internally appeal a denial, but these appeals may only work in a narrow set of circumstances. You may have a better chance of recovering compensation in an external appeal or lawsuit. Discussing your options with an Ontario standard group disability insurance denial lawyer may help you learn more about your options.
Speak to Our Group Disability Insurance Legal Team About Your Case
If you filed a claim based on your standard group disability insurance and received a denial, you may qualify to take additional actions to try to overturn the denial. A member of the Preszler Injury Lawyers team may be able to evaluate whether you might benefit from appealing the decision internally or if you qualify to file a lawsuit and take the insurance carrier to court.
Our lawyers serve injured or sick workers in Ontario. Call us today at (416) 364-2000 to learn more. Your initial consultation on your case is free.