Applying for Long-Term Disability Benefits

Lengthy absences from work may be caused by any number of illnesses or injuries, mental or physical. For example, the toll of chemotherapy to treat cancer, chronic back pain due to a historic sports injury, or broken limbs after a car crash could all be reasons you cannot perform your job duties. While your living expenses will remain steady or even increase during this period, your income will drastically drop.

Long-term disability (LTD) benefits protect you from financial hardship by replacing a portion of your income if you cannot do your job because of health issues. The amount payable will usually range from 40% to 70% of your income prior to claiming disability.

Often these types of benefits are available through a group employee plan, or you may have access to them through a privately purchased policy. Benefits from an insurance policy you bought yourself are not considered taxable income while those from an employer-paid plan are. Group insurance plans may be subject to monthly maximum limits, but the benefit amount in private plans is already determined by their terms.

A vast variety of health conditions may be covered by your LTD insurance. Click here to review a list of health conditions that could qualify for long-term disability benefits in Canada. Note that this list is not comprehensive and you may still be able to receive benefits under your policy if you have another illness or injury. Even if the underlying cause of symptoms is not well-known, as long as the symptoms prevent you from carrying out your job duties (like migraines or insomnia, for example), there is a good chance they are covered. In particular, the ability to work is measured according to your actual occupation at the time that you applied for LTD, also known as the “own occupation test”, at least at first (you can read more on this in our page about the “change of definition”).

It is not necessary to be hospitalized or unable to live independently to make a long-term disability claim. Generally, you must only be “totally disabled” according to your insurance’s definition, which is based on capacity to work. Our long-term disability lawyers can examine the terms of your policy at a free initial consultation and provide more information tailored to your situation.

How do I apply for long-term disability benefits in Canada?

To begin the process of filing a long-term disability claim, you must first fill out an application form. Should you have a print copy of your insurance policy already, a copy may be included. Otherwise, this form will be available on your insurance company’s website or can be sent to you if you call or email your insurer to request one. If you are part of a group employee plan, your company’s human resources department should have the form as well.

The application will ask for your contact details, those of your healthcare professionals, a full account of the health issues causing your disability (for example, details of the car crash in which you were injured or when you were first diagnosed with cancer) and how they prevent you from working, your banking information, where you work and what your job is, and personal information.

Along with the application form, you will need to submit evidence supporting your claim. As you search for and collect this evidence, keep in mind that you will need to:

• Prove your income (T4s, pay stubs, tax returns, notices of assessment)
• Prove your disability (reports from any healthcare professionals who examined or treated you, describing your diagnosis, treatment, and prognosis)
• Prove your job duties (letter and other supporting statements from your employer that detail your work responsibilities)

You will want to provide as much documentation as you can so that all aspects of your claim, as they are stated on your application, are backed up. This can speed up the claims process considerably. Otherwise, the insurer will likely delay approving the claim due to insufficient or incomplete evidence, possibly for months. The insurer may seek additional evidence anyway, via interviews, for example, or an independent medical examination (IME).

It is within an insurer’s rights to hire private investigators to observe and follow you to verify that your disability claim is legitimate. Therefore, it is especially important to be honest whenever you are communicating or otherwise dealing with your insurer. If you feel investigators are acting unsafely or trespassing, it is within your rights to contact law enforcement and report your concerns.

Your disability may make this process more challenging. Nevertheless, submitting a claim as soon as possible ensures that it will be assessed sooner and could help avoid the potential stress and other negative effects of waiting for coverage to start. In the worst cases, waiting too long to apply could result in penalties, up to the refusal of coverage. Seek documents from your healthcare providers and employer in a timely fashion and follow up with them soon after to make sure you have everything you need from them. Our experienced long-term disability claims  can aid you by tracking deadlines as well as corresponding with your insurer for you.

What happens at an independent medical examination?

Your insurer will probably order an IME. This examination, conducted by a third-party healthcare professional, usually a doctor, will check your ability to function at your current workplace as well as the medical causes of your disability. The examining doctor or other professional is paid by the insurer but is meant to provide a neutral opinion and bound by professional ethics and rules to that end.

A vocational (meaning work-related) assessment may be necessary as well. This assessment will look at your job duties and consider the effect of your medical conditions on your ability to perform them.

You may want to keep a record of what occurred during the IME, including details like what was said, the questions asked, and the examiner’s contact information. Request a copy of the IME report and the results of other assessments too, which you are entitled to receive.

If you disagree with their findings, our long-term disability lawyers can arrange medical exams with qualified specialists who can accurately assess your condition and its impact on your working ability. While expert testimony often sways a trial, it is not necessary to make a successful legal claim or prove the existence of a mental (or physical) injury.

The Supreme Court of Canada clarified this issue in its landmark ruling on Saadati vs. Moorhead in 2017. Lawyers Darin Shane and Joseph Fearon of Preszler Injury Lawyers represented the plaintiff in this case. The plaintiff and defendant agreed that the defendant was liable for a car accident between him and the plaintiff. However, the defendant disputed that the plaintiff was injured by the accident in a way that could be compensated. The plaintiff complained of severe headaches and violent mood swings. Friends and family testified at the initial trial that he had turned into a totally different person. Then, the British Columbia Court of Appeal overturned the trial court’s ruling, finding that recovering damages for mental injury required a claimant to prove a “recognizable (or recognized) psychiatric illness” using expert testimony.

In the end, the Supreme Court unanimously found that the plaintiff did not suffer a physical injury but had suffered a mental one, even in the absence of expert testimony or a formal diagnosis of a specific condition. Notably, the 2017 judgment related to a liability claim alleging mental injuries, but in its reasons, the Supreme Court explicitly stated that physical and mental injuries should be viewed as equivalent (figuratively if not literally) in terms of the legal tests courts use to determine whether an injury occurred. That is, physical injuries do not require expert testimony to be proven, either. In both instances, a relevant party such as coworker or spouse may be able to speak to or give a statement on the origins and effects of an injury. Expert opinions such as those offered by an IME may still be used by defendants, like insurance companies, to rebut plaintiff evidence.

Try your sincere best to fulfil any requests or demands from your insurer. Any resistance or refusal on your part risks your claim moving forward. If your attitude is not co-operative, the insurance company is very likely to question the credibility of your claim and deny you coverage on that basis.

When do my long-term disability benefits start?

Before you apply for long-term disability, there are often other benefits you are eligible for that you should claim first, such as those from sick days, short-term disability coverage under your group policy or federal Employment Insurance (EI). LTD benefits will not be paid out until other sources of insurance have been exhausted.

After you have submitted an LTD claim, you will have to wait until the elimination period has passed, then you can receive benefits. This period is typically 90 to 180 days.

Your insurance policy will contain the exact duration of your elimination period. If you are under a group plan, your employer can again provide this information.

Exclusions to coverage may apply if your disability is because of a medical condition that you already had before coverage started (or that afflicted you early on in your coverage, generally 24 months). Coverage varies widely from policy to policy. Check your insurance documents to find any exclusions specific to you.

Let our long-term disability lawyers help

If you are seeking advice about a long-term disability claim, you are welcome to call us at 1-844-791-8202. We offer a free initial consultation where you can describe your claim to us and then we can advise you of your options to proceed.

Since our founding in 1959, we have exclusively worked in the field of personal injury, including thousands of disability-related cases. All of our client retainer agreements operate on a contingency fee basis, so you do not need to pay anything to us upfront until we win your claim for you.

Our long-term disability lawyers provide reliable, easy-to-understand legal assistance to clients around the country so they can concentrate on their health instead of the complexities of claiming insurance. We are ready to take your call 24/7 and hope to hear from you.

*Please note the content in this article is only intended to be a general overview on this topic and not intended to be taken as legal advice. Please speak with a long-term disability lawyer for specific legal advice as each situation is unique.