Injuries and illnesses are an unavoidable part of life. This is why it’s crucial to know what supports are available if an accident, chronic medical condition or mental illness prevents you from being able to work and earn your wages.
If you do have short-term disability (STD) and/or long-termdisability (LTD) coverage and are diagnosed with a disabling medical condition that will prevent you from working for a significant amount of time, your first step is to consult your policy to ensure your condition is covered.
Your next step, ideally, is to consult a long-term disability lawyer in Toronto before you complete the application. Disability claims are notoriously challenging to get approved, and an LTD lawyer knows what insurance companies want to see in an application, thanks to their years of experience dealing with denied claims.
They also know what to do when an insurance company denies a claim despite your providing them with all the information and documentation they require, as they often do.
If you’ve never had to file a claim for disability benefits in the past, the process can be both confusing and intimidating. The information in this post can help clarify the disability system in Ontario and give you the confidence to demand the benefits you are entitled to.
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An Overview of Short-Term Disability
The law in Ontario requires a minimum of three days of unpaid, job-protected sick leave. However, many employers offer a certain number of paid days off for employees to use as sick days. Generally speaking, if an employer offers a short-term disability plan, an employee must exhaust all of their sick days before they can apply for STD benefits.
There may also be a waiting period that can be as long as two weeks, during which time the employee can not receive STD benefits.
Qualifying for Short-Term Disability Benefits
Every short-term disability policy will have its specific wording, but to qualify for STD benefits, usually, the criteria is that the medical condition you suffer from prevents you from the ability to substantially complete the main duties of your job function. This is commonly referred to as your “own occupation.”
Short-Term Disability Benefit Period and Amount
Short-term disability benefits will typically be a percentage of an employee’s regular, pre-disability wages (anywhere from 50-85%), although some policies will pay the full amount of an employee’s earnings. Most STD policies will pay benefits on a weekly or bi-weekly basis and will only cover lost wages.
Although designed for injuries and illnesses that last longer than several days, short-term disability benefits, as the name implies, are meant for a relatively shorter period of time. STD benefit periods typically last anywhere from 15 to 26 weeks.
What to Do if You Do Not Have Short-Term Disability Coverage
If your employer doesn’t offer STD coverage and you suffer from a disabling medical condition, or your claim for STD benefits is denied, you can apply for Employment Insurance (EI) Sickness Benefits. These benefits can cover up to 55% of your employment income for a maximum of 15 weeks.
You can also apply for EI Sickness Benefits if you are waiting for your STD claim to be processed, but you must repay any amounts you receive from EI if your claim is approved. However, if your STD benefits expire and you are still eligible to receive EI Sickness Benefits, you can apply and will not have to repay any amounts you receive.
Long-Term Disability Insurance in a Nutshell
An easy way to distinguish between short- and long-term disability is to think of STD as what you will need if your break your arm and LTD as the coverage for losing your arm. Long-term disability is meant for chronic medical conditions, debilitating injuries and mental illnesses.
The same standard of eligibility applies to STD claims and LTD claims, meaning that as long as your diagnosed medical condition prevents you from substantially completing your work tasks, you may be eligible for LTD benefits.
Other highlights of long-term disability benefits include:
- The waiting period (or qualifying or elimination period) for LTD claims can be anywhere from 90 to 180 days typically.
- LTD benefits can cover anywhere from 50-80% of your wages but may also include coverage for medical expenses.
- Many LTD policies will pay benefits until an employee recovers or retires, but there are LTD policies that have a hard cap of anywhere from 5 to 15 years.
- You can apply for Canada Pension Plan’s (CPP) disability benefits while you wait for your LTD claim to be processed, and whether your claim is approved or denied, you can collect CPP disability benefits without having to pay them back. Your insurance company, however, may reduce the amount of LTD benefits you receive from them by the amount of CPP disability benefits you receive.
Another important characteristic to be aware of with LTD benefits is that after two years, many insurance companies change the qualification criteria. This means they will only pay benefits if you are disabled from completing tasks of “any occupation” you could potentially be suited for with the right training.
If you receive a letter from the insurance company notifying you that this is their intention, or they require you to attend an “independent medical examination” (IME), or your claim for STD or LTD benefits is denied, contact a long-term disability lawyer immediately. Many offer free consultations and can still get you the support you are entitled to in your policy, but your options to do so are time-sensitive.
