Frequently Asked Questions About Disability Benefits

Long-term disability benefits (often called “LTD” benefits) are monthly income-replacement payments made to a person who cannot work because of a disability. To be eligible for benefits, you must be a covered person under a disability plan (either a group insurance plan through your workplace or association, or an individual plan).

While you aren’t eligible to receive long-term disability benefits until after your policy’s elimination or waiting period, you can and should begin the application process as soon as you anticipate that your disability will continue to prevent you from being able to work. LTD claims can take weeks to prepare and submit. You will also likely be asked by the insurance company to provide further information, medical records and reports which add to the delay in processing your application. Most long-term disability policies also have a limit for the length of time after becoming disabled that you are allowed to make a claim. If you do not apply for benefits before the deadline set out in your policy, your insurance company will deny your claim.

Every insurance policy has its own wording, guidelines and coverages, but both short-term and long-term disability policies typically provide a percentage of an employee’s earnings as income replacement if the employee qualifies for benefits. An employee can only start receiving LTD benefits after their Employment Insurance or short-term disability coverage has ended. Some of the differences between short-term disability and long-term disability coverage include: • Short-term disability insurance sometimes provides a higher percentage or maximum payment than LTD benefits, however, LTD benefits are paid over a much longer period of time. • Short-term disability benefits typically only cover an employee’s earnings whereas long-term disability benefits tend to include rehabilitation and medical expense coverage. • Claims processing happens a lot faster with short-term disability benefits as they are meant to be approved within days or weeks of an employee applying for them. LTD claims can take months to process after they have been submitted. • LTD benefits can be stopped after a specified period of time (usually two years) if the insurance company feels that the employee is able to work in another occupation to which they are reasonably suited. Short-term disability policies are not subject to this change in the definition of what is considered a 'disability'.

A long-term disability lawyer is one that specializes in disability insurance law. As LTD lawyers in Toronto, we know what it takes to file a successful claim, how to handle a denial and how to litigate LTD claims in court. The sad truth is that insurance companies tend to look for any reasons to deny LTD claims and often the only way to get the benefits you’re entitled to is by having a long-term disability lawyer on your side who knows the ins and outs of the process.

Ideally, the best time to call a long-term disability lawyer is before you file your claim. A trustworthy long-term disability lawyer in Toronto will review your policy, understand the criteria for filing a successful claim and put together the documentation you will need to give yourself the best chance of getting your application for benefits approved. Most people, however, only call a long-term disability lawyer after their claim for LTD benefits is denied. If the insurance company denies your claim, call a long-term disability lawyer immediately. You may still be able to receive the benefits you deserve, but there are time limits for making a legal claim against the insurance company. This is often the only way to ensure that they fairly consider your application for benefits.

Finding the right long-term disability lawyer in Toronto is an important process. The person you choose will be responsible for getting you the compensation you’re entitled to when you need it most. Read disability lawyer reviews and consider a consultation to ensure the lawyer is equipped to provide the assistance you need, and at a reasonable price. At Ertl Lawyers, we offer free consultations to better understand your case and walk you through your options.

Long-term disability payments are either paid for a set number of years (e.g., 2, 5 or 10 years) or until the policyholder reaches a certain age (usually 65 years old).

The amount of the disability payment is set out in the policy of insurance, but it will be based either on a fixed amount (e.g. $2,500 per month) or else calculated as a percentage of your salary (mostly between 60% and 75% – and frequently it is 66.7%)

It depends on the language of your policy. That said, all long-term disability insurance plans will have something called a “qualifying period” (also called a “waiting period” or "elimination period"). This period is typically between 90 and 120 days long. You must be disabled for the entire waiting period before you can receive long-term disability benefits.

Some employers provide their own paid sick leave or short-term disability plan. So, you should start there. Otherwise, you can apply for Employment Insurance (EI) sickness benefits. EI sickness benefits can provide you with up to 15 weeks of financial assistance if you cannot work for medical reasons. You could receive 55% of your earnings up to a maximum of $573 a week. You must get a medical certificate to show that you’re unable to work for medical reasons. Medical reasons include illness, injury, quarantine or any medical condition that prevents you from working.

You must be “totally disabled” from your current occupation. However, this does not necessarily mean that you have to be completely physically incapable of performing all aspects of your job. The test is whether your injuries prevent you from performing the substantial and important duties of your job.

You will need medical evidence. Usually, when you apply for LTD benefits, your doctor will have to fill out a form (often called the "Physician's Statement"). You may wish to meet with your doctor before he or she completes the Physician’s Statement to ensure the doctor includes all relevant information about your disability. The doctor should attach all supporting documentation such as test results, specialist consultations reports and any other records that support your claim.

If you can, you should provide the insurance company with the requested information. In the case where you have provided all of the relevant documents to the insurer, it may be appropriate to direct the insurance company to speak with your doctor directly, particularly where the insurer has any outstanding concerns or questions related to your disability.

You will receive a "denial letter" explaining that your application for long-term disability benefits has been denied, and the reason why. The denial letter will also set out the time frame during which you can make an appeal. Most of our clients contact us after they receive a denial letter. We offer a no-obligation, free consultation. We will help you understand the reason for your denial, and we will discuss your options with you.

It depends. If your condition has worsened or changed in a significant way, or you have additional medical documentation to support your claim, it might be worth appealing your denial. However, in many cases, we find that our client’s condition is generally unchanged, they remain disabled, and they have already provided complete medical documentation. In these cases, it probably makes sense to commence a legal claim instead. Caution: It is important that you consult an experienced long-term disability lawyer to discuss your options and strategy.

Under most long-term disability plans, the insured will receive benefits (typically for two years) if they are totally disabled from performing their "own occupation". After two years, the policy will only pay out benefits if the person is totally disabled from performing "any occupation". This is called a "change in definition".

It depends on who pays the premiums. In a group insurance plan, long-term disability benefits are untaxable if you (and the other plan members) pay 100% of the premiums. If your employer pays any portion of your premiums, your benefits will be taxable (unless your employer includes the premiums in your taxable income.

If you have been denied long-term disability benefits and are being pressured to return back to work, you should consult with a long-term disability lawyer. Generally, the employer should be informed that you are either appealing the denial or that you are hiring a lawyer to dispute the denial. Returning to work before you are healed is a recipe for trouble. You are likely to aggravate your disability. We find that returning to work prematurely often results in an irreparable breakdown in the employer/employee relationship, often resulting in the termination of the employee. Caution: Often, when an employee is denied benefits, the employer will seek “additional” information from the employee (e.g. medical information) or continual “updates”. Many times, the employer is setting up the employee. Meaning that if the employee doesn’t provide sufficient information to justify their disability, the employer will say that the employee has “abandoned” their job.

Depending on the nature/cause of your injury or illness, the terms of any plan of insurance you might have, and what government programs are available, your options for financial support could include: • Short-Term Disability or Weekly Indemnity Benefits through a group insurance plan; • Employment Insurance (EI) Sickness Benefits; • Long-Term Disability Benefits through a group plan or private/individual policy; • Disability Creditor Insurance (under your mortgage or credit cards); • Critical Illness Insurance; • Accidental (Death) or Dismemberment Insurance; • Workplace Safety Insurance Benefits (WSIB); • Ontario Disability Support Plan (ODSP); • Ontario Works (OW); • Income Replacement Benefits (IRB’s); • Tort Damages (personal injury); • Accident Benefits (motor vehicle); • Extended Health Care benefits; • Trillium (extended health benefits); • Canada Pension Plan Disability (CPPD); and • Disability Pension (employer).

For the most part, an employer is entitled to terminate an employee for any (or no) reason, as long as the employer provides proper notice or pay in lieu of notice (i.e., severance). However, if an employee’s termination is because of (or influenced by) the person’s disability, the employer may be liable for human rights damages. Discrimination based on disability is prohibited under Ontario’s Human Rights Code. In certain circumstances, the employer may also be liable for additional monetary damages which can compensate an employee for the emotional harm caused by the “manner” of the termination (i.e., moral damages). Further, sometimes (though it is relatively rare), an employer can suffer “punitive” damages, which is the court's way of punishing heavy-handed, reprehensible conduct. You should always consult an employment and long-term disability lawyer if you have been terminated from your employment for any reason, regardless of whether you applied for LTD benefits or were receiving long-term disability benefits around the time of your termination or not. Putting aside possible human rights violations based on disability, many employees are wrongfully terminated by not receiving the notice or pay in lieu of notice they are legally entitled to upon termination.

From an employment law perspective, if it is determined that you are not likely to ever return to work, then your employment relationship may be "frustrated". In such a case, the employer is not obligated to provide you with any notice or severance, except for that which is required under the Employment Standards Act, 2000. This situation is rare because it can take years before a contract is said to be frustrated.

It depends on the plan. Many long-term disability plans provide that severance pay will be deducted from long-term disability benefit payments.

Current case law provides that where the employee has paid 100% of the premiums of the disability plan, then the employee can receive both severance pay and long-term disability benefits. Meaning, there is no deducting one from the other.

How much a disability lawyer will cost depends on your specific needs. The overall costs depend on the work required on your case, associated timelines, and other circumstances. Contact our disability lawyers in Toronto to book a free consultation and get a quote based on your unique needs. We offer fair and flexible pricing including contingency fees where you don’t pay unless and until we get you money from the insurance company.

If you’re wondering "how can I find a disability lawyer near me," you’ll be happy to learn that we are long-term disability lawyers equipped to help individuals across Ontario. Contact us today and get connected with an LTD lawyer who can help you wherever you are located..

Ertl Lawyers provides long-term disability legal services across most of Ontario. Our long-term disability lawyers are available in: • Western Ontario (Windsor, London, Kitchener-Cambridge-Waterloo, Guelph, Brantford, Sarnia) • Central Ontario (Barrie, Orillia, Peterborough) • Southern Ontario and the GTA (St. Catharines-Niagara, Hamilton, Burlington, Oakville, Milton, Halton Hills, Brampton, Mississauga, Toronto, Caledon, Aurora, Markham, Newmarket, Richmond Hill, Vaughan, Whitchurch-Stouffville, Pickering, Ajax, Whitby, Oshawa, Bowmanville, Clarington, Brock, Scugog, Uxbridge, Port Hope) • Eastern Ontario (Belleville, Kingston, Brockville, Ottawa, Cornwall), Northern Ontario (North Bay, Sudbury, Timmins, Sault Ste. Marie)