Long term disability payments are an essential safety net for the ordinary Ontarian who lives paycheque to paycheque. In the event someone is unable to work and earn, long term disability can provide an alternative to employment income. Long term disability coverage varies from policy to policy. And there are factors objective – amount of coverage, waiting period – and subjective – the severity of the injury, medical assessment of the condition – that affect how much and for how long someone receives long term disability.

In this article we explain the basics of long term disability simply. Regardless of your understanding of the subject, seeking expert counsel is essential! Insurance lawyers who regularly help people settle and fight cases against insurance companies will help you receive the income-replacement you are owed.

What is long term disability?

Long term disability benefits is often shortened to just ‘long term disability’. It is ‘income-replacement’ paid by the insurance company to someone who has:

  • suffered an injury due to an accident or sickness and
  • is unable to work because of this disability.

A person can receive long term disability insurance from the employer’s insurance plan or buy one privately.

Long term disability payments do not start immediately after an accident. The waiting period can be several months before payments start.

 How much do you receive on long term disability?

Long term disability benefits can be a fixed amount or be calculated as part of the wages/salary. For instance, a payment can be $2500 per month, or 55% of the monthly wages. Long term disability payments are intended to act as income-replacement, but will not compensate your complete income.

When do you apply for long term disability?

A person will apply for long term disability benefits if they have become mentally or physically incapacitated that renders them unable to perform work. The policy will require a waiting period (also known as the ‘elimination’ or ‘qualifying’ period) before payments begin. This can be 3-4 months – depending on the terms of the policy.

If the person is unable to return to work within the waiting period, they will begin to receive long term disability benefits.

What if your injuries are serious and it is inevitable that you will not return to work in the next few months? That’s where an experienced insurance lawyer in Ontario can help.

What qualifies a long term disability?

Regular medical reports from doctors and clinicians are used by disability evaluators (from the insurance company) to assess if your injuries constitute a long term disability. If the right and complete medical records are not submitted, the evaluator can mis-assess the scope of the injury. Medical records not being considered, getting lost or simply being ‘buried under paperwork’ is also not unheard of. Your lawyers make sure the insurer understands your condition correctly.

There is no right answer or list of ‘types of injuries that constitute long term disability. Injuries can be mental or physical – but their effect must be such that they prevent you from working.

  • Amputation
  • Brain and spinal injuries
  • Cancer
  • Poisoning
  • PTSD
  • Accident injuries
  • Childbirth injuries

What is ‘total disability’?

Most long term disability policies start by defining ‘total disability’. It means that you are unable to perform your job. This does not mean you can perform any other occupation. This definition changes after 24 months.

Own occupation – first 24 months of coverage – Benefits are payable if you cannot work in your ‘own’ occupation.

Any occupation – after 24 months of coverage – Benefits will be payable only if you cannot work in ‘any’ occupation.

As you can imagine, this is a highly subjective area of long term disability benefits. It is not unheard of for the insurance assessors to try and coerce accident victims to return to work, or try to force them into unsuitable occupations.

Why are long term disability claims denied?

  • Failing to meet the strict definitions in the policy
  • Not meeting the deadlines set by the insurer
  • Medical information missed by the disability evaluator
  • Insufficient evidence to prove the claim
  • Incorrect / Illegal denial of the claim
  • Biased evaluation by the claims assessor

How long can you stay on long term disability?

How long term disability benefits are paid depends on the insurance policy. This can be 2 years, 5 years, 10 years or even till the person retires (65).

If you or someone you know has had their long term disability claim denied or payout reduced, speak to a Pace Law insurance lawyer immediately. We understand the importance of disability payments to safeguarding your treatment and your standard of living.

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