If you have been unfortunate enough to have been involved in a major accident or have developed a serious illness that has forced you to stop work, ensure you can still cover yours and your family’s living costs by making a claim for financial assistance. This can either come from the Ontario government, or from any relevant long-term disability income insurance policies you or your employer may have in place.
Unfortunately, the process is not that simple. Bureaucracy at its very best can rear its ugly head. Life at a difficult time could be made less stressful if making a long-term disability claim were straightforward, but it isn’t.
To try and help you navigate your way through the complexities of the long-term disability claim process, the following should provide a clear guide to better inform you of what is required to qualify for financial benefits, and how to successfully apply for them.
There is no clearly defined definition of what is classed as a disability in Canada. Although, there are working definitions used by the Canadian government and Canadian insurance companies.
However, their definitions vary. Ultimately where insurance policies are concerned, each policy will have a set list of definitions. These should be carefully consulted before starting any long-term disability insurance policy for individuals, or group ones provided by certain employers.
It’s also important to know what a long-term disability is to ensure that you are able to make a successful claim.
To help understand what a long-term disability is, it is easiest to begin with a broad description of what is classed as a disability. One definition is provided by the World Health Organization: “Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.”
In Ontario, there is a difference between what the government and what insurance companies see as the length of long-term disability. The government sees a long-term disability as a disability which lasts for more than fifteen weeks. For insurance companies, their long-term disability insurance policies will usually come into effect after a period of six months. So, their definition of a long-term disability is one which lasts longer than six months.
It’s important to state here that there is a very big difference between long-term disability and permanent disability. A long-term disability may stop you from working completely when an illness is first contracted, or immediately after an accident. When you are able to work again, the insurance policy will either stop paying out or drastically reduce payments. A permanent disability is a disability which means you will not be able to work again.
The law does not require you to have any form of disability insurance policy. Nor does it demand your employer provide short-term or long-term disability insurance for their employees.
The Canadian government provides two forms of support for anyone making a claim. Employment Insurance (EI) covers the first 15 weeks of incapacitation. After EI ends, a claim for long-term disability benefits would be made to the Canadian Pension Plan (CPP).
In both instances, benefits are paid at the rate of 55% of your average insurable weekly income. This is up to a maximum of $51,300 per annum for long-term claims, and $501.00 per week for short-term disability claims, as of January 1, 2017.
Payments from any insurance policies you hold will generally pay between 60% and 85% of your average weekly income.
If an employer is covered by the Workers’ Compensation Program, you may qualify for financial assistance. This applies if you were injured while at work and are disabled as defined under Ontario’s workers’ compensation legislation.
Aside from the levels of payment, there is one other major difference between government payments and payment from insurance companies. A long-term disability insurance company will start to reimburse you as soon as any short-term disability policy ends, usually after six months. Whereas when governmental EI payment stops after 15 weeks, it can take up to a year to sort out a claim for benefit from the CPP.
Because of this lengthy long term-disability waiting period, one of the long-term disability questions you should be asking yourself is whether you could last for up to nine months (that period of time between the end of EI and reimbursement via CPP) without any income. If the answer is no, you need to consider a long-term disability insurance policy.
If you find yourself in a position where you need to make a medical disability application, it is important you clearly understand all that is involved.
It’s also critical that you very carefully read all sections of any claim form. This will establish exactly what information you will be required to provide with your application.
If the claim is to an insurance company, you will also need to check the policy documents for that specific insurance company’s claims procedure. Don’t forget to check that all premiums have been paid and are fully up to date!
To be entitled to make a claim for long-term disability benefit from the government, here is what’s required:
You or your employer need to have made all the appropriate payments to the CPP program
Have met the minimum contribution requirements
Have worked between 420 and 700 hours in the previous 52 weeks
Able to prove you are disabled as defined by the CPP legislation
In both instances, you will also need to support your claim with medical documentation. In cases of long-term disability, you will be presented with a claim form that will ask a wide range of questions. Here are some examples:
When did your symptoms first appear?
From what date did your illness or injury prevent you from working?
Have you ever had the same, or a similar illness or injury?
Describe how your injury or present illness prevents you from working. Be specific about which duties you are unable to perform and the duties you are able to perform.
Is your illness or injury work-related?
What treatment, if any, are you currently undergoing?
Please supply the names of all physicians, consultants and specialists you may have seen for the illness or injury or any you
intend to see.
When do you expect to be able to return to work, either your original work or an alternative?
Have you made any attempt to resume working?
Is your disability the result of an accident at work?
Please provide all details of any savings and investments?
There is a great deal at stake when making a claim for long-term disability payments. With the number of forms you will be required to fill in, it’s easy to make a mistake.
At Conte Jaswal, we are empathetic to your situation. We’ll fight for you and be your advocate when you go up against the big insurance companies. You do not have to do this alone.
Book a free, no-obligation consultation with us to discuss your options. Accidents happen, but we can help you get the compensation you need to recover.
Contact Conte Jaswal now to start getting your life back on track.