Ryan Findlay | December 18, 2024 | Long-Term Disability
How Do I Apply for Long-Term Disability Benefits in Ontario?
If you are injured or develop an illness that prevents you from working, you may be entitled to disability benefits. Consulting a Hamilton long-term disability attorney can provide guidance through the application process to help you secure long-term disability benefits.
What Is Long-Term Disability Benefits in Hamilton, Ontario?
Long-term disability (LTD) is an insurance policy designed to provide income replacement if you become disabled and are unable to work. LTD insurance may be provided through your employer as part of a benefits package, or you may purchase a private policy through a broker or insurance company. While private disability insurance often offers more extensive protection, it may come at a higher cost compared to employer-provided policies.
LTD insurance policies vary in several respects. Your policy’s specific terms and conditions will determine the benefits you receive and the duration of payments. In most cases, LTD benefits are paid until age 65, although the duration can vary depending on the policy. Generally, LTD policies pay between 60% to 85% of your pre-disability salary.
It’s important to review the terms of your specific LTD policy, as coverage amounts, waiting periods, and exclusions can vary widely.
What Conditions Qualify for Long-Term Disability Benefits in Ontario?
There is not a finite list of conditions that qualify for LTD benefits. Some private insurance plans contain exclusions for specific conditions, but employer plans generally do not exclude certain conditions from coverage.
Examples of conditions that could qualify for long-term disability benefits include, but are not limited to:
- Cancer
- Autoimmune disorders
- Spinal cord injuries
- Psychiatric disorders
- Multiple sclerosis
- Chronic pain
- Digestive system disabilities
- Mental illness
- Breast cancer
- Musculoskeletal disabilities
- Schizophrenia
- Neurological disorders
- Post-surgery complications
- Respiratory and lung disease
- Bipolar disorder
- Endocrine disabilities
- Huntington’s disease
- Serious orthopedic injuries
Many conditions may qualify for disability benefits. However, you are not automatically disabled if you have one of the above diseases or another condition. The illness or condition must prevent you from working to qualify for LTD benefits.
Steps for Applying for Long-Term Disability Benefits in Ontario
When you apply for long-term disability benefits in Ontario, you must follow specific steps. Insurance companies deny claims even for the slightest errors. The basic steps to apply for long-term disability are:
Determine Your Waiting Period
Disability insurance policies have a waiting period (i.e., elimination period) before you can begin receiving benefits. The waiting period is the time between the onset of your disability and when you can receive benefits. The elimination period differs from policy to policy but is commonly between 90 and 120 days.
Your insurance policy will tell you how long you must wait to file an LTD claim. Some insurance companies allow claimants to file applications during the elimination period so they can be processed once the waiting period ends.
During the waiting period, you may qualify for short-term disability benefits, which can help you pay bills and expenses while you wait to apply for your long-term benefits.
Talk With Your Physician
Discuss your condition with your physician to determine whether your doctor agrees that the condition qualifies as a disability. Your claim is unlikely to be approved if your doctor is unwilling to acknowledge your disability.
Obtain an Application Package
Inform the long-term disability insurance company that you intend to file a claim for LTD benefits. The company may send you an application package, or you may obtain the package from your employer, HR representative, or insurance broker.
The package should include detailed instructions for completing each form. You must also attach supporting documentation, such as your medical record and income statements.
Most application packages include:
Employee Statement
Your statement explains your condition, including when the condition developed and how it progressed. It also details a general medical history, including a summary of your medical treatments, medications, rehabilitation, and all medical providers you have sought treatment from for the condition.
Additional information about whether you have suffered the same disability or illness in the past must be included as well.
Employer Statement
Your employer will provide a statement regarding your monthly earnings, benefits, and other financial information. This information will be used to determine how much you would receive in LTD benefits. The employer statement also describes your job responsibilities and the time you missed because of your disability.
Attending Physician Statement
Your doctor must complete a statement describing your medical condition, disability, diagnosis, and the connection between your diagnosis and your debilitating condition.
All medical records pertaining to the condition should be attached to the physician’s statement. If your doctor fails to include copies of clinical documentation, speak with their office. The more information the doctor provides about their observations, diagnosis, and clinical findings, the better your chances of receiving benefits.
Submit the Application Package to the Insurance Provider
Go through the list of documents and instructions to ensure you are providing everything the insurance provider requires. Double-check to confirm that all statements are correctly signed and dated by the person completing the statement.
Interview by a Claims Adjuster or Case Manager
The insurance company will assign a disability claims adjudicator or adjuster to your case. In most cases, the adjuster or other representative contacts you by telephone to obtain information about your claim. They will want to confirm the information you provided in your application and/or gather additional information about your disability, job, education, employment history, medical history, and other relevant information.
Receiving a Decision
The insurance company should send you a written explanation of its decision. If it denies your application for long-term disability benefits, the letter should include the specific reason for the denial, such as:
- Your condition does not meet the definition of disability.
- Pre-existing medical conditions are responsible for your disability.
- You filed the application too late.
- The application is missing documentation and/or information.
- There are discrepancies in your story.
- You are not following medical advice.
- You failed to communicate and/or cooperate with the insurance company.
You can appeal a denial of LTD benefits, but the deadline can vary depending on the terms of your policy. While a deadline could be as short as 30 days, many insurers offer a longer period to file an appeal (e.g., 60 days). Make sure to check the terms of your policy for clarity on the deadline to file an appeal.
Contact Our Personal Injury Law Firm in Ontario, Canada
If you need legal help with a personal injury case, contact the team at Findlay Personal Injury Lawyers to schedule a free initial consultation today.
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