FAQ

Long-term disability (LTD) insurance protects if you suffer an injury or illness that stops you from returning to work. The long-term disability benefits can be used to cover medical treatment fees, bills, and other expenses. Essentially, you will not suffer financial hardship as a result of being unable to work. Most policies provide benefits for the first two years, after which you must prove you are unable to return to work to continue receiving the LTD benefits.

Short-term disability insurance provides replacement wages if you are unable to work temporarily. Long-term disability insurance provides permanent income replacement after a medical condition prevents you from working for a prolonged period.

Disability benefits differ markedly from workplace insurance benefits. The illness or injury that leads to a disability must not arise from the job/workplace to qualify for disability benefits. Workplace insurance benefits are provided if you get injured on the job.

Individual disability insurance policy is purchased by an individual directly from an insurance company. It protects them in the event of an injury or illness that leads to temporary or total disability.

Group disability insurance is bought by businesses/organizations to provide disability insurance for employees that become temporarily or disabled due to a medical condition. For the group plan, premiums are paid through employee paychecks or partly and fully by an employer. Always ask if you are covered under the group plan.

Individual disability insurance policies contain a wider range of features compared to group disability insurance policies.

There are four types of disability insurance:
Short-term disability insurance offers temporary income replacement if you cannot discharge your duties due to a medical condition. It acts as income replacement for the first 120 days.

Long-term disability insurance provides income protection if you can’t return to work due to a medical condition. It offers a portion of your income so that you can cover medical treatment expenses.

Critical illness insurance offers financial support if an individual is diagnosed with a critical illness. Some of the conditions covered in the policy include stroke, heart disease, cancer, and as many as 20 other medical conditions. The benefit is paid as a lump sum after a 30-day survival period after the diagnosis of a medical condition.

Disability mortgage insurance offers financial support when you become disabled and are unable to work again. It covers part or all of your mortgage payments, either bi-weekly or monthly, after a 60-day waiting period. The policies have limitations concerning the amount and duration of coverage provided.

Long-term disability insurance is purchased privately either through an insurance broker or directly from the insurance company. Additionally, long-term disability insurance can be availed through group insurance provided by your employer. For group disability insurance, premiums are paid either by the employer, the employee or shared between employer and employee. In each case, there are different tax implications for all parties. It becomes more complicated if the payment of premiums is shared between employer and employee.

There are long-term disability policies that exclude some illnesses and injuries, such as those covered under Workplace Safety Insurance. However, most long-term disability policies cover all illnesses and injuries despite the type or severity of the condition that prevents you from working.

You qualify for long-term disability benefits if you are unable to complete all or some of the functions of your job. Some policies may demand proof that the disability prevents you from doing your job and any other job you are qualified to do with respect to your education, training, and experience.

Yes, you must file a claim to receive long-term disability benefits. Consult your employer or insurance provider on the process to follow when filing a claim. The claims form can be issued by the employer or insurance provider. You will fill it out before handing it over for approval.

The information required for the disability claim form includes:

• general demographic information
• information on how, when, and where you suffered the injury or illness
• symptoms, when you stopped working
• healthcare professionals that you have consulted
• diagnostic and treatment information for your disability
• duties you are unable to perform in your job
• income sources
• banking information
• occupational information, and any other requested information

The claim form will have different segments to be filled by you, your employer, and your doctors. Ensure that you provide accurate information in the claim form.

Yes, the filing of a claim has deadlines to be met to get approvals. Immediately contact your insurance provider for guidelines or get a disability lawyer to guide you through the claim filing process and alert you to approaching deadlines.

No. A hospital stay is not a requirement in getting approval for a disability claim. Many medical conditions don’t require long hospital stays since treatment can be completed from home.

If your policy demands that you must be completely disabled or have a total disability, check to see the definition attached to the term total disability in your policy. In most instances, it means that you are unable to carry out the normal functions of your job in the period required to recover from your medical condition.

Most long-term disability policies demand that you are assessed by a medical professional chosen by your insurance provider to determine if you qualify to receive disability benefits. However, the insurance company is required to choose healthcare professionals who are reasonably qualified to carry out the assessment.

If you feel that there was unprofessional conduct in how the assessment was carried out, contact a qualified personal injury lawyer to help you out.

Yes, it’s perfectly legal for insurance providers to hire private investigators to undertake photo and video surveillance on claimants to ascertain their disability claims. The surveillance helps to weed out fraudulent claims and misrepresentations. Ensure that you provide accurate information to the best of your ability.

Contact the police if you feel that the investigators are trespassing, putting you in danger, breaking the law, and violating your privacy.

After making a disability claim, a mandatory waiting period has to pass in which the claim is evaluated and approved. For short-term disability policies, you need to wait five days to access benefits.

You must be out of work for several months to access long-term disability benefits. That waiting period is referred to as an elimination/qualifying period and may range from 90 to 180 days. Ask your insurance provider or employer for clarification.

Employer-sponsored group long-term disability policies pay out benefits that cover 50-80% of your pre-disability salary. On average, the typical disability policy covers 66.66% of your pre-disability salary.

Many policies put a limit to the amount of monthly benefit you can receive. In most individual disability policies, the benefits to be received are pre-determined so that people know what their monthly disability will be when they are unable to work.

Ottawa Disability Lawyers works on a contingency fees basis, meaning that the legal fee is collected only if the claim is successful. You get a free initial consultation.

You will be suing for payment of disability benefits that you are entitled to as per the long-term disability policy. Where necessary, you may sue for bad faith if you think the insurance company acted unfairly. Your lawyer may also claim pre-and post-judgment interest on the amounts claimed as well as financial contributions by the defendants to go towards legal fees.

If the long-term disability claim goes to court and you are successful, you will be awarded all or some of the outstanding disability benefits as well as interest and costs. The court may order the insurance company to continue paying your disability benefits in the future as per the letter of your policy.

Most cases are settled based on a full and final payment that sums the amounts for past and future benefits. The agreed amount is determined between the claimant and the insurance company.