Frequently asked questions

If you have any general questions We recommend check our all faq. This includes common questions and queries.

What is long term disability insurance?
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.
What is the difference between short term disability insurance and long term disability insurance?

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.

What is the difference between individual disability insurance and group disability insurance?
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.

What types of disability insurance are there?
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.

Who pays for long term disability coverage?
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.
What type of disability allows me to qualify for long term disability benefits?
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.

Will I have to file a claim in order to receive long term disability benefits?
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.
What information is required on my disability claims form?

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.

Are there deadlines when making a claim for long term disability insurance benefits?
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.
To receive disability benefits, is it required that I be confined to a hospital?

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.

Why does the insurance company require me to have an assessment done with a doctor they have chosen even though I have already gone to see my doctor about my long-term disability claim?

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.

Is it legal for insurance companies to hire someone to follow and videotape me?
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.

How long do I have to wait to collect long-term disability benefits?
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.

How much will I receive from long-term disability insurance benefits?
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.

I think that I need to sue for disability benefits, but I have no income. What if I cannot afford a lawyer?
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.
When I sue the insurance company for disability benefits, what do I sue for?
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 insurance company agrees that I am still entitled to benefits, what are the different ways my settlement can be paid to me?
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.

How long do the long-term disability insurance benefits last?
The long-term disability policy that you purchase will determine how long you receive benefits. Most policies have a time frame of 5-10 years, while some will pay benefits until you attain 65. Other LTD policies provide a lifetime benefit broken down as a percentage paid up to 65 years, and then a lesser amount is paid for 5, 10, 15 years, or for life.
Are my benefits taxable?
If you pay the premiums of your disability insurance policy, the benefits you receive are not taxable. If your employer pays the premiums for the employee’s disability insurance policy, the benefits payments received are taxable.
Can other benefits be deducted from my long-term disability payment?
Yes, most policies have provisions that reduce the monthly payment after taking into account:

  • Benefits from a Workers’ Compensation plan such as Workplace Safety Insurance payments.
  • Disability benefits paid by a government program such as Ontario Disability Support Program, Canadian Pension Plan- Disability, Employment Insurance- Sickness Benefits, etc.
  • Income earned from the Criminal Injuries Compensation Act.
  • Wages or remuneration payable from any employer, including any statutory or common law termination and/or severance pay.

Your long-term disability benefit can also be reduced by payments made to your dependents, including minors in any of the above-listed areas. 

Can my long-term disability insurance company force me to apply for Canadian Pension Plan (CPP) Disability or other benefits?
Most long-term disability policies allow the insurance provider to make you apply for benefits from other sources such as the Canadian Pension Plan. You may also be asked to appeal if the benefits are denied. Talk you your insurance provider to understand what your policy requires.
What policy ‘riders’ can you purchase with long-term disability policies?
Policy riders or endorsements offer extra coverage to an existing long-term disability policy. Riders are only available for individual disability policies. If the rider is bought mid-term, you will be required to complete a medical form. Some popular riders include:

  • Cost of living adjustment that considers annual inflation and adjusts your benefits accordingly. 
  • Own occupation to 65 eliminates the ‘any occupation test’ and offers disability benefits until 65 years if an individual is unable to complete the functions of their occupation.
  • Future earnings protection option allows you to avoid getting a new medical every time you get a wage increase. Additionally, it helps prevent a new application or premium increase in case your health has since deteriorated. 
Does long-term disability provide extended medical or dental care as well?
No, LTD policies provide wage replacement only. People with a benefit plan from their employer can get a benefit continuation paid by your employer in addition to long-term disability benefits if unable to return to work.
I am on long-term disability, and my employer terminated my employment. What does this mean for my long-term disability entitlement?
The termination of employment doesn’t stop your long-term disability benefits. However, termination or severance payments may be deducted from your long-term disability entitlement. The situation becomes complicated if you were on short-term disability at termination or were on temporary layoff at the time of getting a disability.
After being unable to work at my job for two years, can my insurance company stop paying me my benefits?
A majority of policies provide long-term disability benefits for the first 2 years after a disability prevents you from performing essential tasks of your job. After the 2-year period elapses, the entitlement may change based on the ability to perform any occupation for which you are qualified through education, training, or experience. It’s called the ‘any occupation test.’
Why has my long-term disability claim been denied? Why have my long-term disability benefits been terminated?
A variety of reasons are provided for denial or termination of long-term disability benefits. The insurer will cite lack of proper documentation, exceeded time limitation, misrepresentation in the claim, contradicting surveillance evidence, failure to follow a treatment plan, and lack of supporting documents from your employer. Other possible reasons include lack of medical proof that you meet disability requirements after the first two years.

The insurance provider may argue that you do not have a claim since you do not suffer a total disability that prevents you from working. They will argue that you can work part-time or with modified tasks. In such cases, loss of earnings may be considered as a result of the medical condition.

I just received a letter from my insurance company terminating my benefits. What should I do?
Start by understanding why your benefits have been terminated. Carefully read the termination letter provided by your insurance provider. If some documents were missing, contact the insurance company and arrange how to send them as soon as possible.

Contact a disability insurance lawyer to contest contentious reasons provided by your insurance provider.

I was recently denied long-term disability benefits. When should I get a lawyer involved?
Always seek the services of an experienced lawyer as soon as your claim is denied. You will prevent the missing of the set-out deadlines for filing a claim.
Do I need a lawyer to handle my long-term disability insurance claim?
The choice is all yours in whether to hire a disability insurance lawyer. In all cases, you must stay in control of the situation. It’s recommended that you work with a disability insurance lawyer who is skilled and experienced in handling claims.
How much will it cost to sue my insurance company?
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.
What can I do to maximize my chances of success in filing a disability insurance claim?

Always go to a medical professional who specializes in the medical condition that you are dealing with. You will be better placed to describe accurately, and exhaustively the prognosis faced and necessary treatment. Ensure that you have described the duties and responsibilities of your job. The information on the mental and physical demands of your job is useful in assessing your limitations. The assessment will determine if you fulfill the ‘own occupation test.’

Who do I sue if my disability benefits are denied?
After discussing your claim, your lawyer will determine the person or group to be sued. In most cases, the insurance company is sued for failure to approve disability benefits. You may need to sue your insurance broker who sold you a policy for misleading you or other reasons.
What is the process for suing the insurance company?
After deciding that suing is the best way to proceed, your lawyer will prepare a Statement of Claim that details the allegations being made against the insurance company. The insurance company will file a defence, and from there, documents from both parties are exchanged.

You will be questioned under oath and/or asked to undertake medical assessments with your doctor and another doctor chosen by the insurance company.

The process will entail taking part in settlement negotiations and even mediation. A full trial is a final step which is not common since a settlement is always made before it gets here.

If I have been denied disability benefits, do I have to go to court to receive them?
Long-term disability claims do not end up at trial. Most disability claims are settled at the negotiation and mediation stages.

Contact Ottawa Disability Lawyers today

To arrange a complimentary consultation with one of our experienced disability lawyers, please complete the online form, or call us at 6134545792