Long-term disability benefits provide financial assistance to people who are unable to work due to an accident, injury, or illness. They are usually available under a group benefit plan through an employer, but can also be purchased under an individual plan.
Every long-term disability plan is different and varies with respect to the qualifying criteria, amount of benefits payable, duration of benefits, whether the benefits are taxable, and what other types of income may be deducted from the benefit amount.
There is usually a waiting period of 90 to 120 days following the onset of disability before long-term disability benefits become payable. During those first 90 to 120 days, different income supplement programs may be available depending on your situation, such as short-term disability benefits, Employment Insurance sickness benefits, Canada Pension Plan disability benefits, Ontario Disability Support Program benefits or income replacement benefits if your disability was caused by a motor vehicle accident.
You do not have to wait for the waiting period to expire before applying for long-term disability benefits. You should submit an application as soon as you reasonably believe you will be disabled from working for an extended period of time. This will provide the insurer with time to review the application and, if approved, pay the benefit as soon as your plan allows.
A completed application for long-term disability benefits usually includes one form completed by the plan member, and a second form completed by the plan member’s attending physician, including any medical records to support your disability.
Under most plans, the test to qualify for long-term disability benefits changes two years following the disability.
To qualify for the first two years, your disability must prevent you from completing the essential duties of your own occupation at the time of the disability. This is usually referred to as the “own occupation” test.
After two years, the test becomes more stringent. To continue to qualify, your disability must prevent you from completing the main tasks of any occupation for which you are reasonably suited by way of education, training or experience. This is usually referred to as the “any occupation” test.
You must provide medical evidence to support you meet the qualifying criteria, should the insurer ask for an update on your condition.
Subject to some exclusions, qualifying for long-term disability benefits is not dependent on what caused the accident, injury or illness. It generally does not matter whether it was a single accident, or the accumulation of multiple conditions that led to your disability. The main question when it comes to qualifying for long-term disability benefits is whether your disability prevents you from completing the tasks of their own occupation or any occupation, depending on how much time has elapsed.
Luis Quail is a founding partner of Quail Warfe Kreder LLP and practices personal injury, disability and employment law in Ontario, Canada. He represents clients with an emphasis on educating them to make the best decision possible for their specific needs.
If you or someone you know has been denied long-term disability benefits and would like a free consultation with a lawyer, please contact Luis Quail of Quail Warfe Kreder LLP at 416-795-0683, lquail@qwklawyers.com or visit his website at www.qwklawyers.com.
