I Can’t Work Due to Illness and Injury. Am I Covered by Disability Insurance?

old woman suffering from neck and shoulder injury, health problem concept

When an individual suffers with a disability – whether due to an accident, physical illness or mental health condition – and cannot work, a disability insurer can and should help in their recovery. Unfortunately, this is not always the case.

Many people are covered by group insurance policies set up by their employer, which commonly offer short-term disability (STD) and/or long-term disability (LTD) benefits. Each policy contains specific information about coverage– including the definition of ‘disability’, the amount of the monthly benefit, and any limitations to overage, among other things. It’s important that you read through your policy to ensure you’re aware of, and understand, the scope of coverage.

Short-term disability

Short term-disability (STD) benefits typically kick in within a few days of disability and can last between 15 to 52 weeks depending on the terms of  the policy. Generally speaking, short term disability insurance covers 60% to 85% of an employee’s regular income. Some plans cover 100% of a person’s income under the short term disability stage.

Long-term disability

Often, employers also offer LTD insurance coverage to their employees.  If an injury or illness is more extensive or prolonged, you can make an application for LTD benefits to cover your continued loss of income. A typical LTD group insurance plan provides 66.7 per cent of a person’s pre-disability income. Depending on the policy, the benefit will be taxable or non-taxable.

LTD benefits start once STD benefits are complete. LTD coverage provides benefits for two or three years, where a person is disabled from working, under what is known as the “own occupation” test. Under this test, the disabled person must show that they are unable to perform the essential duties of their own occupation.

Following the own occupation test, a person will receive LTD benefits if they meet the “any occupation” test, which is typically defined as a person not being able to do any job, in accordance with their education, training and experience, and where they would be able to earn 65 or 70 per cent of their pre-disability income (depending on the policy). Most policies provide coverage under the any occupation test to the age 65, as long as the person continues to qualify under the test.

Your Road to Recovery and Financial Support

Considering the difficulties and limitations of the claim process, it’s not surprising that many people are denied disability insurance. That’s where a disability lawyer can help you, particularly one with extensive experience in insurance policy claims.

At HSH, we help clients recover their disability benefits, their health and their well-being. If your disability claim has been denied and you are too sick and too tired to deal with the insurer, please call me, Brad Moscato, at 416-646-7655 or email me at bmoscato@hshlawyers.com. I would be more than happy to help you.

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