The Waiting Is The Hardest Part: Qualifying Periods for Long Term Disability And Insurer Delays

About half of Canadians live paycheque to paycheque. For these people, even a short disruption in their regular schedule of payments can be a serious financial stressor. But imagine if you are already navigating a debilitating injury or illness when confronted with this additional financial stress.

Sadly, this is the situation many people find themselves in during periods when they are applying for short-term or long-term disability (LTD) benefits. Not only are there waiting, qualifying, or elimination periods before an applicant can begin to receive these benefits, but sometimes insurer delays or unexpected denials can also leave an applicant in limbo as they await a decision or are forced to challenge a denial letter.

In this blog post, I offer some insight into the short term and long term disability benefits application process and explain when and why you should consider contacting a long term disability lawyer.

How Long is Short Term Disability in Ontario?

Depending on the nature of your injury or illness, you may find yourself in a circumstance where you suddenly can’t work for an extended period of time, or slowly find yourself unable to work consistently. Whether through illness or a temporary or permanent disability, if your regular sick days or personal days will not cover the time you expect to be away from your job, you will need to consider applying for short-term disability benefits.

Most people with disability benefits plans (either paid for by an employer or an insurer) will be eligible to access up to three or four months of paid short-term leave (sometimes more, depending on your terms of employment). Generally, an application and a letter from your family doctor, a treating physician, or another medical practitioner who you are consulting is sufficient for approval. These short-term benefits will provide you with some or all of your normal earnings.

If you don’t have access to a short-term disability plan, Employment Insurance Sickness Benefits can provide up to 26 weeks of financial assistance when medical reasons prevent you from working. These benefits pay up to 55 percent of your regular earnings to a maximum of $668 per week.

Don’t Wait to Start Your Long-Term Disability Application

If there is even a small chance that you will not be able to return to work at the end of the short-term disability period, you should begin gathering the documents necessary for an Long-Term Disability application. Individual insurance policies will have different waiting or qualifying periods that must pass before you can begin receiving Long Term Disability benefits. However, if you file your paperwork as soon as possible (or as soon as your policy permits), you will reduce your risk of being caught without income replacement benefits for an extended period.

Sometimes a person who is eligible to apply for LTD benefits will not submit an application before the deadline established by their insurance policy. There are many reasons why this may occur, including:

  • Inability to book medical appointments necessary for documentation
  • Late documentation sent by a medical provider
  • Being unaware of the extent of application requirements until it’s too late to fulfil them on time
  • Having a disability that prevents you from completing the application on time
  • Being denied short-term benefits and believing (incorrectly) that an LTD application would automatically be rejected

Although insurers will often deny long term disability benefits if the arbitrary deadline in the policy passes before a completed application is submitted, there are ways to contest this denial in court by seeking “relief from forfeiture.” Courts consider the conduct of the applicant, the gravity of the breach of contract, and difference between the value of the property forfeited and the damage caused by the breach when deciding whether to grant relief.

Long Term Disability Denied or Unreasonable Delays

Many people will only contact a disability benefits lawyer if their LTD application has been denied. You need not and should not wait that long. Most reputable long term disability lawyers provide a no cost, no obligation initial consultation. If you contact a lawyer at the beginning of the LTD application process, you will likely be able to get valuable information and advice on what is necessary for the application, receive answers to any questions you may have, and make contact with someone who could represent you in legal matters at a later date if necessary.

For example, many Long-Term Disability applicants very much want to return to work. They may even attempt to return to their jobs before they may be medically ready. In some cases, these people are not fully aware of how difficult it will be to function at work until they try to perform their usual duties. In other cases, a person may feel the need to return to work out of financial necessity. If they are unable to manage a return to work, these people may think they’ll need to start the application process all over again. By consulting an LTD lawyer prior to their attempted return, they would learn that they could likely continue the same LTD application. Provided that it’s been less than six months (known as a recurrence provision in most group disability benefit policies) since they returned to their job, they could forgo an additional qualifying period.

If you’re considering seeking legal advice for the first time later in the LTD application process, or after a denial, a knowledgeable and experienced LTD lawyer can still provide valuable advice on how best to proceed. For example, in my extensive experience dealing with insurers, I generally recommend having a long-term disability lawyer contact the insurer if there has been no response or decision on the LTD application 30 days after it’s been submitted.

Moreover, if an applicant receives a denial letter that invites them to appeal the decision with the insurer, I would suggest it’s generally preferable to file a lawsuit instead. Unless an applicant plans to submit some significant new documentation or identifies a clear error on their part or the insurer’s part that would likely change the insurer’s assessment, the appeals process usually just causes further unnecessary delays before a dismissed appeal results in an inevitable civil lawsuit.

Finally, in my experience, the greatest number of LTD applications are denied either at first instance, or after an applicant has been receiving LTD benefits for two years. It is at this point that many insurance policies only continue to pay benefits if the applicant is not able to work at “any job” which is suitable for their level of education, training, and experience.

Being aware that initial LTD approval does not necessarily guarantee ongoing benefits is an important distinction that an LTD lawyer can explain to you while reviewing your personal medical evaluations and assessments.

Hope Starts Here

Whether you’re contacting me at the beginning of the application process or when you’ve encountered a worrisome setback, I will always be ready to clearly explain your legal rights and options. By listening to your story with empathy and taking the time to get to know you and your needs, I hope to show you that even at this difficult time in your life, better days are ahead. At Howie, Sacks & Henry LLP, we always work tirelessly to show you that Hope Starts Here.

To learn more about what our team can do for you, contact me anytime at bmoscato@hshlawyers.co or a 416-646-7655.


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