Right now, as you are reading this web page, about one in 10 members of the Canadian workforce are off work as the result of injury or illness and receiving some form of income replacement (worker’s compensation or short-term/long-term disability benefits).
Many of these people will return to work once they’ve recovered from their debilitating condition or negotiated workplace modifications that permit them to continue working with a long-term disability. But after a year off work, only one in five disability benefits claimants will eventually return to work.
Some will remain on long-term disability or decide to take an early retirement. But others may find that their applications for long-term disability have been denied. They could be faced with the terrible choice of trying to return to work before they are ready (potentially injuring themselves further or causing their condition to worsen), or leaving the workforce and attempting to make ends meet using social assistance programs and draining their savings.
If you or a loved one has been denied disability benefits, the fear of what the future holds for you and your family can be debilitating in itself. At a time when you may feel hopeless, the knowledgeable, experienced, and skilled disability lawyers at Howie, Sacks & Henry LLP want you to know that you are not alone. When you contact HSH for free legal advice, we’re ready to demonstrate that Hope Starts Here.
As a top ranked Canadian personal injury firm, HSH LLP can be trusted to provide valuable legal advice when you have questions needing answers. We have established a strong reputation among our legal peers and clients for getting results. We also have a strong reputation among insurer defendants – they know an HSH lawyer will prepare thorough, trial-ready cases with persuasive evidence that lead many to negotiate fair and just settlements rather than face us in court.
A disability benefit denial need not be the end of your claim. Contact the HSH LLP team for a free, no obligation initial consultation and learn how we will help in any way we can.
What Are Short-Term And Long-Term Disability Benefits?
When an illness, injury, or other medical condition prevents you from working and you have exhausted regular sick days provided by your employer, you may be eligible to go on short-term disability leave.
Following a qualifying period, short-term disability benefits will cover some or even all of your regular wages/earnings for a period lasting 15 to 52 weeks, depending on your employer’s insurance policy or your own private disability group insurance policy. Some employers, who have plans providing long-term disability coverage, do not provide short-term disability benefits. Instead, employees must draw on EI benefits during the qualifying period for long-term disability.
To remain on short-term disability, the insurer will generally require reports from your treating medical practitioner which describe the nature of your disability, outline its scope and severity, and an anticipated date when you should be able to return to work.
As you near the end of the short-term disability period, if your medical practitioner determines that returning to your job is not possible or not advisable based on your recovery to date, you will begin the long-term disability application process.
To be granted LTD benefits, your insurer will normally require additional medical examinations by doctors or medical practitioners of their own choosing. Depending on your policy, your eligibility for LTD benefits will rest on its particular definition of disability and whether your disability prevents you from working at your “own occupation” or “any occupation” which would reasonably be suited to your education and experience. Sometimes a policy will specify a period when your LTD eligibility will change from your “own occupation” to “any occupation.”
Understanding the language in your policy is vitally important when applying for and continuing to receive benefits. Some notable considerations outlined in your policy may include:
- the definition of disability
- the amount and duration of your benefits
- exclusions which may prevent you from claiming benefits for pre-existing medical conditions for a minimum period of employment (usually one year)
What Types of Conditions Qualify For Disability Benefits?
While individual policies may exclude certain conditions, generally a person suffering debilitating effects of the following types of conditions may qualify for benefits:
- mental health issues – depression, anxiety, Post-Traumatic Stress Disorder (PTSD), postpartum depression, mood disorders,
- Central Sensitivity Syndromes – Chronic Pain Syndrome (fibromyalgia), Chronic Fatigue Syndrome (myalgic encephalomyelitis), Multiple Chemical Sensitivities, chronic lyme disease, Irritable Bowel Syndrome, chronic migraines
- autoimmune diseases – rheumatoid arthritis, Multiple Sclerosis (MS), Hashimoto Disease/Graves’ Disease, myasthenia gravis, lupus, Guillain-Barré Syndrome, narcolepsy, endometriosis, Crohn’s Disease
- Traumatic Brain Injuries (TBIs)
- orthopedic injuries – fractures, tears to cartilage, ligaments and tendons, and dislocated joints.
- cancer and its after effects (post cancer brain fog)
- cardiovascular diseases – coronary heart disease, strokes, peripheral arterial disease, aortic disease
- alcohol or drug addiction
Disability Benefits: By The Numbers
- In 2022, more than one quarter of Canadians, or about 8 million people, over the age of 15 reported having one or more disabilities
- Pain-related disabilities are most prevalent among the population as a whole (16.7%), followed by flexibility, mobility, and mental health disabilities (10.9%, 10.6%, 10.4%, respectively).
- Between 8% to 12% of employed/working Canadians draw on disability benefits or worker’s compensation on any given day.
- About one in every three people will have a disability that prevents them from working for 90 days or more at least once before they reach age 65.
- Nearly half (43%) of Canadian households which include working people have had a member take time off work due to disability. Temporary disruption of income resulted in 29% dipping into savings, 17% taking on more debt, 17% borrowing from family and friends, and 9% redeeming RRSPs to pay for living expenses.
- Employer group disability insurance policies provide short-term disability and long-term disability coverage to 4.6 million Canadians and more than 10 million Canadians, respectively.
- One major insurer states that mental disorders are both the leading cause and fastest growing type of workplace disability claim, with volumes increasing 53% for short-term disability and 70% for long-term disability between 2014 to 2020 across all industries.
- After mental health disorders (22%), musculoskeletal disorders (19%) and cancer (14%) are the next most common causes of disability claims.
- One in six disability claims are made by people under the age of 40.
- Employers pay an estimated $9.1 billion in long term disability premiums in Canada each year.
LTD Claim Denials
The insurance industry has, insensitively, referred to long-term disability as “living death” because “in the actuarial view it is worse than dying: the disabled person is deprived of income but left with the same or higher living expenses as an able-bodied person.”
Long-term disability benefits, which provide income replacement, coverage of some medical expenses, and funds for housekeeping/maintenance, are often an essential lifeline to a claimant. However, they are also a major liability for insurance companies who have a financial incentive to deny claims or end LTD benefits prematurely.
Insurers can legitimately deny claims that are incomplete or submitted after deadlines spelled out in the policy. Other common reasons for denials, which may be legitimate, include insufficient medical evidence, failure to meet the specified criteria in the definition of disability, exclusions due pre-existing conditions, or failure to meet the definition of disability. In some cases, the reasons for these denials can be contested.
However, other rejected claims or notices of termination may cite inconsistencies in medical reports, the absence of “objective evidence” of disability, or surveillance reports which provide contradictory evidence. This reasoning may not always stand up to scrutiny, and there are many instances where claims that were initially denied have been approved or settled after negotiations with an experienced disability claims lawyer.
Hope Starts Here
If you or a loved one has been unfairly denied disability benefits or had your benefits terminated prematurely, it may feel as though insult has been added to injury. Insurance is supposed to be a safety net when an unforeseen event causes you harm; instead, an unjust denial or termination will likely make a difficult situation even more stressful.
You should know that you are not alone. Howie, Sacks & Henry LLP has helped many people just like you successfully fight for the compensation you need and deserve. Our disability benefits lawyers draw on our renowned network of experts in the medical field to ensure your condition is evaluated accurately and fairly. We build cases that clearly demonstrate you have a rightful claim to these benefits. And if insurers aren’t persuaded during settlement negotiations, we have no hesitation in bringing our cases to trial and demonstrating our arguments to judges and/or juries.
With an HSH disability benefits lawyer on your side and by your side, you will have a tireless advocate skillfully guiding you through the legal process. Above and beyond our professionalism, we always ensure you are treated with the empathy, compassion, and respect you deserve. Our interest is serving your best interests so that you receive the financial resources you need to start a hopeful new chapter in your life.
Contact a member of the HSH disability benefits team today for a free, no obligation initial consultation to learn what we can do for you.
A Comprehensive Guide to Long-Term Disability Claims in Ontario
This Guide was created for Canadians who are planning to apply or who have applied for Short-Term Disability (STD) or Long-Term Disability (LTD) benefits. In this Guide, you will find:
- Information about the application process, types of insurance policies, and common terms or language you may encounter while reading your policy;
- A review of illnesses, conditions and other disabilities frequently covered by disability insurance;
- An explanation of Canadian Pension Plan (CPP) disability benefits; and
- Answers to questions about why some applications are denied, and how an experienced Howie, Sacks & Henry LLP disability benefits lawyer can help access the benefits you deserve.
