Area of Law: Personal Injury
Answer # 490
Who can make a claim for long-term disability benefits?Region: Ontario Answer # 490
In order to make a claim for long-term disability (LTD) insurance benefits, you generally must meet three conditions:
- You must be covered under a long-term disability insurance policy
Most people are covered by a private insurance policy or provincial Workplace Safety and Insurance (WSI).
Your insurance policy could be a group disability insurance plan provided by your employer, or it could be an individual, private disability insurance policy you purchased yourself from an insurance agent or provider, such as an insurance company or bank. To receive disability benefits under these types of insurance plans, your disability does not have to be as a result of an illness or injury that occurred on the job. If however, you are making a claim under WSI, then your injury or illness must be work-related.
- Your medical condition or injury must meet the definition of disability in your insurance policy
Every LTD insurance policy contains it’s own definition of ‘disability’ or ‘disabled’ that determines what, if any benefits you will receive.
While most LTD claims involve common sickness or other conditions many people suffer from, some long-term disabilities are due to serious personal injury. Each policy will include a list of medical conditions and injuries that meet the definition of disability, such as heart disease, cancer, PTSD and mental health issues. Check your insurance policy to see if your disability qualifies.
- Your disability must make it impossible for you to work
To make a long-term disability claim you must be able to prove to the insurance company that you are physically or mentally incapable of working at any job. To support your LTD claim, your doctor or specialist must provide notes and records, including a medical certificate.
The definition will include many distinctions, such as:
- How long does your illness or injury prevent you from performing your job? (Sometimes called the qualifying period)
- Does the illness or injury prevent you from working at your regular job, or at any job for which you are reasonably suited?
- How much income are you losing due to the illness or injury?
- Are you participating in a Rehabilitative Program?
Insurance policies will have definitions of what regular and any job mean. The basic definitions are:
Regular job or occupation refers to the main duties of the job you had at the time the disability started.
Any job or occupation refers to the duties of any job for which you’re reasonably suited. You don’t qualify for benefits if you can work in a different job from the one you had before your disability, based on your training, experience and education.
Getting legal advice and help
Even when an individual has a legitimate cause for claiming their long-term disability benefits, often insurance companies will initially deny the claim, or offer an amount much lower than asked for.
If you or someone you care about suffers from a long-term disability and has disability insurance, contact our preferred lawyers, Bergmanis Preyra LLP . They can help you get the long-term benefits you are entitled to, even if your claim was denied. They offer a free consultation and do not charge up-front fees.
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