Long-term disability policies are very different from insurance that’s legally required (like car insurance, for example). Because you aren’t required by law to have it, there’s no “standard” policy. LTD policies are completely customized and can be completely different from one to the next.
That’s convenient when you’re looking for the right insurance coverage, but it also means that making a claim can get very complicated. Information you find online may not apply to your case at all. If you’re in a union, your collective agreement may also affect the way your insurance policy works.
These are the basic steps of an LTD claim, but because each claim is so different, we strongly suggest talking to a lawyer about your claim.
Employment insurance sick benefits are available for up to 15 weeks following an accident if, as a result of the accident, your regular weekly earnings from work have decreased by more than 40% for at least one week. You can visit the EI sick benefits webpage for more information or call Service Canada at 1-800-206-7218.
Open a claim with your disability insurance if you haven’t been able to work for longer than the “exclusion period” or “elimination period” specified in the contract (usually 60, 90 or 120 days).
Read carefully: Be sure to read your policy documents very carefully (or get a lawyer to help). LTD policies can vary a lot from one to the other.
If you’re approved, great! If your claim was denied, your insurance company probably offers an “appeal” process where they will re-evaluate your claim.
Unfortunately, the appeals process is rarely successful, so we suggest contacting a lawyer right away if your claim was denied rather than wait weeks or months for the insurance company to evaluate your claim again.
Your claim may be terminated even after you have received benefits for some time, due to a change in how the insurer determines whether you are “Totally Disabled” that usually occurs two years into your claim. If your claim is terminated at this stage, you may still be entitled to benefits.
Sometimes the contract says you still have to do an appeal before you can sue to get your benefits, but your lawyer can let you know if it’s necessary.
If you’ve been off work for at least a year and you have recently contributed to CPP (it’s usually taken off your paycheque automatically) you may have access to CPP disability payments. You’ll have to meet specific medical requirements to qualify – what they consider to be a “severe and prolonged” disability. A lawyer with experience in disability claims can help you.
Do I really need a lawyer?
Hiring a lawyer to represent you is completely optional. You can choose to handle your insurance claim alone if you want to.
Some people choose to do it themselves to save on legal fees, but we believe that in those cases the outcome will be worse than if they had hired a lawyer to represent them. The insurance company has a whole team of adjusters and lawyers on their side with years of experience in making sure insurance payouts – including yours – are as small as possible. A lawyer with experience in insurance claims, on the other hand, will fight for you to make sure you get the full compensation you deserve.
Do I have a case?
Contact us to find out!
We offer free consultations for personal injuries resulting from motor vehicle accidents, slip and falls, pedestrian accidents and other accidents as well as Long Term Disability claims.
Please do not hesitate to contact our team of lawyers for all of your legal needs.