A primer on successfully claiming LTD benefits in Ontario

By Paul Russell, LegalMattersCanada.ca • If an injury or illness prevents you from working for an extended period you may be eligible for long-term disability (LTD) insurance, says Ontario disability and personal injury lawyer Joshua Goldberg.

“It is meant to help you financially after any short-term insurance coverage runs out. But problems can arise if your LTD claim is denied or prematurely terminated,” he says. “That is when you should seek legal counsel.”

Suffering from an illness or injury is stressful enough without worrying about providing for your family as you recover, says Goldberg, principal of Joshua Goldberg Law.

“LTD insurance is there to provide you with the funds you need as you recover. Or in the worst-case scenario, for the years after an injury that leaves you unable to return to the workforce,” he tells LegalMattersCanada.ca.

Goldberg says LTD benefits typically represent between 60 to 80 per cent of your regular income.

LTD coverage is delayed

“These payments don’t start immediately, as most plans will require you to be continuously disabled for three to six months before benefits kick in,” he says. “During this waiting or elimination period, you can receive short-term disability benefits either through a group insurance plan or from the federal government’s Employment Insurance sickness program.”

“After two years, some insurance policies will only continue to pay the disability benefit if you cannot return to work in any occupation,” Goldberg adds.

He explains that the type of work an insurance company can claim you are capable of doing must be commensurate with the education, training and job you held before the injury.

“If you were a manager at a mid-sized firm before you went on disability, you wouldn’t be expected to work as a labourer on a construction site,” Goldberg says.

He says common conditions covered by LTD benefits include spinal cord injuries, cancer, bipolar disorder, chronic pain, post-surgery complications and serious orthopedic injuries.

“LTD payments continue until you are well enough to start working again or until the coverage period terminates, which is usually at 65 when you can start collecting from the Canadian Pension Plan,” says Goldberg.

Canadian employers are not legally required to provide LTD coverage to their staff members, he says, though many offer it as a benefit.

An option for the self-employed

“If you’re self-employed you may want to consider getting disability insurance through a life and health insurance agent,” says Goldberg.

He says claimants must clear many hurdles before LTD benefits are approved.

“The key one is that you must meet your insurance policy’s definition of being disabled,” Goldberg says. “If you cannot perform essential duties in your usual employment field, you will be considered eligible for LTD benefits.”

He says the paperwork for an LTD insurance claim is much more rigorous than for a short-term claim, which is why he tells his clients to gather evidence of their disability before making a claim.

“That would include medical reports from your family doctor or any record of treatment you have received due to your injury,” Goldberg says. “Without documentation and recommendations from medical professionals, insurers will not approve your disability benefits.”

If you provide insufficient medical evidence or refuse to attend an independent medical assessment, your LTD claim can be rejected, he says.

“You must be willing to submit to treatment and/or participate in rehabilitation,” Goldberg says. “There is also the chance the insurance company could put you under surveillance to collect evidence to disprove your claim.”

Consult a disability lawyer first

He says some people consult with a disability benefits lawyer before filing their LTD claim to increase the chances of approval.

“An experienced disability lawyer can review your medical records and draw out the evidence that shows the extent of your disability,” Goldberg says.

“The language in many insurance policies is needlessly complex, which can discourage or mislead some applicants,” he adds. “A disability lawyer can help you cut through the jargon to receive the benefits you deserve.”

If your LTD claim has been denied, a disability lawyer can identify the weaknesses in your application and file an appeal to have it reassessed, Goldberg says.