If you’re suffering from a mental or physical health condition that is preventing you from being able to work and earn a living, you likely have no choice but to apply for long-term disability benefits.
If you do, you should also hire a long-term disability lawyer to help you file your claim, as they know what an insurance company looks for in an application for LTD benefits. The guide below outlines the LTD claims process, so you know what to expect.
Long-Term Disability Insurance – Are You Covered?
Some employers offer long-term and short-term disability insurance as part of a benefits package. It can also be purchased by contractors, self-employed individuals, and others not covered by a workplace policy.
LTD insurance is meant to provide coverage for a portion of your employment income if you develop an illness or suffer an injury severe enough that you are no longer able to perform the primary functions of your work for an extended period of time.
Some policies are meant to top up disability benefits available through the government, such as Canada Pension Plan and the Ontario Disability Support Program, in which case you could be required by the policy to apply for these programs as well.
Disability Benefits: Applying for LTD Benefits
If you’ve been diagnosed with a medical condition that disables you from working at your own occupation, the first step is to check your policy to ensure that your condition is covered and to learn about the claims process. Some common disabilities covered by LTD policies include:
- Fibromyalgia
- Various types of arthritis
- Chronic fatigue syndrome
- Degenerative disc disease
- Bulging discs
- Adjustment disorder
- Major depressive disorder
- Anxiety disorders
- Crohn’s disease
- Diabetes
- Multiple sclerosis
- Cancer
Disability benefits: apply for LTD benefits, you will need to:
- Get the forms from your employer or the insurance company.
- Speak to your healthcare provider about the ‘Physician’s Statement’ – the portion of the claim they are required to complete. Ideally, your doctor will provide as much paperwork and evidence as possible to show specifically how your disability prevents you from completing the essential work tasks required by your occupation.
- You and your employer will also fill out sections of the application and send them in separately.
- When the insurance company receives your claim, they will assign a case manager to your file.
- The case manager will likely interview you over the phone about your application. These calls are recorded and whatever is said is crucial in determining whether or not the insurance company will approve or deny your claim.
- You might be asked to attend an “independent medical examination” to be assessed by the insurance company. An independent medical examination is an examination performed by a medical professional of the insurance company’s choosing to evaluate your disability from an “objective” standpoint. If you do not attend, your claim will most likely be denied.
- You’ll also be notified of how long it takes to receive a decision. This can be anywhere between 30 and 90 days.
Keep in mind that every insurance policy is different, and the process for applying for LTD benefits under your policy may vary.
If Your Claim is Approved
The insurance company will notify both you and your employer. The approval letter will include information on the amount of the benefit payments you will receive, payment frequency and instructions to maintain your eligibility.
If Your Claim is Denied
If your claim is denied, you’ll be given a reason in the denial letter. You will also be advised of your right to appeal the denial. Speak to an LTD lawyer right away. They will advise on the best way to move forward with your claim based on the reasons given in the denial letter.
It’s crucial not to get discouraged and give up your claim for benefits if it’s denied. Insurance companies routinely deny legitimate claims, and LTD lawyers routinely get them to pay up.
However, there is a two-year time limit from when you received the denial letter for you to file a lawsuit against the insurance company and sue for your benefits. This may seem like a long time, but there is a lot of work to be done and assessments you need to attend to build the strongest possible case before your lawyer files the lawsuit against the insurance company.
Additional Resources
- Government Benefits: If you’re ineligible for LTD through an insurer, consider applying for CPP Disability Benefits through Service Canada.
- Support Groups and Organizations: Disability advocacy groups can help with guidance and resources.
Here are some additional resources to help you navigate the process of applying for long-term disability benefits in Ontario:
Government Programs
- Canada Pension Plan Disability Benefits (CPP-D)
- For individuals with a severe and prolonged disability that prevents them from working.
- Administered by Service Canada.
- Learn more: CPP Disability Benefits
- Ontario Disability Support Program (ODSP)
- Provides income and employment support to individuals with disabilities in Ontario.
- Learn more: ODSP
Legal and Advocacy Support
- Ontario Legal Aid
- Offers free or low-cost legal services to eligible individuals.
- Website: Legal Aid Ontario
- Disability Advocacy Groups
- Organizations like the Ontario Disability Coalition and Disability Alliance BC (which sometimes works with Ontario residents) offer advice and resources.
- Disability Lawyers
- Many lawyers specialize in LTD claims and offer free consultations to review your case.
Medical and Vocational Support
- Community Health Centres (CHCs)
- Provide accessible medical care and support for disability-related conditions.
- Find a CHC near you: Ontario CHCs
- Employment and Vocational Rehabilitation Services
- Ontario Works: Offers employment supports for individuals transitioning back to work after a disability.
- Learn more: Ontario Works
Financial Planning Resources
- Disability Tax Credit (DTC)
- A federal program offering tax relief for individuals with disabilities.
- Learn more: Disability Tax Credit
- Registered Disability Savings Plan (RDSP)
- A long-term savings plan for individuals with disabilities.
- Learn more: RDSP
Mental Health Support
- ConnexOntario
- Free and confidential mental health and addiction support.
- Website: ConnexOntario
- CAMH (Centre for Addiction and Mental Health)
- Offers various mental health resources and services in Ontario.
- Website: CAMH
- ConnexOntario
