Navigating Long-Term Disability | Author: Brooke M. Auld, Employment Lawyer
COVID-19 remains a credible threat to human health. Over the last eight months, medical professionals have learned much about how the virus behaves. One of the most insidious is its ability to cause blood clots which results in cardiac arrest and stroke. Even healthy, young people are not immune. Some individuals will require several months off from work with intensive physiotherapy and rehabilitation as part of the recovery plan. When catastrophic changes to your health keep you from returning to work for extended periods, most people also suffer financially. You must ensure you can get through such critical periods with some financial assistance. This blog will help Ontario employees understand how to navigate long-term disability.
Sources of Financial Assistance
Depending on your employment, Ontario employees can apply to government or private plans for help with income replacement during a long-term disability. When illness strikes, you should start by immediately applying for federal Employment Insurance (EI) Sickness Benefits. Presently, it covers a portion of your income for up to fifteen weeks and changes are on the horizon. Other government programs include the Canada Pension Plan Disability (CPPD) and the Ontario Disability Support Plan (ODSP). Sometimes, you might have to exhaust one to be eligible for the other. If your illness was caused by a workplace incident, then you might also qualify for Worker’s Compensation Benefits (WSIB).
Union employees often receive enhanced sick leave benefits through the collective bargaining process. And many employees receive private insurance coverage through their employment in the form of short-term and long-term disability benefits. Most private plans cover short-term disability for three to six months. Employees should know that they are often funded by employers, using insurers as administrators. If your physician indicates that you will be off for six months or more, then you should apply for long-term disability benefits right away. The claims process is lengthy. In some cases, the coverage will only start after you have used up your EI Sickness Benefits.
Navigating Private LTD Insurance
Private long-term disability plans cover a percentage of your salary for up to two years, sometimes more. Consequently, these claims are expensive ticket items for insurance companies. You can expect the screening process to be equally intense.
It will begin after your critical phase is over and your physician has discharged you to recover at home. For heart and stroke patients, recovery can occur at differing paces. Furthermore, your long-term disability may not be as clear cut as someone paralyzed from a stroke. Indeed, thousands of COVID-19 survivors across the globe, dubbed “long-haulers“, continue to live with “intangible” debilitating symptoms like chronic fatigue and brain fog. Your physician may not want you to return to work until you are fully recovered.
Do not expect your insurer to view your situation in the same light. If you received the most stellar and compassionate care from your medical team, then you will find the harsh and contrasting treatment from your insurance provider to be jarring.
Denied and Rejected Long-Term Disability Claims
For a successful claim, you will need to demonstrate that your symptoms are severe enough to limit your ability to perform your tasks at work. The assessment process will begin with junior-level claims advisors asking for medical reports to evaluate your application in detail. Expect to visit multiple specialists for numerous medical examinations and tests to prove your case.
In our estimation, insurers use every means at their disposal to deflect, delay and reject all but the most persistent of applicants. Sometimes they will set unreasonable deadlines, knowing fully well that it will take you a while to obtain specialist appointments. Rightfully, they will expect progress reports from your physician and may cancel your coverage over a technicality because adjusters often apply the most stringent interpretations of the clauses. A slight improvement to your condition might prove fatal to your claim, even if you are far from full recovery.
Generally, insurers use two standards for judging long-term disability. For the first two years, they will evaluate whether you can perform work in your own occupation. Things may get complicated here if your employer has moved on, hired someone else to do your job and does not want you back.
The pestering will not cease even after the insurer approves your claim. At the two-year mark, they apply a different standard. Now, they may stop your claim suddenly, or evaluate you for your ability to work in any occupation. If you qualified for benefits when you first stopped working, do not assume it will continue two years later, even if your disability remains the same. Expect the assessments to become increasingly contentious.
Unfortunately, the wording of your medical reports will matter. You will need to have a very good grasp of the fine print in your policy to handle these matters. And all of this may arrive when your health least permits you to handle it.
Seeking Legal Help for Long-Term Disability Claims
Many individuals require the services of a lawyer at this point. If you are in this position, then ensure you seek the right type of legal intervention. A generalist or personal injury lawyer may not be able to help you.
Disability benefits are considered peace-of-mind contracts under the law. If your employer offered them to you as part of your compensation package, then you are entitled to them, just like your salary. Withholding them for no good reason is a breach of your employment rights. You will require an employment lawyer who is experienced in litigating disability benefits and has a skillful grasp on medical terminology to maneuver the case.
Lecker & Associates have over 35 years of experience successfully fighting insurance companies over denied and cancelled claims. Do not let the matter of legal fees keep you from seeking your entitlements. We encourage you to contact us for a complimentary assessment of your case. For a majority of the long-term disability cases we take on, we charge a fee based on a percentage of the settlement we obtain for you. If we can prove that your insurer acted in bad faith, then we will take a vested interest in seeing your case succeed. Our team will go after them with every tool at our disposal. You will feel confident with us having your back and this will allow you to return your focus on your health and recovery.
About The Author
Brooke M. Auld, B.A. (Hons.), LL.B, LL.M, is an employment lawyer at Lecker & Associates and a passionate advocate for employee rights.
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