What factors affect how long long-term disability benefits last?

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Your insurance plan will determine the length of your LTD benefits. Most policies expire at age 65, although others include limitations on the length of time that LTD benefits may be paid, typically 5 or 10 years.

Definition Alteration:

Suppose your insurance provider determines that you meet their “own occupation” disability test rather than “any occupation” disability test (usually two years, but check your policy). In that case, they may decide to stop paying benefits and they will write you a letter your benefits are ending and invite you to appeal their decision.  

Medical Proof:

Benefits may be stopped at any time during the claim process if the insurance company determines that the medical data does not sufficiently demonstrate that you are fully handicapped. The insurance provider is searching for proof that your attending physicians medically justify your restrictions and limitations and, if relevant, test findings.

Watch Out! – Insurance Adjuster Phone Calls

Your insurance company will probably call you on the phone from time to time to get medical updates.  The adjuster will usually start with small talk about how you are doing and will ask about what sort of activities you are doing on a daily basis.  They will also make notes and record their phone calls with you.  Sometimes those phone calls and transcripts are given to doctors that the insurance company hires to get medical opinions that are favourable to the insurance company.

Treatment:

The insurance company anticipates that you would seek out and accept reasonable medical care and be under the supervision of qualified doctors and specialists. For instance, if you cannot work due to a psychological condition, they will anticipate that you will seek medical attention from a psychiatrist, attend cognitive behavioural therapy sessions, and take any recommended drugs. If the insurance provider believes your care is subpar and you aren’t pursuing the appropriate care, they may decide to stop paying your monthly benefit.  Sometimes it is very difficult to obtain referrals to specialists and psychologists because of long waiting lists so it may be important to be able to prove that you have been given a referral.  

Plans for recovery and returning to work:

The insurance company will push your employer and your doctor to agree to a return to work plan, even if you aren’t medically able to work.  Sometimes these phone conversations with your employer will happen without your knowledge because you signed a consent form.  Without any supporting medical records and your doctor, an insurance company may stop paying benefits if a rehabilitation or return to work plan is not followed.

Get a diagnosis for long-term disability: 

You do not need a particular illness or injury to qualify for the benefits.  You must ultimately pass the disability test described in your policy.  The term “complete disability” is frequently used but in reality your policy will define what qualifies as a disabling.  Sometimes insurance companies will incorrectly write the definition of disability in their letters to you.  That is why it is important to get a copy of the policy and to get a legal opinion if you have been denied coverage.

It is wise to get a diagnosis as quickly as possible. Insurance companies are more likely to pay out your long-term disability claim if they can identify a specific diagnostic or medical condition. Back troubles, psychological problems, chronic pain, eye impairments, cardiac issues, etc., are a few examples.  Sometimes injuries and problems go undiagnosed for a long time without proper tests or MRIs. 

Payments for long-term disability don’t begin right away. Before you can begin receiving compensation under most programmes, you typically need to be continuously disabled for three to six months. The “waiting period” or “elimination period” is the name given to this period. You may be eligible for short-term disability compensation throughout this period. It can be through a group insurance policy or the federal government’s employee sickness insurance programme.

    As an illustration, consider how long-term disability operates:

        • You participate in a group insurance plan through your job and have long-term disability insurance.
        • You get unwell with a chronic condition that makes it challenging for you to work.
        • You struggle at work for a while and eventually find yourself unable to carry out your “own” occupation’s routine tasks.
        • You receive a note from your physician authorizing leave of absence from work.
        • You take sick leave, and your group insurance plan pays you short-term disability benefits.
        • Your short-term disability payments expire after three months, and long-term disability benefits begin.
        • The definition of disability changes after two years to and you need to demonstrate that you can’t really be gainfully employed at any occupation.
        • Your physician attests to the fact that you are also unable to perform any work.
        • You will continue receiving monthly long-term disability payments until you are 65 or until you recover enough to be able to return to work.

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