What is long-term disability?

Reportedly, many insurance companies frequently deny valid long-term disability (LTD) claims.

However, according to industry estimates, around 60% of all long-term disability claims are rejected annually.

An insurance adjuster or “case manager” will often send an LTD applicant a letter notifying them that their claim has been denied and encouraging them to appeal the insurance company’s decision. This type of letter is usually sent out a few months before the second anniversary of the claim.  The insurance company will typically notify the claimant that the definition of “disability” is changing soon and they will lose their benefits if they can do any sort of work or job.  This can be scary because the insurance company will request new medical information directly from your doctor and sometimes they will call the doctor on the phone without your permission or knowledge.  They are allowed to do this unless you revoke your consent for the insurance company to have complete access to your medical information.  You probably signed a consent form at the start of your claim and forgot about it.

LTD appeals are one-sided and challenging if you don’t have proper legal representation.  Your lawyer may recommend that you don’t participate in an appeal if your medical evidence is already strong that you are not able to work.

Disability Benefit programmes in Ontario:

• There are many programmes in Ontario that cater to long-term disabilities. Under each programme or plan, “totally disabled” or “complete disability” is defined differently. However, it typically indicates that you cannot work due to disease, injury, disability, or accident.
• Group insurance policies, individual insurance plans, provincial government programmes (WSIB, ODSP, Ontario Works), and federal government programmes are all used to pay long-term disability payments in Ontario (CPP Disability and Disability Tax Credit).
• When a person cannot work due to a disability, long-term disability payments are provided monthly. A disability plan must first cover you to get long-term disability benefits.
• A fixed amount or a percentage of your earnings determines the monthly disability payment. Typically, it lasts until age 65 or for a predetermined number of years (such as two, five or ten).
• A waiting period is required for most long-term disability policies (a period that you must wait before receiving your first payment). Frequently, you must first go through short-term disability or EI sickness benefits to receive a long-term disability award.