As a worker, you may always be at risk of encountering a disabling accident, during or outside your day-to-day work. If this unfortunate event happens, one of your concerns would be how to apply for long-term disability benefits.
Whether it be a sudden illness, injury, or a chronic condition, here’s a brief primer on the important considerations when applying for long-term disability benefits.
What are long-term disability benefits in Canada?
Long-term disability benefits (LTD benefits) are provided to eligible persons, such as employees, after being disabled due to a sickness, injury, or accident. These causes can be workplace-related or not.
It supports the disabled employee by replacing a percentage of their salary, plus other benefits, depending on the entity giving the benefits.
Also called permanent disability benefits by some entities offering similar programs, these are usually offered by:
- private insurance companies
- employers, group insurance, or employee’s unions
- government (e.g. Canada Pension Plan, provincial Workers’ Compensation Boards)
How can I apply for long-term disability benefits?
The specific process when applying for long-term disability benefits will entirely depend on the insurance plan or government program.
In any case, we’ll discuss here the common steps in these applications, and what you should consider before, during, and after applying.
Eligibility when applying for long-term disability
Each long-term disability program has its own eligibility rules. A common requirement is that you must have paid enough premiums.
You must be enrolled in a plan to be eligible to apply for long-term disability benefits. Claiming for these benefits is not automatic. Your program will also specify what illnesses and disabilities it will only cover. Usually, it will include the number of months before it treats such as a “long-term” one.
This can also be related to the short-term benefits that you can be eligible for, since you may only be eligible for long-term benefits only after exhausting the short-term benefits.
Related to eligibility, you may wonder about your insurance company’s surveillance over you. Watch this video to know more:
For questions on long-term disability, contact a lawyer in your area. If you’re from Toronto, Kingston, Vaughan, or other nearby areas, you can reach out to one of the Lexpert-ranked best long-term disability lawyers in Ontario.
What’s the application process for long-term disability benefits?
Here’s a summary of how to apply for long-term disability benefits in Canada:
- Apply for short-term disability benefits
- Wait out the “waiting period”
- Prepare and submit the insurance claim and other documents
- If applicable, appeal the decision
Let’s go over each step in more detail.
1. Apply for short-term disability benefits
Some insurance policies may require you to first apply for short-term disability benefits. Once approved for it, you may only then apply for long-term disability after your short-term disability’s period.
This is also part of their assessment of whether you can resume working after using the short-term disability benefits, or if you’re eligible for the long-term one.
2. Wait out the “waiting period”
In long-term disability policies, the “waiting period” is the time that you’re not working, or not allowed to work, due to your disability, illness, or injury.
Most entities set this standard to determine if a disability can be considered “long-term”. Some policies say that it should last longer than 5 or 6 months. Others set it longer, even up to 1 year.
For other policies, the waiting period may (or may not) overlap with the period when you’re receiving your short-term disability benefits.
Again, it’s better that you read about your policy’s waiting period even before enrolling. You can ask your policy agent or broker, or your employer or union if they’re connected with your insurer.
The waiting period is important since it will tell you when the perfect time is to apply for long-term disability benefits. Typically, you’ll want to apply before your waiting period ends, so that there’s no gap between receiving your short-term and your long-term benefits.
3. Prepare and submit the insurance claim and other documents
Your insurance provider – whether it be a private one or the government – will have a form that you must fill out when applying for long-term disability benefits. This is usually called your notice of claim.
Your provider will also require a report from your employer to prove that you’re still unable to resume work with them.
This report is also to assure your benefits provider that you won’t be working anytime soon, since working back may diminish, or even cancel out, your long-term disability benefits.
You will also be required to submit your doctor’s evaluation through a medical report.
Automatic processing of long-term disability benefits
If your insurer is the same entity that will provide both your short-term and long-term disability benefits, they may automatically process the long-term disability benefits.
It may be subject to the submission of your medical report, and only after the end of your short-term disability benefits.
Processing time
There will be a separate period for your insurance provider to process your long-term disability benefits application. It may take from 3 weeks to up to 1 month.
Submit your application early, so that its approval will coincide with the end of your short-term disability benefits.
4. Appeal the decision
If your insurer denies your application for long-term disability benefits, you may file an appeal. This may be a lengthy process, but the benefits you would have received may be retroactively given if you are entitled to these benefits.
If it’s still disapproved, or if you think that your insurer disapproves your application without valid cause, filing a case against your insurance company can be an option.
This can be your last resort. Your long-term disability lawyer can also assist you in dealing with your insurance company after your claim’s initial denial.
Got more questions on how to apply for long-term disability benefits? Consult the best long-term disability lawyers in Canada as ranked by Lexpert.