Claims and durations: How long is long-term disability coverage?

When it comes to long-term disability, the lingering question in an injured person's mind would be, “how long is long-term disability benefit?” Even if there’s no one-size-fits-all answer, understanding the basics can help injured persons and their families plan for their future. 

Here, we’ll discuss the duration of long-term disability benefits, and what to do to maintain these benefits. This article can be useful for personally injured individuals. Lawyers can also share this educational piece with their clients. 

How long is “long-term disability” coverage in Canada? 

There are several statutory and contractual benefits that an injured person can claim because of long-term disability. These long-term disability benefits (LTD benefits) can range from medical benefits to household and personal support. Still, this will depend on your qualifications, as mandated by the law and the body implementing the program. 

As these benefits are great and nurturing, your next question might be for how long can you claim these long-term benefits. Generally, the duration of LTD benefits can either be any of the following:  

• for a specific period: e.g. for 10 years, subject to re-evaluation  
• until the disability is removed: e.g. after healing and insured is now able to work 
• when reaching a certain age: e.g. when insured reaches 65 years old 
• when the insured violated the policy: e.g. concealment or misrepresentations 

To know the specific duration of your benefits, you’ll have to look at your insurance policy or program benefits. Each policy is unique, depending on the insurance company and the premiums you have paid. 

Watch this video to learn more about how long LTD benefits last: 

If you need legal help because of how long your long-term disability would be, consult the best long-term disability lawyers in Canada as ranked by Lexpert. 

When LTD benefits would start 

Most insurance policies would start off by giving you short-term disability benefits. These benefits usually range from three to six months, counted from the time that you were injured or hospitalized. 

Elimination period 

After this period, or for any other reason that your short-term disability benefits end, is the start of an elimination period. Also called qualifying or waiting period, this is the transition period between your short- and long-term disability benefits when your insurer assesses whether you qualify for LTD benefits or not.  

This period usually runs from one to six months; although there are other insurers that have a one-year elimination period. The most common timeframe is two months. At most, the period is dependent on your premiums — the larger the premiums, the shorter the elimination period. 

For this duration, you’ll be handling your own expenses. It’s why this period is sometimes done alongside your other benefits, such as your short-term employment benefits. 

Starting your LTD benefits 

If your insurer approves your application for LTD benefits within the elimination period, then that will be the definitive date that your benefits start. However, some insurers require that you first exhaust all your other benefits before resorting to the long-term benefits. These include: 

• leaves granted by your employer (both sick and regular) 
• sickness benefits from your employer or the government 

When LTD benefits would end 

There are many instances that can result in your LTD benefits ending, either prematurely or because of the terms of your insurance policy. As mentioned above, it can either be when you’re well enough to work again or when a specific period arrives. 

Usually, insurers approve a fixed two-year long-term benefit, after which there will be an evaluation of your case. This can include submission of additional medical reports, seeing if employment is now possible, among others. 

Here’s a video that explains more about LTD benefits, and what happens to it after a certain period: 

For legal advice on how long long-term disability in Canada is, reach out to the Lexpert-ranked best long-term disability law firms in Canada. 

Summary: period from short-term to long-term disability benefits 

Here’s a summary of the periods of when each benefit takes effect and when it ends: 

However, these periods are not final, since your policy will also be in control. For a more definitive answer, it's best to consult with your long-term disability lawyer. 

What are the benefits for long-term disabilities in Canada? 

There are no fixed LTD benefits in Canada, since what you’ll be receiving will depend on two things: 

• the institution giving the benefits: if it’s government, private insurance through your employer, your employer itself, or a direct insurance policy with an insurer 
• the policy that you took with that institution: as with any other contract, your policy will show the specific benefits you're entitled to if you’re living with a short-term or a long-term disability 

If looking at your policy is just giving you a headache, let the professionals handle it by consulting an LTD lawyer. These experts can evaluate the terms of your policy and help you understand what your rights are. 

Specific LTD benefits 

Again, how much and what benefits you’ll be receiving is dependent on your policy coverage with your insurer. The usual long-term benefits are: 

• income replacement, which may range from 70 percent to 90 percent of your earnings 
• medical expenses for continued rehabilitation and treatment 
• other forms of support, such as medicines, equipment, or caregiving services 

Applying for LTD benefits 

When you’re applying for LTD benefits, it’s presumed that you’re on your short-term benefits or in the elimination period. The crucial thing here is that when your insurer or policy says that you must submit an application within a specific timeframe, you must do so. 

At this point, you must also be ready with your evidentiary support proving your long-term disability. Depending on your policy, applying for other government benefits may be a prerequisite for your benefits application. 

Denying an application for LTD benefits 

Violation of an insurance policy is the most basic reason why your application for long-term benefits will be denied. In addition, there are many reasons why your insurer will deny your application, including: 

• lacking medical evidence: a major consideration for approving your benefits is that your disability is supported by medical evidence from your doctor, such as the clear finding of a long-term sickness that requires long-term medication 

• excluded disability: your disability may not be included in your policy’s definition of covered disabilities, or that it is an excluded disability, since your policy would have a list of the disabilities that it considers as “long-term” 

• misrepresentation or concealment: a claim for benefit will be denied by the insurer due to the insured’s misrepresentations on the material information or concealment (e.g. an undeclared pre-existing illness) 

• violating medication plan: while you’re on your short-term disability or during the elimination period, your physician will be prescribing a treatment plan, and not following this plan will cancel your benefits 

Whether you’re still applying for LTD benefits, or if you’re already in one, following your healing plan, as prescribed by your doctor is important. This is not only for your own health’s sake, but also to ensure and continue your LTD benefits. 

These are just some of the things that can be used against you by your insurer when it comes to your medication plan: 

• being absent on your doctor’s appointments 
• failure to submit regular doctor’s reports as needed 
• doing activities that are prohibited by your doctor 

This just means that while your LTD benefits can be as long as you’re entitled to it, it’s still vital to be diligent in keeping with your policy. 

Appealing a denial of LTD benefits 

Know that you have legal remedies against the unfair ending of your LTD benefits. Just like when your insurer has unreasonably denied your benefits application, you can immediately refer to an LTD lawyer for assistance. 

Disputes with your insurer about your claims will first have to be raised with them. Whether it’s government or a private insurance company, they have an appeal process that you can first avail of. If still unresolved, court intervention may be sought, with the help of your LTD lawyer. 

How can you prove long-term disability? 

Part of staying on extended disability benefits is to prove that your disability is long-term. But how can you prove this with your insurer? 

First off, it’s important to note that insurance companies will try to deny your LTD application, and it’s up to you and your LTD lawyer to prove otherwise. While there’s a probability that your application will be denied, it’s not impossible to have your LTD benefits approved by your insurer. 

Pieces of evidence need to prove LTD 

Medical reports and records from your physician/s are your best evidence when proving long-term disability. These may also include testimonies from your physician/s when you filed a court action against your insurer. 

Alleging that you’re living with a long-term disability is a factual question that must be proved by evidence. This may include:  

• presenting medical records that will prove that indeed you’re affected by a long-term disability 
• comparing your medical history and your medical records after the debilitating injury or illness 
• proving that your medical condition or the disabling injury prevents you from doing any work and personal stuff 

It would be helpful for your case if you knew the criteria that your insurance company are using to evaluate if a disability is long-term or short-term. Most probably, they’ll be looking at the gravity of the disability or illness, its effects on your personal life, and your capacity to still be employed. 

It’s also prudent to know what classifies as “totally disabled” under your insurance coverage. For some, it uses a specific period where you cannot do any gainful employment and personal care (e.g. for two years).  

How long is long-term disability: a far journey towards recovery 

How long you can receive your long-term disability benefits depends on many factors. By understanding the rules and speaking with a long-term disability lawyer, you’ll be better informed about your rights and know that you'll be covered by these benefits when you need them the most. 

Looking for other resources on how long long-term disability is in Canada? Bookmark our Legal FAQs for more legal articles about Canadian law, and more.