Toronto Injury Lawyer Blog
Long Term Disability claims aren’t simple.
I wish they were, but they just aren’t.
The amount of money you are entitled to is based entirely on your age, income, the set offs you are receiving or have received in the past, and what your long term disability policy says about the duration and quantum of benefits payable.
Are the benefits taxable or not?
Are the benefits eligible for COLA indexing?
Does the definition of disability change at the two year mark from your “own occupation” to “any occupation” or was an “own occupation” rider purchased under the policy?
Is there a means test under the Policy and if so, what is the percentage of income or income allowable?
Each long term disability policy is different.
There is no “master policy” for every employee out there. While some policies may look the same; they carry different nuances which often translate to very large differences.
When a group of employees has access to a variety of collateral benefits; things like private or public pensions (old age or disability); HOOP Benefits; OMERS Benefits; CPP; other disability benefits, vacation pay, sick pay, union benefits etc. things get complicated fast.
The more benefits available, the more complex the case.
Three groups of workers come to mind as a personal injury lawyer when discussing this topic. All three groups tend to me unionized employees. They are Nurses, Teachers and Canada Post workers.
Let me tell you; for nurses, teachers and Canada Post Workers there are A LOT OF MOVING PARTS when it comes to applying for Long Term Disability Benefits. You almost need to have an HR Degree or be a personal injury lawyer to make the application. Just getting the application forms in the first place can be tricky.
For starters, one would think that one’s Union would be of assistance in applying for long term disability benefits. Many Unions aren’t very helpful when it comes to this sort of thing. I certainly don’t blame them. Some Unions are too small and lack the resources to deal with this sort of thing. Other times the Union Rep has no idea where to start because they’ve never seen this sort of thing before.
But getting information from you Union, no matter how little is still very important. There is the odd time that the Union may have the forms at the ready and some knowledge about making a Long Term Disability Claim.
Even more important is finding out from your Union what happens if the long term disability claim gets denied. Must you go through you Union to fight the denial or are you on your own?
This is a very important question which your Union should know. Some collective bargaining agreements state that any long term disability dispute must be handled by way of grievance under the terms of the collective bargaining agreement. If that’s the case, you’re at the mercy of your Union and their expertise in handling your Long Term Disability claim. This does note apply to Canada Post Workers. However, it can apply to teachers in some school boards, along with some nurses. Ask your Union Rep it it applies to you.
In the event you don’t have to go the Union route, then you’re free to retain a lawyer to help you fight the insurance company; and that’s a good thing. Find a lawyer who knows what they’re doing and has expertise and experience in handing long term disability cases like yours.
You will have a ton of questions such as:
–If I get denied, should I appeal their decision or not? Quick tip: just sue. Going down the appeal route is not advisable save in rare circumstances.
-When is a good time to apply for Long Term Disability Benefits?
– Can I take an early retirement option and still make a Long Term Disability Claim?
-Can I take a “retire and return” option if available? How do I go about doing that?
-Can I quit my job and still claim long term? Can I take my severance or a retirement package and still have a valid long term disability claim?
-Which doctor should I consult with to complete the long term disability paperwork?
-Do I have to speak with the insurance company; and if so; what do I need to say?
-What do I have to do if I get denied and how long do I have to start a claim?
-Why did I get denied in the first place?
-Do I need to apply for CPP Disability Benefits?
– If a buyout is offered to me, can I take it and what impact will it have on my Long Term Disability claim?
-How will a return to work attempt impact my long term disability claim?
-Can I try working again?
All of these are valid and common questions we see from disability claimants. Rest assured that you’re not alone. Even though it may seem dark, there is light at the end of the tunnel. It’s always darkest before dawn so hang in there!
Our lawyers have seem some long term disability cases advanced by nurses, teachers and Canada Post workers which have been ruined before they even had a chance to take off. It’s important that you think about your decisions and actions before making a long term disability claim. Not everyone is going to be perfect; and that’s ok.
Being disabled is binary. Either you are disabled, or you’re not. There are few policies which deal with “partial disability”. They certainly exist, but they are the exception and not the norm. If you are disabled, it means you cannot work and are not working. Being totally disabled doesn’t mean that you’re working a few days a week here or there. Being totally disabled also doesn’t mean that you have a side job, or work somewhere under the table for cash. Being totally disabled means that you are not working in any gainful capacity; and cannot work in any gainful capacity. Your doctor’s opinion matters in this regard. If your doctor does not believe in your disability, then it will be problematic for your long term disability claim.
