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WHAT DOES IT MEAN TO BE “DISABLED” TO BE ENTITLED TO LTD BENEFITS?

Two Road signs, Short Term and Long Term

There are two ways you might be covered for private or group disability insurance: either you purchased the policy personally or, more comonly, you are covered under a disability plan through your employment.

Whoever owns the policy, to get access to benefits, you will have to prove you qualify according to the policy’s terms. Every disability insurance policy is different, and the precise definitions can vary from policy to policy so it’s important to review the exact wording in your policy. (We recommend that you ask a local & experienced disability insurance lawyer, like the lawyers at Martin & Hillyer Associates, to review your policy and give you personalized legal advice about your particular situation.)

While the details will vary from policy to policy, there are a lot of similarities that are shared by most disability insurance policies and plans.

Usually, you start with short-term disability (STD) benefits which are typically available to you immediately after you become disabled (or after a brief “qualifying” or “elimination” period). STD benefits may not be provided by the same insurance company that provides your longterm disability benefits, and may even by provided by a large employer directly.

Typically, in order to receive STD benefits, you must demonstrate that you are disabled, through illness or injury, from preforming the essential tasks of your own job. This is known as the “own occupation” period.

To prove this, your insurance company will require your doctor to complete a statement that describes your disability and your limitations. You will also be required to complete an application form yourself.

The insurance policy will set out the length of time that STD benefits will be paid. Once this period has expired, and assuming you remain unable to work, you may qualify for long-term disability benefits. Long-term disability (LTD) benefits are similar to STD benefits, however the monthly benefit amount may differ, as may the definition of disability.

Under most policies, the disability test you have to meet to get LTD benefits remains the same as it was to get STD benefits for the first two years – you qualify if you are unable to perform your own job.

However, the definition of “disability” typically changes at the two year mark to an “any occupation” disability definition: in order to continue to qualify for benefits after 2-years, you would have to be unable to perform any occupation for which you are reasonable suited by education, training or experience.

Since the “any occupation” disability definition is more restrictive, it’s common for people to have their benefits terminated at this 2-year point.

To avoid inappropriate terminations, it’s important to ensure that you are accessing treatment if it is recommended for you, and providing your insurance company with enough medical evidence and supporting opinions from your healthcare providers to explain to them what your limitations are, and why you are unable to work.

Remember that, while these observations apply to most disability policies, the specific details of every individual policy are different. You should look into the exact wording, tests and requirements of your particular policy if you are or will be making a claim for disability benefits. An experienced local personal injury lawyer will be able to help you with this.


BURLINGTON LTD & DISABILITY LAWYERS

If you have questions about a disability insurance claim (LTD or STD), if your insurance company has denied your claim or terminated your benefits, or if you would like help understanding your own disability insurance policy, we’re here to help. Our local personal injury lawyers have the experience and the expertise to provide the advice and representation you need to succeed with your claim.

Get in touch to arrange a free consultation and find out how we can help you.

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About the Author

DAVID HAYWARD

DAVID HAYWARD

David’s practice includes representing injured people in various areas including automobile accidents, Mediations/Arbitrations at the Financial Services Commission of Ontario, slip-and-fall accidents, LTD claims, CPP, and ODSP disability claims.

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