Claiming Long-term Disability Benefits in Ontario

Claiming Long-term Disability Benefits in Ontario

Long-Term Disability Benefits

You may need time off work due to an accident, an illness, or an injury. If so, long-term disability benefits may pay you a percentage (usually 60 – 70%) of your monthly income. There are many different types of long-term disability (or LTD) claims. Sometimes short-term disability claims turn into long-term disability claims when injuries do not heal, or result in chronic pain. Other times an injury is so traumatic or an illness so severe that the victim is immediately eligible to make a long-term disability claim.


Accidents may include such events as a slip-and-fall, or a motor vehicle accident. One minute the victim is well and capable, the next he/she is incapacitated. Accident injuries may include such problems as whiplash or broken bones. These usually heal with time, and may be eligible for short-term disability benefits, which last up to six months. However, accidents sometimes result in serious brain injuries, spinal cord injuries, or other life-changing trauma. These latter victims may be eligible for long-term disability.


Illnesses that may make one eligible for long-term disability benefits include fibromyalgia, multiple sclerosis, severe arthritis, or cancer. These may have a sudden onset or develop slowly, but when they begin to affect job performance, victims may be able to apply for long-term disability benefits. Other conditions that may be eligible for LTD benefits include orthopaedic problems such as degenerative disc disease, chronic conditions such as Crohn’s disease or diabetes, and psychological illnesses like schizophrenia or bipolar disorder.


Filing an LTD Claim

If you or a family member needs to claim for long-term disability benefits, make sure you have a copy of your policy, and read it carefully. Next, contact a personal injury law firm. These firms usually offer a free initial consultation where you can explain your situation and get advice as to how to proceed. A good personal injury lawyer understands the insurance system and the paperwork necessary, and can help to guide you through the process.


Seek medical treatment, and do what the doctors tell you to do. If a doctor recommends physiotherapy, be sure to do the exercises, for example. Take any medication promptly and properly. Write down all of the things you are doing to improve your health, including any prescriptions or treatments that you get. Keep copies of medical records such as x-rays. Be honest with your doctors; they’ll be assessing your limitations and capabilities with regard to your claim, and it’s important that they have an accurate picture of your condition.


Take notes on any conversations you may have with representatives from your insurance company. Be as honest as possible about your condition with your insurance company, but remember that they are likely to deny your claim if you give them any reason to do so. Your lawyer may want to see notes on any communications you’ve had with the insurance company. If your insurance company offers to settle, don’t do so until consulting with your lawyer.


Staying on Benefits

Many people with serious illness or injuries wonder how long they will be eligible for long-term benefits. This can vary, depending on a number of factors. One of these factors is the terms of the policy itself. Some policies stipulate that benefits can continue to age 65. Other times benefits terminate after five or ten years.


Another factor that may cause the benefits to cease is medical evidence. If the insurance company finds that the medical evidence shows you are fit to go back to work, they can terminate the benefits. “Change of definition” is a related cause for termination of benefits. This refers to the fact that many policies base the first two years of benefits on the definition that you are unable, due to illness or injury, to do your “own job”. After two years, this definition often changes to “any job”. If and when this happens, you must demonstrate that not only are you unable to do your previous job, you are unable to do any job for which you are or may become qualified.


The insurer can also terminate benefits if they feel you are not following medical advice, or are not doing all you can to recover from your injuries or illness. Sometimes a rehabilitation plan has been recommended, and if you are not following this plan diligently, benefits can be terminated.


Benefits may also be reduced if you begin receiving other disability monies. For example, many people receive money from both long-term disability and CPP disability plans. You can check your plan to see how the company handles off-setting of other disability plans.


If your claim for long-term disability benefits has been denied or terminated, work with a personal injury lawyer to ensure that you get the compensation that you deserve. A good personal injury lawyer will walk with you through the whole process of application, and fight for you and your family.