Once you have submitted an application for Long Term Disability benefits, you have certain responsibilities to ensure that your claim for benefits is accepted or to ensure that you continue receiving benefits. These responsibilities, detailed in your benefits policy, usually include the following:
Making reasonable efforts to facilitate recovery
As part of your responsibilities, the insurance company expects that you will make efforts to help recover from your illness or injury. This includes being under the care of a physician(s), specialists or treatment providers, participating in any reasonable and customary treatment program or rehabilitative program.
If you and your treating physician(s) believe that you cannot take part in a program recommended by the insurance company, you will need to provide medical evidence that indicates that your participation in a program would hinder your recovery efforts and an explanation as to why/how it would impact your recovery.
Making reasonable effort to attempt a return to work
The insurance company will also expect you to make reasonable efforts to attempt to return to work either in your own occupation or alternate employment.
Usually, a return to work will start with a gradual return to work respecting your physicians’ recommendations regarding hours, schedule, restrictions and limitations. The return to work may also consist of modified duties for a certain period of time, depending on your physician’s advice.
Pursuing other benefits
Your policy will most likely set out your responsibility to apply for other benefits that you may qualify for, such as Canada Pension Plan (CPP) Disability benefits. Some policies will even ask that you appeal any decision denying those benefits.
You will also be required to let your insurance company know if and when you apply for and get approved for other benefits as those new benefits may reduce the amount you receive from the insurance company.
Insurers usually set up their insurance policies such that they become the “payers of last resort”. This means that other sources of income such as CPP Disability benefits are deducted, or off-set from your LTD benefit. For more information on this topic please refer to our article on long term disability offsets.
Reporting any other reportable income
The insurance company will expect you to report any income you are receiving from other sources other than your LTD claim.
It is important for you to advise your case worker about any other sources of income from other employment or benefits. If you do not advise your insurance company, you could be responsible for overpayment of LTD benefits.
Please check your specific policy to see what qualifies as reportable income but generally, reportable income consists of the following:
- CPP Disability Benefits
- WSIB payments
- Notice or Severance payment from your employer if you are terminated
- Employment Income not previously approved by insurance company
Cooperating with the Insurance Company regarding your health
It is important to cooperate with your insurance company and provide them with updated medical documents and medical information when requested such as surgery dates, new diagnosis, new findings, testing results and new medications.
Unlike the employment context, where you do not need to provide all medical reports or diagnoses to your employer when on sick leave or when making an accommodation request, when you are dealing with your insurance provider, you are required to provide them with medical reports and diagnosis to show that you meet the definition of disability as set out in the LTD policy.
It is also valuable to inform the insurance company of your progress or set backs regarding your illness/injury.
We are here to help navigate the Long Term Disability claim process. Consult one of our experienced Disability lawyers at Raven, Cameron, Ballantyne and Yazbeck LLP if you are considering making a claim for disability benefits or if your disability claim for benefits has been denied.
[This article is for informational purposes only and does not constitute legal advice, which cannot be given without consideration of your individual circumstances.]