Many individuals have long term disability (LTD) benefit coverage through their employer. These are group policies that apply to all employees in the workplace. A group policy is a legal contract often containing technical language which may be difficult to understand. Insurance companies will use this technical language when denying or terminating long term disability benefits. We have identified some of the commonly used terms and have attempted to demystify them here for you. It is always important to remember, however, that this does not replace legal advice and if you have any questions about your policy or specific situation, you should contact an experienced long-term disability lawyer.
This is the amount of time an individual must be an employee before he or she can make a claim for LTD benefits. The qualifying period can vary depending on the policy.
This is the amount of time an individual must wait between the first day he or she is unable to work due to disability, usually the first day of sick leave, and the first day they are eligible to receive LTD benefits. The elimination period can vary depending on the policy. Individuals who do not have access to paid sick leave or short term disability benefits can apply for EI Sickness Benefits.
Total Disability or Totally Disabled
In order to qualify for LTD benefits, an individual must meet the definition of total disability in the contract. It does not mean that an individual must be absolutely physically or mentally incapable of doing anything related to her or his own occupation. At the outset, being totally disabled generally means that an individual is unable to perform the regular duties of her or his own occupation. In the majority of LTD group insurance policies, the definition of total disability changes 24 months after the end of the elimination period. At this point, in order to continue receiving LTD benefits, an individual must be unable to perform the duties of any occupation.
This is the work an individual performs at the time she or he becomes disabled. The insurance company does not look at the specific job, but the occupation in general. If the insurance policy defines total disability as being unable to perform the regular duties of your own occupation, an individual is not required to find employment in a different field even if she or he can perform other tasks that are not related to her or his own occupation. For example, a dentist would not be required to work as a clerk even if she or he can sit at a desk and use a computer.
As mentioned above, most insurance policies provide a change in the definition of total disability 24 months after the end of the elimination period. In order to continue to receive LTD benefits, an individual will be required to show that she or he is unable to perform the regular duties of any occupation. It will be important to refer to the terms of the insurance policy as any occupation may be further defined with additional language. Often policies will refer to any occupation for which an individual is reasonably qualified based on education, training or experience, or any occupation for which an individual may reasonably become qualified by education, training or experience. At this point, an individual may no longer qualify for LTD benefits if she or he can perform duties of another position for which they are qualified or can become qualified. For example, if the dentist could no longer physically work as a dentist, he or she may be qualified and able to teach courses.
If you are unable to work and are applying for LTD benefits or if your benefits have been denied or have been terminated, please contact an experienced long-term disability lawyer for advice.
We are here to help navigate the LTD application 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 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.]