How do Long Term Disability claims work?

How do Long Term Disability claims work?

The purpose of long term disability claims are to help protect you in case of an unexpected illness, injury or condition that leaves you unable to work and earn an income. A common example of this is a catastrophic car accident that leaves someone in such a serious condition as to be unable to work. 

The qualifying period for a long term disability claim

Depending on the policy, claimants need to apply and receive short term disability benefits first. This is often called the “qualifying period”, “elimination period” or “waiting period”. Again, depending on the policy, the qualifying period will range from about three to four months. Once the qualifying period is over, then the claimant can apply for long term disability and will be accepted providing they meet the particular disability test.

The first two years

In the first two years the disability test usually means that the claimant is unable to carry out the duties of his or her own occupation. This is usually called the “own occupation” test.

After two years the total disability test is defined as a disability that prevents the claimant from doing any occupation reasonably, comparable to his previous job, in terms of education training and experience.

Years ago Statistics Canada release numbers on the number of Canadians with a disability at about 14% of the population. Prevailing disabilities were those related to pain (10%), flexibility (8%), and mobility (7%)

A report by the Chief Public Health Officer in 2016 – entitled “Health Status of Canadians 2016” report that cancer continues to be the leading cause of concern.  The report further indicated that most common health concerns in Canada were:

  • Cancer
  • Cardiovascular Disease
  • Diabetes,
  • Accident and injuries,
  • Mental health disorders, and
  • Multiple sclerosis

In our office the most common type of conditions that we see are victims of car accidents who are no longer able to work but also carry a long term disability policy through their employer. Often times the injuries are severely psychological or physical in nature. A common example we see are psychological issues that stem from a car accident causing a head injury that, over time, leads to psychological issues.

Improving the likelihood of long term disability claim approval

To help your chances of being approved for long term disability benefits it is recommended that you seek medical attention regularly in hopes of getting some sort of diagnosis and prognosis in order to get a better sense of how long your condition will last. 

The medical reports and treatment will assist your lawyer and the insurance company in determining the extent of the loss. The claimants injuries will need to be more severe in order to qualify for the post two-year disability payments. It cannot be emphasized enough how important it is that sufficient medical documentation is available to prove that you are unable to work. It is entirely possible that the insurer requests that you attend a medical assessment in order to determine your eligibility for long term disability payments. If this is the case, then the claimant will be required to attend.