How COVID-19 affects your pre-existing LTD claim, eligibility, and insurance
COVID-19 is a perfect example of how our lives can change unexpectedly at any moment. Suddenly, millions of Canadians lost their jobs, and a global health crisis became the number one threat to the health, livelihood, and careers of the entire population. Like COVID-19; unfortunately, many people will face unforeseen circumstances in their lives that will prevent them from working, either for a few months or for the duration of their career. In the event of sudden illness or injury, preventing you from working, long term disability (LTD) benefits are used to help cover bills and medical or other expenses. You are eligible for benefits if health-related issues hamper your ability to meet your daily job requirements; this includes COVID-19 related sickness or complications. Many people have questions regarding their pre-existing benefits and their eligibility concerning COVID-19 and long term disability.
Changes to your long-term disability coverage
Many Canadian workers have access to LTD insurance either through payroll or individual insurance companies. In concerns to insurance via payroll, it is crucial to be aware of how your disability plan could be affected. Your plan could be affected if you’ve been furloughed, placed on unpaid leave, or lost hours. Generally, you are only eligible for benefits if you are still actively employed and work the necessary number of hours outlined in your plan. If you are working less than the minimum number of required hours, you are at risk of losing your coverage.
However, in the wake of the pandemic, some insurers have implemented “internal exceptions” (e.g. exceptions not found in your plan document). These exceptions may allow you to continue receiving coverage for an extended period (e.g., the pandemic) if you no longer qualify for coverage as a result of COVID-19. Be sure to contact your insurance provider to find out more about your specific plan and existing/additional exceptions.
Pre-existing long term disability claims
If you are already receiving LTD benefits, a COVID-19 diagnosis does not affect your pre-existing claim. Regardless of causation, you will continue to receive benefits as long as you are unable to work.
COVID-19 and long term disability: When you should apply
As mentioned, you are eligible for long term disability benefits if you have experienced COVID-19 related sickness or complications that prevent you from working for an extended time. This includes mental health related conditions. The standard protocol for submitting an LTD claim would apply.
Submitting a long term disability claim
Even before COVID-19, getting a disability claim approved can prove to be a bit of a hassle. To bring a claim for LTD benefits, your primary physician must agree that you can not report back to work because of your COVID-19 (or otherwise) related condition. You will need to provide supporting documentation to prove this (i.e. attending physicians’ statements). If your COVID-19 and long term disability claim gets denied, you shouldn’t appeal. Do not appeal the denial unless you can get additional and extensive documentation to prove your claim further. Otherwise, the company will continue to deny your claim. Many insurance companies will deny claims based on “insufficient medical advice” or a lack of meeting the eligibility requirements.
Insurance companies are in business to make a profit, therefore the fewer claims they pay, the more money they make. Regardless of whether your claim has been denied if your treating doctor says you can’t work, you are very likely eligible for LTD. Upon denial, it is best to seek legal help about the wrongful denial of your COVID-19 and long term disability. Once presented with a legal claim, an insurer is more likely to re-evaluate their decision.