Over the past twenty years, our disability lawyers have repeatedly seen claimants who are denied short-term disability benefits suffer great financial strain and hardship. The emotional distress from the financial burden created when claimants are denied short-term disability benefits often has a cumulative impact that can lead to more significant problems.
Remember, if your employer offers short-term disability benefits through your group benefits – you have the full right to apply for monthly disability benefits if you cannot complete the duties of your own employment. The contractual test set out in your group policy (which most claimants are unaware of) is not very onerous. The problem is that disability insurance companies often do not properly consider or seek to understand a claimant’s disability – whether psychological, emotional, cognitive, or physical, and take it upon themselves to weigh the medical evidence as if they have a medical background or training.
While it is true that adjusters make decisions based on what medical evidence is provided, often, the decision to deny short-term disability benefits is made because the adjuster simply “thinks” that you can work or complete the tasks of your own job.
The reality is for a claimant who suffers a disability, there is always more. There is more of a history or a story. Often, a long-standing psychological or emotional issue comes to a head – or a breaking point. There can also be a chronic physical ailment which a person has been suffering from that flares up – either due to an accident, age, or the body simply giving out. There could be a history of mental health issues that a claimant has been suffering from an abusive childhood that has finally reached a breaking point. In our experience as disability lawyers in Ontario, there is more to what the disability insurance company knows or cares to understand.
We understand that a denial of disability benefits can cause emotional aggravation and frustration. We understand that being sick or hurt, then only to be denied short-term disability benefits, can be devastating. If you have been denied short-term disability benefits, many firstly think it is some bureaucratic error – but we urge you not to contact your disability insurance company in an emotional state. It is vital that you contact a short-term disability lawyer first and learn more about your rights.
Our Ontario Short-Term Disability Lawyers have recovered millions in denied disability benefits. Call or Send us an Email today. Talking to us is always 100% free.
In Ontario, short-term disability benefits are normally available if you are unable to complete the substantial duties of your own employment.
It depends on your disability policy, but typically in most cases, short-term disability lasts for 120 days.
You normally qualify for short-term disability if you can prove that you are unable to complete the substantial duties of your employment because of an illness, chronic disease or injury.
It depends. Some employers who offer short-term disability do not offer long-term disability. In these types of cases the claimant must first apply for EI Sickness benefits before applying for long-term disability.
If you applying for short-term disability as part of your employment benefits, you would speak to you benefits administrator. If you are applying as part of an individually purchased disability policy, you would speak to your broker or directly with your insurance company.
It depends on your policy. Typical policies pay short-term disability benefits 65% of a person’s salary. In some cases with municipal, education or unionized employees, the percentage can be up to 70%.
They cannot terminate you because you are disabled, but employers in Ontario can terminated anyone so long as the appropriate reasonable notice it paid.
if your short term disability claim was denied, call our Ontario disability lawyers at 1-844-525-2633 or at 905-333-8888 and we will be happy to walk you through your options as a policy holder and what your legal rights are.
We cannot answer for other firms or lawyers, but talking with our Ontario short-term disability experts is 100% free AND if we decide to work together, we will never charge you upfront fees.
It is important to understand the different types of disability benefits available to a person who suffers a chronic illness, disease, disorder, or injury that prevents him or her from being able to work in order to understand short-term disability benefits.
Firstly, there are government plans that provide disability benefits, such as the Canadian pension plan (CPP), the Québec pension plan, unemployment insurance, and workers’ compensation (WSIB) plans. These plans offer limited financial protection as part of Canada’s Social Security benefits.
Secondly, disability benefits can be offered through group benefit plans offered by your employer or association. These benefits generally offer more limited protection but at a lower cost to the insured (or the employer). This is referred to as private insurance.
Thirdly, disability benefits can be provided by an individual policy purchased directly from an insurance company on a client-by-client basis. Individual disability policies often offer the most extensive protection but at a higher premium cost to the insured. This is also considered private insurance.
Short-term disability benefits are a type of private insurance which pays you a portion of your income if you cannot work due to an injury or illness. Short-term disability is typically offered as a part of employment group benefits. However, not all employers in Ontario offer it, and there is no legal requirement to offer short-term disability benefits. Your employer might not offer short-term disability, meaning you need paid or unpaid leave. If your leave is unpaid, then you may want to apply for EI sickness benefits. Remember, before you can start receiving EI benefits, there is a one-week waiting period during which you will not be paid.
Typically, you would talk to your benefits administrator or your HR department to obtain a short-term disability application package. Most short-term disability packages will contain a plan member statement, a plan sponsor statement and an attending physician statement. You must fill these documents in accurately, and provide the attending physician statement to either your family practitioner or whatever specialist you are seeing regarding your current medical condition.
The plan member statement or short-term disability claim form will be an online or .pdf questionnaire asking about your condition, how it occurred, your overall medical history and any expected income while on short-term disability. The plan member statement will most likely include a direction or authorization which allows the insurance company to communicate with and obtain clinical documentation from your doctor concerning your health and disability.
Your plan member statement or short-term disability claim form will ask for such things as:
The attending physician statement will be signed by your doctor, who will provide a diagnosis and prognosis of your overall condition. All clinical findings should be included on or within the statement. The attending physician statement requires your doctor to forward any specialist consultation notes. The attending physician statement will outline your medical issues, diagnosis and when/if your doctor expects you to return to work. The attending physician statement is a required and standard document concerning all short-term disability benefits applications.
What you won’t see is a short-term disability benefits form that is also sent to your employer or plan administrator – which is typically to get more information about your employment, your disability, your time away and your income to calculate your monthly short-term disability benefit payment. The form is similar to your plan member statement or short-term disability claim form, but it’s meant for your employer or plan administrator to fill out. The form will typically ask for such things as
You will qualify for short-term disability benefits if you meet the definition of total disability within the context of your particular insurance policy. Look at your disability benefits booklet and read the particular provision or definition regarding total disability and what that means concerning your injury or illness.
If you are eligible to apply for short-term disability benefits, there may be a waiting period or a qualifying period,, or your benefits may start immediately. It depends on your particular plan.
Your disability insurance company will review the medical documentation regarding your injury or illness that you submit to them, as well as your doctor’s attending physician statement and then determine if you meet the definition of disability as it is defined in disability policy. Your doctor must provide an attending physician statement to your disability insurance company for you to qualify for short-term disability benefits.
The disability benefits adjuster assigned to your particular case will more likely than not interview you over the phone about your injury or illness once your application for short-term disability benefits has been received. If you cannot communicate by phone for any reason (e.g. hospitalized), your case adjudicator should make other arrangements to communicate with you or your power of attorney to discuss your claim. Sometimes, they may call your doctor to ask additional questions concerning your short-term disability benefits application. Normally, it will take a few weeks to process your application for short-term disability insurance. Once your insurance company has decided, they will inform you and your employer of their decision.
Your case manager must not work in an adversarial manner with you. Rather, the case manager must provide a reliable and timely decision on your claim as to whether or not you meet the definition of total disability. That case manager must also provide clear, concise, and reliable answers to any questions that you may have about your claim.
After gathering all the required information, your case manager will review your claim to determine your eligibility for benefits based on your group benefits contract. If your claim is approved, you will probably receive a letter from your insurance company advising you of your monthly benefit amount and the expected duration for which your short-term disability claim will be paid. The letter may include your initial or retroactive payment. If you complete the direct deposit authorization on the application form, your short-term disability benefit will be deposited directly into your bank account. You will also be provided details of what to expect from the ongoing claims process.
Some of the short-term disability conditions that we often see claimants suffering from are:
Your disability insurance company is asking you to sign authorizations to order your non-medical and medical information from your doctors and other medical places you have attended. When you sign an authorization, you are authorizing and permitting your disability insurance carrier to obtain all of your private information from your doctor, employer, other insurance companies, or from anyone else or wherever else you received treatment.
To better understand, doctors in Ontario have a professional responsibility to protect your confidential medical information as a patient. As a general rule, the only way medical doctors or medical institutions would release patient information is if they have the written authorization of that particular patient, the patient’s substitute decision-maker, or if they are in receipt of a court order. By signing authorizations and providing them to the insurance company, you are giving them full disclosure and access to your private medical records. It’s best that you speak to a disability lawyer before signing any medical authorization.
Your doctor must provide the insurance company a clear diagnosis and prognosis. In addition, most policies mandate that you need to be in any treatment program or follow appropriate treatment recommendations by your doctor to promote your overall recovery. Your doctor’s clinical notes and records will be provided to the insurance company to help them adjudicate your claim.
It depends. Typically, you would receive short-term disability benefits if you satisfy the definition of total disability as per your contract, meaning that you cannot perform the substantial duties of your occupation for the maximum benefit period. The maximum benefit is the term chosen by your employer that is defined in your certificate of coverage. In most cases, your STD benefits are payable anywhere from 120 days to 6 months.
Monthly short-term disability payments are based on a percentage of your pre-disability income at the time you are approved for LTD. Typically, the benefit is a percentage of your weekly earnings specified in your individual policy or employee benefits booklet.
This depends on whether you or your employer paid your premiums, or perhaps a mix of both. Benefit taxability is determined by how your premiums are paid. For example, if your employer or employee paid the disability premiums on a pretax basis, the benefits would be taxable. If you paid your premiums after taxes, the benefit would be nontaxable.
If your illness or injury is expected to cause you to remain off of work at the end of your maximum benefit period, then you will need to convert your coverage to long-term disability benefit coverage. Long-term disability will continue to be paid to you if you satisfy the definition of total disability as set out in your disability policy. Most long-term disability benefits begin about 120 days after the onset of disability, but it’s important that you do not wait until the end of the elimination period before filing your disability claim.
Insurance is one of the only products we ever purchase, either privately or through employer-offered benefits, with the hope that we will never have to use it. Many have paid years and years of premiums, expecting the benefits to be paid when they need them most. That is why it is so disappointing and frustrating when you ultimately file a claim, and the insurance company refuses to honour its end of the bargain and denies your application for disability income benefits.
If you are denied benefits, don’t give up. You can likely file an internal appeal. Your insurance company is waiting for you to give up. The disability insurance company wants to wear you down so that you return to work while sick, dying, hurt or abandon your claim entirely. We’ve heard this referred to as “starving out” the claimant. If an internal appeal does not work, or you do not have the option to appeal your short-term disability benefits – you have the option of hiring a disability lawyer to represent you and ask a Court to declare you disabled as per your policy definition and pay your benefits.
The reality is, however, most people do not know that they have the option of hiring a lawyer after they’ve been denied their short-term disability benefits. It is hard enough to deal with the day-to-day limitations due to your medical conditions. It is not surprising, therefore, that most policyholders do not bother with seeing the claim through to the end. The insurance companies know this and that is why they deny so many claims.
Keep in mind that your time to file an appeal or file a lawsuit is limited. Don’t throw away the denial letter and give up. Contact a Hamiltom short-term disability lawyer to assist you in fighting the wrongful denial of your benefits. Remember, our Ontario Short-Term Disability Lawyers have been fighting for the rights of victims for nearly 20 years. If you’ve been denied short-term disability, call our disability lawyers today at 1-844-LALANDE or local at 905-333-8888.
There are certain instances where short-term disability may not be paid – each of which has been individualized in your own disability booklet or policy provided to you by your broker or your employer. In our review of disability policies over the years, we have seen such exclusions as:
For more information about short-term disability exclusions or other circumstances under which benefits will not be paid, contact our Hamilton short-term disability lawyers today.
Yes, you must complete a separate long-term disability application and submit the application to your insurance company. If you do not, you may, in fact, forfeit your right to benefits. Your insurance company should provide you with your LTD forms before the end of your short-term disability, and if they don’t, you should make that request. Again, you will be required to submit a member’s plan statement in the attending physician statement. Please review your policy to determine how long you have to apply and transition to long-term disability benefits.
There can be various reasons why your short-term disability claim is denied. Typically, our disability lawyers see much more long-term disability claims denied than short-term disability denials.
Your short-term disability claim denial could have been due to you not submitting enough medical information to assess your claim. Also, your doctor or clinical provider may not have taken complete notes or have accurately documented your medical issue or treatment, which can confuse the disability insurance company. Most disability policies mandate that you be in and remain in active treatment. If you did not follow your doctor’s advice or you have not participated in active treatment, then your disability claim can be denied.
Your disability can also be caused by one of your policy exclusions, such as drug and alcohol addiction. If drugs and alcohol are the main factors of your disability, then please review your policy. Substance abuse and addiction are typically excluded from most disability plans. It is important to contact a Hamilton Disability lawyer as soon as you have been denied your short-term disability benefits – the longer you wait, the longer it will take to resolve your case and get your short-term disability benefits back on track.
We understand that being unreasonably denied your short-term disability benefits can be very stressful and frustrating. If you suffer from a chronic condition or serious injury that prevents you from working – and you have been wrongfully denied your short-term disability benefits – call our Hamilton Disability lawyers today no matter where you are in Ontario at 1-844-LALANDE or local in the Hamilton/GTA at 905-333-8888 or send us a confidential email through our website. We would be more than happy to sit and speak with your about your situation, at no cost to you.
Our Hamilton short-term disability lawyers have been representing disability claimants at all stages of disability since 2003 and have litigated against some of Canada’s top disability carriers. We can help get your benefits back on track.
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I was a dental hygienist that suffers from really bad scoliosis. My insurance company ignored my doc & cut my benefits off & told me I could do “something”. Matt got me CPP Disability and and LTD settlement – I don’t know what I would have done without him.
My daughter was killed by a drunk driver and it forever changed all of our lives. It seemed that for two years time stopped. This was no an easy journey. Matt let me sit in on the discovery of the driver and boy, he never let up. In the end, our grand-daughter was taken care of and we were compensated for our loss – which we then donated to a cause we believed in.
I call Matt my knight in shining armour. After I was struck by a car while cycling and permanently crippled, he fielded all communications with my especially difficult and downright nasty insurance adjuster. Every step of my care was a battle and I did not have the strength to fight alone.
I lost my leg in a terrible motorcycle accident and Matt help me recover compensation I need because I could not work and the cost of prosthetics and rehab are out of this world. I don’t know what I would have done without him.
My brother ended up paralyzed after a car accident and Lalande did SO MUCH to help get things straight from him getting out of the hospital to all his care for life. We are so grateful for Matt & Heather. I don’t know how my family could have done this without them.
