Denied Short-Term Disability? Our Disability Lawyers can Help.

Hamilton Short-Term Disability Lawyers Serving Nationwide – If your Short-Term Disability Benefits have been Wrongly Denied or Terminated, Call Now. No Fees Unless We Win.

Free Consultations Provincewide. Call 905-333-8888 or Send us a Message Today.

Matt Lalande is a sought-after disability lawyer in Hamilton who ONLY represents claimants who have been wrongfully denied disability benefits. He is also a contributing author to “Disability Insurance Law in Canada,” a book referred to by Lawyers and Judges Coast to Coast.

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 group benefits, you can apply for monthly disability benefits if you cannot complete your employment duties. 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 “thinks” that you can work or complete the tasks of your 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.

In that case, many firstly think it is some bureaucratic error – but we urge you not to contact your disability insurance company in an emotional state. You must 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.

Quick Short-Term Disability FAQ

What are Short-Term Disability Benefits in Ontario?

In order to understand short-term disability benefits, it is important to understand the different types of disability benefits available to a person who suffers from a chronic illness, disease, disorder, or injury that prevents him or her from working.

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.

How do I File a Short-Term Disability Claim?

Typically, you would talk to your benefits administrator or 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:

• Identification questions
• Your policy and certificate number
• Your cause of disability
• Your cause of accident or accident details
• Your expected return to work date
• Whether the accident was work-related
• Whether you are applying for other benefits from other sources
• Your bank information

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 in 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

• Your last day worked.
• Your return to work date
• Your regular gross earnings
• Your deductions
• Whether or not your disability is due to an occupational injury or illness
• Whether you reported your claim to WSIB
• Your contact information
• Your job description
• The essential duties of your job
• Your work environment – particularly in regards to respiratory irritants, noise, humidity, heat, cold and if there are any hazards
• They will inquire about whether your job is active or physical, and if so, they will ask your employer to mark off physical activities required for your job, such as lifting, bending, reaching, crouching, stooping, kneeling, climbing, standing, pushing, pulling, walking, etc.
• The cognitive demands required of your job
• Driving requirements of your job

How do I Qualify for Short-Term Disability Benefits?

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 or 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., being hospitalized), your 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. Instead, 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.

Short-Term Disability Medical Conditions

Some of the short-term disability conditions that we often see claimants suffering from are:

• Mental health conditions
• PTSD
• Anxiety
• Depression
• Bulimia nervosa
• Mood dysregulation
• Psychosis
• Panic disorder
• Social anxiety disorder
• Schizophrenia
• Schizo-effective disorder
• Bipolar disorder
• Auto-immune disorders
• Brain injuries
• Chronic pain
• Fibromyalgia
• Scoliosis
• Injury-related chronic pain
• Amputations
• Neuropathic pain
• Alzheimer’s 
• Dementia
• Rheumatoid arthritis
• Muscular dystrophy
• Serious back issues

Why is my Insurance Company Asking me to Sign Medical Authorizations?

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 patient’s written authorization, the patient’s substitute decision-maker, or receive a court order. By signing authorizations and providing them to the insurance company, you give 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.

Does my Doctor Need to be Involved in my Disability Case?

Your doctor must provide the insurance company with a clear diagnosis and prognosis. In addition, most policies mandate that you must be in any treatment program or follow appropriate treatment recommendations by your doctor to promote your overall recovery. The insurance company will provide your doctor’s clinical notes and records to help them adjudicate your claim.

How Long will my Short-Term Disability be Paid for?

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.

How Much will my Monthly Short-Term Disability Benefit Be?

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.

Do I Pay Tax on my Short-Term Disability Benefits?

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.

What Happens if I’m Still Disabled at the end of my Short-Term Disability?

If your illness or injury is expected to cause you to remain off work at the end of your maximum benefit period, you must 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. Still, it’s important that you do not wait until the end of the elimination period before filing your disability claim.

What if I am Denied Short-Term Disability?

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 asking a court to declare you disabled as per your policy definition and pay your benefits.

However, most people do not know that they can hire a lawyer after being denied their short-term disability benefits. It is hard enough to deal with the day-to-day limitations due to your medical conditions.  Unsurprisingly, most policyholders do not bother seeing the claim through to the end. The insurance companies know this, so 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 fought for victims’ rights 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.

In What Circumstances Would Ontario Short-Term Disability Benefits Not be Paid?

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:

• Participating in a riot
• Riding in or driving any motor-driven vehicle in a race, stunt show or speed test
• Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft, including those which are not motor-driven. This does not include flying as a fare-paying passenger
• Hang-gliding
• Bungee jumping
• Parachuting
• Sail gliding
• Parasailing
• Para-kiting or any similar activities
• Participating or attempting to participate in an illegal activities and/or being
• If you’re in jail
• If you have tried to commit suicide or injured yourself intentionally, whether you are sane or not
• Addiction to alcohol
• Addiction to drugs, except for drugs taken as prescribed by your physician
• Having a Pre-Existing Condition as described in your policy (if applicable)
• Practicing for or participating in any semi-professional or professional
• If you’re hurt in a competitive athletic contest for which you receive any compensation or remuneration
• Having a psychiatric or psychological condition including but not limited to affective disorders, neuroses, anxiety, stress and adjustment reactions. (At times, however, Alzheimer’s disease and other dementia are covered)
• Suffering from a work-related injury, unless an “On-Job” Total Disability benefit is shown in your policy;
• Giving birth within the first nine months after the effective date of the coverage as the result of a normal pregnancy, including a Cesarean.
• Pregnancy complications will be covered to the same extent as any other covered sickness.

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.

Once my Short-Term Disability Benefits are up, do I Need to Make a Separate Application for Long-Term Disability Benefits?

Yes, you must complete a separate long-term disability application and apply to your insurance company. If you do not, you may 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 must apply and transition to long-term disability benefits.

What are Some Reasons why I Would be Denied Short-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 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.

Have you Been Denied Short-Term Disability? Contact Our Ontario Short-Term Disability Lawyer for a Free and Confidential Consultation

At Lalande Personal Injury Lawyers, we take pride in being trusted Hamilton personal injury lawyers since 2003. Over the years, we’ve helped our clients recover more than $45 Million in settlements and verdicts in personal injury, disability, and employment law cases. Whether you’re dealing with a life-changing injury, a denied disability claim, wrongful death, a hurt child or employment termination, we are here to provide compassionate and experienced legal representation. If you believe you have a case, call us today—we’re ready to help you secure the compensation you deserve.

Call Lalande Personal Injury Lawyers today, no matter where you are in Ontario at 905-333-8888 for your free consultation. Alternatively, you can contact us online, confidentially, by filling out a contact form.