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LONG TERM DISABILITY & CPP

What’s the Difference?

 

Is your LTD Insurance Company forcing you to apply for CPP Disability? Read more about the Difference between CPP and LTD.

What’s the difference between CPP disability and Long-Term Disability?

Surprisingly, our Disability Law firm gets a significant amount of inquiries from claimants that are confused between long-term disability and CPP disability. Below is some information about both both benefits.

What is CPP Disability?

CPP disability (or otherwise called CPPD) is a disability benefit that is provided by the federal government to provide partial replacement for your lost income because of your inability to work. Eligible claimants must prove to the federal government that he or she suffers a severe and prolonged mental or physical disability. Severe is defined by law as someone who is incapable regularly of pursuing any substantial gainful occupation. Prolonged, means that the claimant will suffer a disability that is likely to continue for an indefinite duration or until that claimant dies. In order to qualify for CPP disability, you must’ve made contributions to the Canadian pension plan in four of the last six years, with minimal levels of earnings in each of these years, or three of the last six years for those with 25 or more years of contribution.

If you suffer from a chronic illness or an injury that prevents you from working, you should no doubt apply to the Federal Government for CPP disability. A decision from service Canada will take about 3 to 4 months, so it’s important that you apply sooner rather than later. Typically, service Canada will provide you with a lump-sum payment that will compensate you from the data your disability, to the date the payment is made. At that point, you would then receive a monthly benefit on the first of every month to assist you with your expenses. The maximum disability benefit for 2019 is $1362.30.

A CPP disability toolkit can be found by clicking here. In there you will find a complete guide that will answer most of your questions including how the benefit is calculated.

What is Long-Term Disability?

Long-term disability, is not a government-sponsored plan. Long-term disability is available through individual policy purchase or a group plan issued through an employer or association. Typically employer provided disability plans offer more limited protection, but at a lower cost to the employer or the insured. Medical evidence is not required at the time of application by the employee. If an employer purchases long-term disability through its group plan, each employee is covered, no matter what their medical history. Most policies issued through employers contain a pre-existing condition provision, which means that long-term disability benefits would not be payable for any disability which begins within the employee’s first 12 months of coverage if that disability is due directly, or indirectly to a pre-existing condition. A pre-existing condition is normally defined as a condition for which you were treated or attended to by a doctor, or were prescribed drugs that were taken during a certain amount of time prior to your effective date of coverage.

Long-term disability benefits will have an elimination period, which is also called the waiting or qualification under some policies. Common elimination periods are 60, 90, 120 or 180 days. The most common elimination period is 90 days. After the elimination period, you would then apply for long-term disability if your disability prevents you from returning to work. We recommended that you apply for long-term disability prior to the end of the elimination period in order to give yourself enough time to gather all of your medical records, give your doctor enough time to fill out the attending physician statement and give the insurance company enough time to review your claim and then ask or obtain any additional information required to complete their assessment.

Long-term disability policies have a definition of total disability. Total disability is defined in virtually all of group or individual contracts. Long-term disability for the first 24 months, is payable if you, as the insured claimant, is totally disabled from completing the substantial duties of your own regular job. After 24 months, the definition of total disability changes. This is typically called the change of definition. This is a more restrictive definition of disability from the insured’s perspective. The definition changes from being unable to complete the substantial duties of your own job, to being totally disabled from completing any job in which you are reasonably suited by education training or experience. In short, you must be totally disabled from working any job which you are trained for or educated enough to complete.

Conditions That Might Lead to Long-Term Disability

Many conditions might qualify you to collect long-term disability benefits. Below are brief overviews of common conditions that might lead you to file a claim and entitle you to long-term disability.

#1. Cancer

Cancer is a condition in which uncontrolled cellular growth of the cancer cells leads to the destruction of otherwise healthy cells, and it can develop for a wide variety of reasons. Cancer can happen due to exposure to caustic substances like asbestos at work, using products with dangerous carcinogens, or simply due to genetics. Cancer can have disabling symptoms, and many treatments are debilitating and prevent people from working. After a cancer diagnosis and treatment, you might qualify for long-term disability if your condition keeps you out of work.

#2. Depression

Depression can develop as a result of genetics, improper brain functioning, a traumatic experience, a traumatic injury or illness, or even general stress. When you have depression, you do not have the sense of motivation and worth that you had before the condition, which can affect your personal relationships and also professional success. Some people have such severe depression that it prevents them from leaving the house or even getting out of bed for long periods. In these situations, depression might qualify for disability benefits.

#3. Chronic Pain

Chronic pain can take over your life and prevent you from focusing on anything else, whether that focus is on your personal responsibilities or your work. You may be unable to be productive at the workplace or even move around to get ready for work due to ongoing chronic pain.

Managing chronic pain can require the use of prescription drugs that you cannot operate motor vehicles while using, which can also change your way of life. Addiction as a result of doctor-prescribed painkillers is also increasingly common in the modern environment and often stems from chronic pain. Chronic pain can entitle you to long-term disability benefits if you cannot perform job functions.

#4. Bipolar Disorder

People diagnosed with bipolar disorder may have uncontrolled mood swings that impact both their personal and professional lives. Managing bipolar disorder often requires substantial medications and psychological therapy, and even such treatments cannot always control someone’s mood disorder. Some effects of bipolar disorder can impact your ability to work or even operate motor vehicles, and you might need disability benefits for financial support.

#5. Mental Illness

Mental illness is a broad categorization for a variety of conditions that affect the brain, including depression, anxiety, bipolar disorder, schizophrenia, and others. Mental illness can place a strain on your personal life and professional future, and some people cannot work at all due to the effects of their mental illness. If you are undergoing treatment and still cannot continuously perform a job, learn more about the possibility of a disability claim.

#6. Heart Disease

Heart disease encompasses a variety of conditions that affect the heart. Heart disease can develop due to genetic predisposition, poor diet, inactivity, smoking, or stress. Some people lead healthy lifestyles and still must face the effects of heart disease. If an individual is suffering from heart disease, they may be unable to experience stress without excess risk, and they might be able to exert themselves. These shifts in behavior can impact your earning ability and entitle you to long-term disability.

#7. Serious Injury

Serious injuries can lead to long-term disability due to lasting impairments and effects of the injury. Some people need years to recover from a severe injury, while others never fully recover at all. The nature and extent of the injury and its impact on your ability to work will determine your eligibility for long-term disability benefits.

#8. Brain Injury

Brain injury results from a collision to the head or body that makes the brain move around within the skull or from a penetrating injury that impacts the brain.

Brain injuries can have many effects that make it difficult to return to work, including:

  • Difficulty with written and verbal communication
  • Memory lapses
  • Trouble with processing information or following instructions
  • Delayed cognitive processing, which can significantly extend the time needed for certain tasks
  • Physical impairments, which can interfere with jobs requiring physical labor

All of these effects can keep someone out of the workforce, which means they will need to apply for long-term disability benefits.

#9. Serious Arthritis

Arthritis can change the way you live your life and what you can do for work. Having extensive joint pain and restricted movement can make working in certain environments unsafe or impossible. When you can’t return to work or cannot make as much money as before your condition, you might qualify for long-term disability benefits.

#10. Rheumatoid Arthritis

Rheumatoid arthritis is a particularly painful condition and can require an extensive treatment regimen to keep the symptoms under control. Unlike other types of arthritis, RA is an autoimmune disorder that attacks the joints – instead of the joints wearing down from age or overuse with other types of arthritis. Rheumatoid arthritis can begin at an early age, and it can be debilitating and make it so that you cannot return to work. With both the movement limitations and chronic pain that come with RA, the need for disability benefits for financial support is common.

#11. Autoimmune Disorders

Autoimmune disorders impact a variety of systems in the body, as your immune systems can attack healthy cells and cause many health problems. Often, these health issues are disabling, even with the available treatment.

Some common autoimmune conditions that might lead to a disability claim include:

  • Multiple sclerosis
  • Lupus
  • Ulcerative colitis, Crohn’s disease, and inflammatory bowel disease (IBD)
  • Guillain-Barre syndrome
  • Chronic inflammatory demyelinating polyneuropathy
  • Rheumatoid arthritis
  • Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS)

If you have an autoimmune disorder that keeps you from performing your work, you should learn about the possibility of disability benefits.

#12. Blood Disorders

Hematological (blood) disorders can cause a wide range of health issues and also put individuals at risk of life-threatening bleeding events. This can limit your ability to work and generate income as you had been before your injury and might entitle you to long-term damages in addition to your disability benefits.

Is my Long-Term Disability reduced by my CPP benefit?

Yes. In virtually all long-term disability plans, monthly long-term disability benefit payment will be reduced by the amount of CPP that the claimants obtains. Therefore if you obtain $3600.00 a month in long-term disability benefits, and your provided with the maximum amount of CPP disability available, or $1362.30, then your long-term disability carrier would provide you a direct deposit or cheque at the start of the month for $2237.70.

In addition, if you have been receiving long-term disability benefits for quite some time, then your retroactive payment from CPP needs to be payable to your long-term disability carrier. It’s important that you do not spend this money and provide it to your long-term disability benefits insurance company.

Reasons For Long-Term Disability Denials

Even if you have a condition that prevents you from working and you know you should qualify for benefits, you might still learn that your claim ended in a denial. This can be distressing, but you should not give up, as you have the right to appeal the denial. Many people find themselves in this same position and, if you have not already, now is the time to call a private or CPP long-term disability lawyer.

A claim denial requires that you proceed through the prospectively complex appeals process. Insurance companies operate to maximize their profits, and they might turn down legitimate claims, not expecting most people to appeal the decision.

Most unrepresented claimants tend to give up on the process—after all, they already have the stress of their disability and lost income, so they do not want to add a seemingly futile appeal process to the list. The good news is that an appeal does not have to be futile OR stressful, with the right lawyer handling the process for you.

The first step a lawyer will take is to determine why your claim resulted in a denial. This determines how your lawyer will strategize your appeal. Some appeals involve simply correcting an error on the initial claim, while others might require additional evidence gathering and legal maneuvering. The following are some common causes of denial that your lawyer might assess.

#1. Insufficient evidence

One of the most common reasons for denials of disability claims is insufficient evidence of a disability presented with the initial claim. Insurers expect a certain level of depth and volume of evidence before accepting a claim and paying benefits, and anything missing may result in a denial.

The evidence that you submit with your initial claim should be as comprehensive as possible, although this can be difficult to do when you are recovering from an injury and trying to get on with your life. Having a disability lawyer by your side from the start of the claim process will help to ensure that you have a successful claim from the start. However, if you do receive a denial, you should immediately contact a lawyer to help you provide sufficient evidence of your disability.

Evidence might include additional medical records, independent medical exams, analysis by an occupational expert, and more.

#2. The insurer claims you can still work

In some instances, your insurer may be unwilling to pay out on lost earnings ability by claiming that you are still capable of working. Insurance companies claiming that you can still work base their assertions on evidence that they have available to them – evidence you submitted as part of your claim. This denial might also be due to the results of an insurance investigation that seems to indicate that your condition is not as disabling as you claim.

Investigators can use many tactics to challenge your claims of having a disability – including looking at your social media accounts or even surveilling you when out in public. If you seem to be engaging in certain activities with your condition, the insurance company might state you should also be able to work.

Having the counsel of a disability lawyer can help in many ways. First, your lawyer can advise you to stay off social media or even suspend your accounts while your claim is pending. They can also challenge the findings of the insurance investigator and work to prove that you, in fact, cannot work due to your condition.

#3. Errors on the application

When you are dealing with a disabling condition, there is a lot on your mind. Not only are you experiencing pain, limitations, or other debilitating effects of your illness or injury, but you also have concerns about your financial stability. You likely want to get benefits as soon as possible, so you might fill out your claim information hastily and without seeking the right legal help.

Errors in your initial claim information can often lead to automatic denials. Sometimes, an insurance company or CPP claim reviewer will not even allow you to rectify the error before they deny the claim. While such a denial can be jarring, it might be relatively simple to address with the right lawyer on your side.

No matter why your claim received a denial, you need a CPP or disability insurance lawyer handling your request for reconsideration or claim appeal. Without this assistance, you might further delay the process and risk losing your right to benefits altogether.

Appealing Your Long-Term Disability Denial

Whether your long-term disability claim was for CPP benefits or through a private disability insurance policy, you must file all appeals within strict deadlines and according to complex procedures. A disability lawyer will know how to comply with all requirements, so you have the best chance at a successful appeal.

First, your lawyer might need to request a reconsideration by the party that denied the claim. Someone else besides the initial reviewer will assess your claim, along with any new evidence or information your lawyer presents to support your disability status. Your lawyer can work with the reviewer to make sure they have all the information they need to evaluate your disability eligibility.

If the reconsideration is successful with your legal support, you can begin receiving the benefits you need. If not, your lawyer can escalate the appeal process. This process will vary depending on whether you filed a CPP claim or a disability insurance claim with a private insurer.

In either situation, the most important factor is that your claim is ultimately granted. Whether you are seeking long-term disability insurance benefits or CPP benefits, the help of the right disability lawyer is invaluable. Improve your chances of receiving benefits sooner by reaching out for legal assistance today.

We handle claims at all stages of disability benefits. We understand that when an insurance company denies your disability payment, you and your family can suffer major financial losses. When you hire our disability firm, you and your family will receive personal attention and focus on your case. Your case is personally handled by a lawyer, and not a paralegal. We provide constant communication, answer all of your questions, phone calls and ensure that you and your family is taken care of.

If you have been denied long-term disability please fill in a contact form or call our disability lawyers no matter where you are in Ontario at 1-844-LALANDE (525-2633) or local in the Hamilton/Burlington/Niagara Areas at 905-333-8888. We are long-term disability lawyers serving on claimants all over Ontario.  We represent people with all kinds of disabilities – both from a chronic illness or serious injuries that prevent them working.


LALANDE PERSONAL INJURY LAWYERS  – HAMILTON OFFICE
1 King Street East, Suite 1705
Hamilton, On L8P 1A4
Local: 905-333-8888
Toll Free: 1-844-LALANDE

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