After a disabling injury or a serious illness, many clients find it hard to fulfill their job responsibilities. In that situation disability benefits provide income replacement and peace of mind while you pursue your recovery.
Many Ontario employers offer group disability insurance plans. But very few employees actually read through their disability policy or understand the nuances of what those policies provide. The only time most employees think about their disability policies is when they have in fact become disabled.
When will you use short term disability?
If you are hurt or sick, you will usually start by using up your sick days. Maybe your employer provides only the sick days under the Employment Standards Act. Maybe your employer provides a certain amount of paid sick leave above that Act. In either situation, once those paid sick days are gone you will look to see what your options are if you can’t return to work. If your company offers short term disability, or if you have purchased a disability policy yourself, you will look to your short-term disability benefits to cover your income.
Different policies provide for a different duration for short term disability and a different percentage of the person salary. It is not uncommon to see a percentage ranging from 65% of a salary to 75%. Occasionally you will see a policy with a percentage that is higher or lower.
Some employers do not offer short term disability insurance. Instead, employees will rely on Canada’s Employment Insurance for 15 weeks of EI medical benefits.
What if I am denied STD?
If you are denied short term disability under a group policy or an individual policy, you should consider contacting a lawyer. If your medical situation continues beyond the time when you can self-fund, and you do not get legal advice, you may find yourself in difficult a situation where you have no recourse.
Long Term Disability
After a certain period that will be specified in the disability policy (contract), if you still cannot work you will apply for long-term disability. Again, long-term disability benefits typically provide a percentage of your earnings.
Often, there will be an initial entitlement for up to 24 months when you were unable to do the specific job that you had at the time you were injured or became ill. In your policy this might be referred to as “own occupation” coverage. This is where the insurance covers you for your own job. Many policies change the test for disability after 24 months on long-term disability benefits. The definition will change from your own occupation to “any occupation”.
After the 24 months, the employee will have to prove that they cannot do any occupation for which they are otherwise suited. Every policy is unique and looking at the exact definition of disability in your specific policy will be important.
How can a lawyer help?
Once an insurance company decides to deny short term or long term benefits, it will be difficult to change their minds without a lawyer’s help. Insurance policies are complex. Plus, you are injured or suffering from an illness and your energy will be better spent focused on recovery.
A personal injury lawyer who has a focus on long-term disability or short-term disability can ease your burden significantly. We can help you understand your policy and your rights under that policy. If you have been denied benefits, we can help you make a strong claim and increase your chances of getting approved.