In Part 2 of our series on LTD & COVID-19, we wrote a post about applying for disability benefits during COVID-19 and provided some helpful tips with respect to understanding your disability coverage depending on your type of employment. Today, we are continuing to provide tips and information on how to apply for coverage, as well as other forms of financial assistance that may be available to you. We also look at how changes to your duties and pay due to COVID-19 may affect a benefits claim.
AM I ENTITLED TO APPLY FOR DISABILITY BENEFITS THROUGH MY INDIVIDUAL OR GROUP DISABILITY INSURANCE PLAN?
If you have any of the disability insurance coverages listed above and you become disabled, you should submit your application as soon as possible. The insurance company will then assess your eligibility for benefits under the group or individual disability insurance policy and provide you with a written decision as to whether you have coverage and whether you meet the definition of disability under the policy. See our FAQs page on our website for more information about applying for disability benefits.
If you were working before you became disabled and you can demonstrate to the insurance company that you are “totally disabled” as defined in the policy (meaning you are not able to do the essential duties of your job), then you should be approved for the disability benefits. If your claim is denied for any reason, you should contact MK Disability Lawyers immediately, to discuss your options.
TIP: There are multiple forms that make up your application for disability benefits under group plans.
A complete application will consist of a form completed by you, one completed by your doctor and another completed by your employer. During COVID-19 you may have to email the medical form to your doctor and then schedule a telephone consultation in order for your doctor to be able to answer the questions on your disability claims form.
TIP: Individual policyholders will be required to submit additional financial documentation.
If you are applying for disability benefits under an individual insurance policy, you will need to complete additional forms and documentation to provide evidence of your business’ loss of profit and your loss of earnings. It may be wise to solicit the assistance of your accountant to compile the necessary financial documentation to support your claim.
TIP: You could be entitled to partial benefits if you are only able to work in a limited capacity.
Both group and individual disability policies may have coverage for “Partial Disability” benefits. It is best to check with your employer or insurance company or broker to find out what disability benefits you might be entitled to.
If you have recently been laid off or your employment has been terminated or you quit your job, you may still have coverage under your group disability insurance plan with your employer. This means that you may still be entitled to disability benefits if you can prove to the insurance company that you are “totally disabled”.
Sometimes the group disability insurance coverage will be extended for a period of time after the date that you were fired or laid off from your job. Sometimes you might be able to demonstrate that you became “totally disabled” while you were still an active employee and had the coverage in place. Your eligibility will depend on the terms of your lay off/termination and also on the wording of your insurance policy and the date you became disabled.
Remember, no two cases are identical and you should seek legal assistance as early as the application stage, if you were no longer an employee for the employer under whose policy you are applying for disability benefits.
TIP: Contact a lawyer immediately if your claim is denied.
If your insurance company denies your claim on the basis that your disability insurance was terminated before you became disabled OR because they say you were “not actively at work” when you became disabled, you should contact MK Disability Lawyers immediately to discuss your options.
TIP: If you recently started a new job and become disabled from a pre-existing condition, your claim may be denied.
Finally, if you recently started a new job you may or may not have disability insurance coverage under your new employer’s group benefit plan. Some employers and some insurance policies require employees to work continuously for a set period of time (often three months) before they are eligible for disability insurance coverage.
In addition to qualifying for the coverage, if you are new to the benefit plan and your coverage has not been in place for at least 12 months, you might also be subject to the policy’s “pre-existing condition exclusion”. This means that under some disability policies, if you become disabled during the first 12 months of being covered under the policy and your disability is due to a pre-existing condition, the insurance company can deny your disability claim. Again, no two disability cases are the same. We encourage you to contact MK Disability Lawyers if your disability insurance claim is denied based on a “pre-existing condition” exclusion.
You might want to consider applying for disability benefits under your previous employer’s plan, as well. In some cases, you might be entitled to coverage under your previous employer’s plan. It is best to consult a disability lawyer to discuss your options. Please also see our blog article, “Can My LTD Benefits be Denied Based on a Pre-Existing Condition”.
HOW COULD MY BENEFITS UNDER MY DISABILITY PLAN BE AFFECTED BY THE CHANGES TO MY JOB OR EMPLOYMENT STATUS DUE TO THE COVID-19 PANDEMIC?
At this stage in the COVID-19 pandemic, it remains to be seen how disability insurance companies will interpret and apply their disability insurance policies to claims where COVID-19 has resulted in changes to a person’s job before they became disabled.
In normal circumstances and under most insurance policies, the insurance company will assess your claim based on the duties and income of the job you were doing as of your last day worked before becoming disabled.
In this unprecedented time of COVID-19, many people who would normally be working at jobs that are demanding (physically and/or cognitively) might now be performing less demanding duties and for less pay. The question is whether the insurance company will assess claims based on the duties and income the person normally receives or the duties and income the person was receiving at the time they became disabled; a time of changes due to COVID-19.
On a strict interpretation of most disability insurance policies, insurance companies could find that you are not disabled from the “easier” job you were doing when you went off work. If you are found to be disabled, the insurer could then calculate your benefit amount on a percentage of the reduced income you were receiving right before you went off work. Arguably, assessing claims this way, is not fair to people who became disabled during COVID-19. As more people apply for and are denied benefits in the coming months and years, this is bound to be an issue that will arise in disability benefit disputes.
TIP: Contact a disability lawyer right away if you become disabled while working in a different capacity than normal due to COVID-19.
If you have become disabled from a job that was not your usual job or did not provide you with your usual income and you are considering applying for disability benefits, contact MK Disability Lawyers to assist you with your application. Similarly, if your disability claim has been denied based on your ability to do an “easier” job (not your usual job) or your disability benefit amount is based on an amount less than what you would normally be earning, before COVID-19, contact MK Disability Lawyers to discuss your options.
WHAT OTHER OPTIONS FOR FINANCIAL ASSISTANCE DO I HAVE IF I’M UNABLE TO WORK DURING COVID-19?
TIP: You may be able to take advantage of other programs and coverage to help with debt and other expenses while you are disabled.
You might also have creditor disability insurance. This is different from group or private disability coverage which provides you with an ongoing income. Creditor disability insurance is tied to a debt such as your credit cards, lines of credit or your mortgage. It is something that you have paid premiums for on a monthly or annual basis. Contact your mortgage lender or mortgage broker or your bank/credit card company to find out if you have any coverage that will help with outstanding debt while you are disabled. If your claim is approved, interest payments on your debt will continue or balances will be paid off so long as you can prove you are disabled from work.
You can also check your mortgage and credit card statements to see if an insurance premium has been deducted/charged to you for this type of disability coverage.
Finally, there is social assistance. If you become disabled you may be eligible to receive various provincial and federal benefits. You may want to consider your eligibility for these benefits even if you have group or private disability insurance coverage. (Check government websites and our recent blog article, “Should I apply for CERB while receiving LTD benefits?” for more information and to determine your eligibility.)
These social assistance benefits include:
- Employment Insurance Sickness benefits (15 weeks);
- Canada Pension Plan Disability Benefits (if your disability is severe and prolonged);
- Ontario Works and/or ODSP (depending on your household income);
- Canada Emergency Response Benefit (CERB) (see our recent blog article about CERB, “Should I apply for CERB while receiving LTD benefits?”)
- There are also various tax credits that may be available to you to offset the income provided to you for your disability.
TIP: Depending on which social assistance benefit you receive, you may or may not have to repay the benefit if your STD/LTD claim is later approved.
In some cases, the social assistance benefit may actually reduce your STD/LTD benefit. Either way, a social assistance benefit may help you stay afloat financially while you wait for your group or individual disability benefits to be approved and paid out to you.
SHOULD I ALSO APPLY FOR CERB IF I BECOME DISABLED FROM WORK?
The short answer is, possibly. Please see our recent blog about the effect of CERB on disability benefits for more details and visit the government websites to find out if you are eligible for this benefit.
WHEN SHOULD I CONTACT A DISABILITY INSURANCE LAWYER TO HELP ME?
If you become disabled during COVID-19 and you are considering applying for STD/LTD or if your STD/LTD has been denied or terminated, or if you have any questions regarding COVID-19 and your disability benefits, we encourage you to contact MK Disability Lawyers to discuss your options.
If you would like to discuss your Long-Term Disability claim with a lawyer, MK Disability Lawyers LLP are experienced lawyers dedicated exclusively to the practice of LTD litigation. We have represented disabled clients with a multitude of disabling conditions, working in various professions, against all major life/health insurance companies in Canada. We would be happy to provide you with a free legal consultation.
The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor-client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, contact a lawyer specializing in disability law.
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