What Is Considered Long-Term Disability?

Long-term disability is a type of insurance that may pay you a portion of your normal working wages if you become injured or have a condition that prevents you from working.

Many types of physical or mental conditions could qualify you for what are considered long-term disability benefits. These may include, but are not limited to:

• Cancer
• HIV/AIDS
• Crohn’s disease
• Parkinson’s disease
• Depression
• Bipolar disorder
• Knee injuries
• Back injuries

Your insurance policy will likely contain specific information about what is considered a long-term disability according to your plan. In general, if a condition prevents you from working, it may qualify for long-term disability benefits.

Sometimes, a long-term disability insurance carrier unfairly denies someone’s benefits. If this happens to you, you may be able to file an internal appeal with more information to request that the company reverses its earlier decision.

You also may be able to file a lawsuit against the insurance company, which could allow a judge to review your case. If a judge decides that your benefits were unfairly denied, they could force the insurance company to pay you benefits.

Applying for Long-Term Disability Benefits

Your long-term disability benefits coverage will have specific instructions on applying for benefits if you have a condition that is preventing you from working. This may require documentation from your doctor about your diagnosis, the severity of your condition, and its impact on your life.

In some cases, pre-existing conditions may not be eligible for long-term disability benefits. Some plans have an exclusionary period in place that allows clients to receive long-term disability benefits for a preexisting condition after a certain amount of time passes from the date they purchased their policy. The details of your policy will contain information on how your coverage handles preexisting conditions.

Some long-term disability plans may also require you to apply for Canada Pension Plan (CPP) benefits when you apply for what are considered long-term disability benefits.

Your application for long-term disability benefits may be rejected. If this happens to you, you may be able to submit additional information to the company for reconsideration. You may also be able to file an external appeal, or lawsuit, against the insurance company to recover benefits if the insurance company maintains their denial following an internal appeal.

How Long-Term Disability Benefits Work

Long-term disability benefits are intended to replace the income you could earn if you could go to work. However, these policies may not completely match your full, standard income. Many long-term disability policies may provide you with around 60% to 70% of your normal income.

You should be aware that the benefits from a long-term disability insurance policy and governmental programs, such as the CPP-D, may not stack. For example, if you normally receive $1,000 in a month in long-term disability benefits and begin to receive $300 a month in CPP benefits, your long-term disability payment may be reduced to $700 to keep you at the same total benefits amount.

If you receive extra payments from the CPP, you may be asked to repay the funds to your long-term disability insurance company.

The qualifications for your long-term disability benefits may change over time. Many long-term disability benefits plans start by qualifying individuals who cannot work their own job, but after a set period of time, that standard may be changed to any job. Accordingly, if your condition or injury persists, but you can work a different job other than the one you had when you filed your original claim, your long-term disability benefits may end.

A Lawyer May Be Able to Help You Secure Benefits

If you are wondering what is considered a long term disability, Preszler Injury Lawyers invites you to call our firm. We assist people in Ontario with long-term disability applications and appeals.

If your long-term disability benefits were denied, a lawyer from Preszler Injury Lawyers may be able to help you. We will review your policy’s details and formulate a plan to dispute the denial of your benefits. We may be able to advise you on whether to file an internal appeal with your insurance company or to head directly to a lawsuit.

For a free, initial consultation with a team member, call Preszler Injury Lawyers at 1-800-JUSTICE.

We may be able to represent your case on a contingency fee basis where you owe us nothing upfront for our services and only pay us if we are successful.