Who Pays for Long-Term Disability?

Who pays the monthly premiums for insurance policies covering long-term disability benefits may depend on a number of factors. If employers provide this kind of coverage to their staff, they may also pay the full costs of the monthly premiums. In other cases, staff may split these payments with their employer. And sometimes, individuals may be responsible for paying them entirely on their own.

People who are self-employed may need to buy an individual insurance policy and may be entirely responsible for paying for its premiums. However, these self-employed workers may qualify for a group policy through a labor union, trade group, or another association. In those cases, these individuals may still be responsible for paying their premiums, but the monthly costs might be somewhat reduced.

Understanding Long-Term Disability Benefits

Long-term disability benefits are designed for individuals who, due to a serious medical condition, are no longer able to perform the duties of their jobs. Claimants may be eligible to receive these benefits after exhausting all other compensatory options available to them, including paid sick leave, vacation time, short-time disability benefits, or other coverage.

Long-term disability benefits claimants may not be eligible to begin receiving payments until their insurance policy’s elimination period has passed. The lengths of elimination periods for long-term disability benefits vary between policies.

In Canada, long-term disability plans typically cover between 60-70% of a recipient’s normal income. Eligible recipients may be able to continue collecting benefits payments until their medical condition allows them to return to work until the term of the policy is fulfilled, or in some cases until recipients reach the age of retirement.

To pay for this insurance coverage, individuals or their employers are charged monthly premiums. The cost of these premiums may differ depending on several factors, including the type of policy (i.e. individual or group), the length of the policy’s elimination period, eligibility requirements for continued coverage, and more.

If you are having difficulty deciding between insurance policies, weighing the potential benefits against the policy’s premium costs may help you reach a conclusion. For example, a policy with a shorter elimination period may be more expensive than one with a longer one, but if you find yourself in a situation where you are unable to earn an income, you may exhaust all other compensatory benefits well before your lengthy elimination period is complete. That may result in a significant hardship if your medical condition prohibits you from earning your regular salary.

Filing a Claim and Applying for Other Benefits

If you sustained a serious injury or have received a medical diagnosis that prevents you from performing the duties of your occupation, you may be able to file a claim for long-term disability benefits as soon as you realize that your time away from work may extend beyond the policy’s elimination period. Many long-term disability policies may provide coverage for one to two years before eligibility requirements may be re-assessed.

You may also qualify for Canada Pension Plan (CPP) disability benefits. If eligible, you may be able to receive disability benefits payments from the CPP, regardless of the status of your claim for long-term disability benefits. However, your insurance provider may decrease the amount of benefits allocated to you based on the cost of the CPP benefits you receive.

Fighting a Long-Term Disability Benefits Claim Denial

Even if you or your employer paid premiums to your insurance provider and believe you are eligible to receive long-term disability benefits, there is no guarantee your insurer will approve your claim.

If your claim for long-term disability benefits has been denied, a lawyer may be able to help you litigate the insurance company’s decision. The advice of a long-term disability claims lawyer may help you determine which course of legal action may be best for you. Your lawyer may suggest filing an internal appeal with your insurance company, which may be effective in some cases. In other situations, a long-term disability claims lawyer may advise you to file an external appeal aka to litigate or challenge the decision in court.

According to Ontario’s Limitations Act of 2002, S.O. 2002, Chapter 24, unfairly denied benefits claimants have only a two-year window of time to file a lawsuit against their insurance company. Filing an internal appeal may have no impact on this deadline. Therefore, if you require the assistance of a long-term disability claims lawyer, you may only have a short time from the date you receive notice of your denied claim to pursue an external appeal.

Discuss Your Denied Claim with Preszler Injury Lawyers

If your claim for long-term disability benefits was denied, even though your medical condition prevents you from returning to work, Preszler Injury Lawyers may be able to provide you with useful assistance and advice. Contact Preszler Injury Lawyers today for a free, initial consultation by calling 1-800-JUSTICE.