If you have become disabled through an accident, injury or any other cause, you may be able to claim benefits under a private or employer-sponsored long-term disability (LTD) insurance policy.
LTD benefits are a form of income replacement that are paid to you based on a percentage of your monthly income. It is a type of coverage provided by a private contract, so the procedures and your rights depend on the wording of your LTD insurance policy.
The LTD policy will define what a “disability” is and will outline the amount and length of time you are entitled to LTD benefits. Most policies terminate at the age of 65, but occasionally some polices will have a defined period where benefits will only be paid out for a maximum number of years.
To be eligible for LTD benefits, medical evidence is required to support that you satisfy that you are disabled as per the policy’s definition of “disability”.
Initially, you are required to show an inability to perform the duties of your own occupation as a result of illness or injury. After the initial two-year period, you will continue to receive disability benefits only if you show an inability to perform the duties of any occupation you are or may become qualified for by education, training and experience as a result of illness or injury.
Throughout this process, the insurance company may decide that you are no longer disabled even though you are not really able to return to work. If you accept its determination and go back to work before you are ready, the insurer is setting you up for failure on the job. This can leave you out of benefits, out of work and too disabled to seek other employment.
Your LTD provider owes you a duty to act in good faith and to reasonably accommodate your disability, including and not limited to accessibility and possible job reassignment if you are no longer physically capable of performing your job. You have a right to basic dignity and privacy, to not be discriminated against due to your disability, and to not undergo unnecessary medical examinations which do not have a reasonable cause.
If you or a loved one has been denied LTD benefits, call 416-780-1413. One of our lawyers would be happy to speak with you to answer your questions and help you determine if you have a case.