Unexpected events can happen quickly, resulting in illness or injury, and can leave you unable to work without time for adequate financial planning. Thankfully, many Albertans have disability insurance available to them through their employers, offering financial support during these challenging times. However, navigating disability claims, especially in the case of denials, can be confusing and stressful, particularly when your time and energy are aimed at managing your treatment and recovery. 

This blog sheds light on short-term disability (STD) and long-term disability (LTD) benefits available to Albertans, exploring the common reasons for denials and your rights in the event that your claim is denied.

What is Disability Insurance?

Disability insurance is available to workers through their employer. It provides them with financial benefits to help them supplement their income when they cannot work due to an injury or illness. Disability benefits only begin once workers have exhausted their sick leave and cater to health-related challenges unrelated to their employment. 

It is important to note that not all employers offer disability insurance to their workers. While workers can receive government assistance (such as Employment Insurance (EI)) when taking time off of work due to injury or illness, their employer is not required to pay their wages or benefits. Individuals may obtain disability insurance either through group disability insurance provided by their employer or through individual disability insurance purchased directly by the person. 

Short-Term Disability Benefits

Short-term disability benefits provide financial aid to an individual unable to work temporarily due to illness or injury. Short-term disability benefits are typically paid to workers covered under the Employment Standards Code after the individual exhausts their sick days (if applicable). Short-term disability benefits may be paid out for a limited period of several weeks or months. Individuals will be paid a certain percentage of their regular wages while receiving short-term disability benefits, although the exact amount will vary depending on the policy. It is also important to review your short-term disability policy to determine whether other factors, such as Canada Pension Plan (CPP) disability benefits or severance packages, may impact your benefits. 

Long-Term Disability Benefits

Long-term disability benefits provide financial assistance to individuals experiencing an injury or illness who cannot work beyond the predetermined qualifying period. Receiving long-term disability benefits allows you to prioritize your health and recovery while reducing your financial stress. Long-term disability benefits may commence once a person has exhausted their other options, including sick days, short-term disability benefits and government assistance. Each long-term disability plan will provide an individual with a certain portion of their regular wages for up to two years if they cannot return to their job before their injury or illness. However, certain criteria must be satisfied to be eligible for long-term disability benefits, so knowing your plan coverage, limits, and exclusions is important.  

Applying for Long-Term Disability Benefits in Alberta

Once you have confirmed that you have long-term disability coverage through your employer or an independent broker, obtaining a diagnosis from your doctor and medical treatment team is important; while a diagnosis can be difficult to obtain depending on the type of injury or disability, it can help enhance the visibility of your claim and increase the chances of approval. Without a confirmed diagnosis, obtaining long-term disability benefits may be more difficult, although not impossible. It is also important to obtain sufficient medical documentation from your healthcare providers outlining the diagnosis, your symptoms, treatment plans and details about how the disability is impacting your daily activities. 

It is important to carefully read and complete the disability benefit application form to ensure that all sections are accurately filled out and that the information provided thoroughly represents the impact of your disability on your ability to work. It is also crucial to ensure that all supporting documentation is submitted with the claim form, as information may be needed to ensure your claim is completed on time. 

Long-Term Disability Claim Denials

Long-term disability coverage allows individuals to continue to pay for essential living expenses while taking time off of work to focus on their health and recovery. When a long-term disability claim is denied or unjustly terminated, it can have devastating consequences.

Long-term disability claims may be denied or terminated for several reasons, with some common denials including:

  • Coverage exclusions under the long-term disability policy (a “pre-existing condition” clause);
  • Failing to meet your plan’s definition of “disability”;
  • Incomplete or inaccurate medical information;
  • Credibility issues uncovered due to insurer surveillance of the insured;
  • A missed limitation period for commencing a claim or appealing a denial under the applicable insurance policy; and
  • Due to “invisible” or “subjective” conditions that cannot be established by a standard test such as blood work or an MRI (ex. chronic fatigue syndrome or mental health conditions). 

Your Rights and Options After a Denial or Termination

Once the insurance company decides on your claim, it is important to review it carefully. If your claim has been approved, it is imperative to understand the benefits you will receive, the terms of such benefits, and how long your benefits will be paid out. 

If your claim has been denied, it is important to take note of the appeal deadline and seek legal advice as soon as possible. A long-term disability lawyer will be able to assist you in understanding the insurance company’s reasoning as to your denial and can help you navigate the appeal process and protect your interests in cases where litigation is required. 

When engaging in litigation against an insurance company after the denial or termination of a long-term disability claim, it is important to work with a skilled long-term disability lawyer who can help you understand your disability policy and identify the types of documentation and supporting evidence that will give your claim the best chance of being properly compensated. This information can range from obtaining medical assessments or additional testing that establishes your inability to work. 

Contact the Calgary Injury and Disability Lawyers at Cuming & Gillespie for Representation in Long-Term Disability Claims

At Cuming & Gillespie, our knowledgeable long-term disability lawyers understand the frustration that comes with the denial or termination of your long-term disability benefits. Our compassionate personal injury team will review the reasons for your termination or denial and will help you determine whether you should pursue a claim against your insurance company. When preparing for litigation, we will investigate your injuries or disability and build the strongest case possible on your behalf. To speak with a member of our team regarding your long-term disability denial, contact us online or call us at 403-571-0555.