A Comprehensive Guide

Navigating the complexities of Long Term Disability benefits can be challenging, especially when you’re on maternity leave in Ontario. If you find yourself in a situation where you need to apply for Long Term Disability benefits while caring for your newborn, it’s crucial to understand the process, your rights, and potential challenges you may face.

Understanding Long Term Disability Benefits and Maternity Leave in Ontario

Long Term Disability benefits provide financial support to individuals unable to work due to a medical condition or disability. These benefits typically begin after short-term disability coverage ends and can last for several years or until retirement age, depending on the policy.

In Ontario, maternity leave is a protected period for new mothers under the Employment Standards Act (ESA). However, it’s important to note that pregnancy itself is not typically considered a disability. Complications from pregnancy, childbirth, or unrelated medical conditions during this time may qualify for disability benefits.

Eligibility Criteria for Disability Benefits During Maternity Leave

To be eligible for Long Term Disability benefits while on maternity leave in Ontario, you must meet several criteria:

1. Nature of the Disability: Your condition must extend beyond normal pregnancy or postpartum recovery. Complications from pregnancy, childbirth, or unrelated medical conditions that prevent you from returning to work may qualify.
2. Policy Terms: Your employer’s Long Term Disability insurance policy determines eligibility. Review your benefit booklet and insurance policy carefully for any exclusions related to pregnancy and childbirth. A disability insurance lawyer can also help you understand your rights.
3. Medical Evidence: You must provide clear, detailed medical documentation that distinguishes your condition from normal pregnancy and postpartum recovery. Your healthcare provider should explicitly state how your condition prevents you from performing your job duties.
4. Timing: While you can typically apply for Long Term Disability benefits at any time, including during maternity leave, benefits usually begin after a waiting period. This period may coincide with or extend beyond your maternity leave. You might be entitled to Short Term Disability benefits during the waiting period and your Long Term Disability benefits might not become payable until the date you are scheduled to return to work. This will depend on what you benefit plan and policy say.
5. Premiums and Employment Status: You must be employed and covered by a Long Term Disability insurance policy at the time your disability begins. It is important to remember that you might need to pay your insurance premiums during your maternity leave to ensure your disability insurance coverage continues while you are on maternity leave.

5 Steps in the Application Process

1. Review Your Policy and Benefit Booklet

Before applying, carefully review your employer’s disability insurance policy and benefit booklet, paying close attention to:

• The definition of disability, which is usually whether you are able to perform the duties of your own occupation.
• Waiting periods, as there may be waiting periods for both Short and Long Term Disability benefits during which no benefits are paid.
• Coverage which will tell you whether you are required to pay your premiums while on leave.
• Exclusions related to pregnancy and childbirth.
• Deadlines for submitting Short and Long Term Disability claims and where to find the forms.

2. Consult Your Healthcare Provider

Discuss your situation with your healthcare provider. Be sure they understand how your medical conditions impact your functioning and why you would not be able to perform the duties of your job, if you were not otherwise on maternity leave.

They will need to provide medical documentation supporting your disability claim, including:

• Detailed medical records
• Test results
• A physician’s statement explaining how your condition prevents you from performing your job duties

3. Notify Your Employer

Inform your employer of your intention to apply for Short and Long Term Disability benefits. They may need to provide additional documentation or forms to support your claim. Under some benefit plans, you are required to apply for and be approved for Short Term Disability benefits before you can apply for Long Term Disability benefits. 

4. Submit Your Application

Complete the disability benefits claim form provided by your insurance company. Be thorough and accurate in your responses, including all relevant medical documentation. It is important that you submit your disability claims forms as soon as possible to ensure you do not miss any deadlines.

5. Follow Up

Stay in contact with your insurance provider and respond promptly to any requests for additional information or clarification. While it is overwhelming to be a new mother while also struggling with a serious medical condition, it is important to ensure that there is no delay in your benefits being approved and paid to you. It is equally important that you continue with your treatment to ensure that you are working toward your recovery and to have an ongoing record of your medical condition.

The Role of Your Employer in the Application Process

Your employer plays a significant role in the disability benefit application process during maternity leave in Ontario:

1. Documentation: They must provide essential documentation to support your Long Term Disability claim, including an employer’s statement which includes information about your job, income, and work duties.
2. Policy Information: Your employer should provide details about your disability benefits including your Long Term Disability insurance policy, or at the very least, your benefit booklet. You can also request the policy from the insurance company who is required by law to provide you with a copy upon your request.
3. Communication: They serve as a crucial link between you and the insurance company, confirming your employment status, salary information, and the nature of your leave. You also want to ensure that your employer does not expect you to return after your maternity leave if you are still too unwell to work.
4. Transition Management: Your employer will be involved in managing the transition from maternity leave to disability leave and ultimately returning to work, which can be a lengthy and complex process.
5. Return-to-Work Planning: If your condition improves, your employer will be involved in discussing and implementing any necessary accommodations or gradual return-to-work plans. They may work with your insurance company to return you to work when you are ready.

Legal Obligations for Ontario Employers

Employers in Ontario have specific legal obligations regarding disability benefits during maternity leave:

1. Non-Discrimination: The Ontario Human Rights Code protects employees from discrimination based on disability, including those that arise during pregnancy or maternity leave. It also protects rights on grounds of sex/pregnancy and family status.
2. Accommodation: Employers have a duty to accommodate employees with disabilities to the point of undue hardship under the Ontario Human Rights Code.
3. Employment Standards Act (ESA) Compliance: Employers must comply with the ESA, which provides protections for employees on pregnancy and parental leave, including maintaining benefits coverage during the leave period.
4. Workplace Safety and Insurance Act (WSIA): If the disability is work-related, employers must comply with the WSIA, which may provide benefits to eligible employees.
5. Policy Administration: Employers must administer their disability benefit policies consistently and fairly.
6. Privacy Protection: Under Ontario’s Personal Health Information Protection Act, employers must maintain the confidentiality of an employee’s medical information related to their disability claim.

If you believe your employer has not fulfilled their legal duties and obligations to you in terms of maintaining your disability coverage while on maternity leave or supported you in your disability claim while on leave, it is critical you contact a disability insurance lawyer right away. 

Addressing Potential Challenges

Applying for Long Term Disability benefits while on maternity leave can present unique challenges:

Proving Disability Beyond Normal Pregnancy

Insurance companies may be skeptical of disability claims coinciding with maternity leave. To address this:

• Provide clear, detailed medical evidence distinguishing your condition from normal pregnancy and postpartum recovery.
• Have your healthcare provider explicitly state how your condition prevents you from performing your job duties.

Policy Exclusions

Some disability policies have exclusions related to pregnancy and childbirth. To navigate this:

• Carefully review your policy for any such exclusions.
• If your disability is unrelated to pregnancy or childbirth, ensure this is clearly communicated in your application and supporting documentation.

Transitioning from Maternity Leave to Disability Leave

The transition from maternity leave to disability leave can be complex. To manage this:

• Communicate clearly with your employer about your situation. Keep in mind that you do not need to share the specifics about your disability with your employer.
• Understand how your company’s policies regarding maternity leave and disability leave interact. A disability insurance lawyer can help you with this.
• Be prepared to provide additional documentation to support the need for extended leave beyond the typical maternity period.

Maintaining Your Rights Under Employment Law

Understand how applying for disability benefits might affect your rights under laws such as the ESA or Ontario Human Rights Code. Consider:

• Consulting with an employment lawyer or disability lawyer to understand your rights.
• Keeping detailed records of all communications with your employer and insurance company.
• Be sure to respond to your employer when they reach out to you to ensure that they do not assume you’ve abandoned your job.
• Do not quit your job. Doing so will result in a loss of benefits and service time.

Tips for a Successful Disability Application

1. Be honest and thorough in your application.
2. Keep detailed records of all medical appointments, treatments, and communications.
3. Understand your policy’s terms, conditions, and requirements.
4. Maintain open communication with your healthcare provider, employer, and insurance company.
5. Consider seeking help from a disability lawyer if you encounter difficulties or your claim is denied. See our Guide to Applying for Disability Benefits and Tips for Applying for Long Term Disability on our website.

The Importance of Self-Care

Dealing with a disability while caring for a newborn can be incredibly challenging. Remember to prioritize your health and well-being:

• Seek support from family, friends, and support groups.
• Don’t hesitate to ask for help with childcare and household tasks.
• Consider counseling or therapy to help manage the stress and psychological aspects of your situation. You have a lot on your plate. Be kind to yourself.

Returning to Work

If your condition improves and you’re able to return to work:

• Discuss your return-to-work plan with your healthcare provider and employer.
• Consider a gradual return or accommodations that may help you perform your job duties.
• Understand how returning to work will affect your disability benefits.
• If your employer is not prepared to accommodate you or if your insurance company is forcing you to return to work before you are ready, contact a disability lawyer, right away.

Frequently Asked Questions

Can I apply for disability benefits while on maternity leave in Ontario?

Yes, you can apply for Long Term Disability benefits while on maternity leave in Ontario if you meet the eligibility criteria and your condition extends beyond normal pregnancy or postpartum recovery.

How long can I receive disability benefits while on maternity leave?

The duration of disability benefits depends on your specific policy and the nature of your disability. Some policies provide benefits until you can return to work, while others have a maximum benefit period.

Will applying for disability benefits affect my maternity leave benefits?

Applying for disability benefits should not affect your maternity leave benefits under the ESA. Your maternity leave benefits may reduce your disability benefits. However, it’s important to understand how these benefits interact and consult with a legal professional if you have concerns.

What if my claim is denied?

If your claim is denied, you have the right to appeal the decision or hire a disability lawyer immediately to dispute the decision on your behalf. Consider seeking legal advice from a disability lawyer who can help you navigate the appeals process or sue the insurance company for you.

Conclusion

Applying for Long Term Disability benefits while on maternity leave in Ontario can be complex and stressful. However, with careful preparation, clear communication, and a thorough understanding of your rights and policy, you can navigate this challenging situation successfully.

Remember, your health and well-being are paramount. By taking the time to properly address your medical needs and secure the benefits you’re entitled to, you’re not only taking care of yourself but also ensuring you can provide the best possible care for your new child.

Contact Mulqueen Disability Law in Markham for Trusted Guidance on Appealing a Long-Term Disability Claim Denial

If you’re facing a Long Term Disability claim denial and are concerned about its impact on your pension, reach out for professional assistance. Our team at Mulqueen Disability Law is here to help you navigate this challenging situation and fight for your rights.  With nearly 25 years experience dedicated to disability insurance litigation Courtney Mulqueen and her specialized legal team are focused on providing highly skilled, trauma-Informed legal representation to clients whose Long Term Disability claims have been denied or terminated.

Mulqueen Disability Law specializes in hard-to-prove long-term disability claims for “Invisible Conditions” such as mental illness (depression, anxiety, PTSD) and chronic conditions (pain, neurological, immunological, concussion, post-COVID)  Contact us for a free confidential 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.