The distinction between short-term and long-term disability benefits can often seem like an overwhelming labyrinth. However, understanding the nuances of these different benefits is crucial, especially when unexpected health challenges arise. Decisions regarding approvals and denials can be influenced by various factors, such as the duration of the disability, the severity of the condition, and the specific provisions outlined in both employer-sponsored plans and government programs.

This blog post provides a high-level overview of the key differences between short-term and long-term disability benefits to provide information on accessing financial support during challenging times.

Understanding the Differences Between Disability Claim Types

Regardless of where you file a disability claim, it is essential to know which type of disability benefits you are seeking, whether short-term or long-term disability. It is important to note that short-term and long-term disability policies do not overlap. Each type of disability benefit has specific eligibility requirements, application processes, compensation amounts, and distinct features that characterize them. For example, if you broke your leg and could not return to work for four months, you could apply for short-term disability benefits. However, if your leg required amputation and you were unable to return to work for one year, you would likely apply for both short-term and long-term disability benefits.

In Canada, aside from short-term and long-term disability benefits, you may also claim Employment Insurance (EI) through the government, which is payable for up to 15 weeks. You may also make a claim through the Canada Pension Plan (CPP) for long-term disability assistance. However, the amount of compensation paid through short-term or long-term disability benefits may be reduced if you also receive Employment Insurance and/or Canada Pension Plan benefits.

Regardless of the type of disability benefit sought, supporting your claim with medical evidence confirming the disabling condition is imperative. However, the burden of proof on the applicant for long-term disability benefits is often higher. As such, assistance from an experienced disability benefits lawyer can help you navigate the claims and appeal processes while mitigating the chance of claim denial.

What Are Short-Term Disability Benefits?

Short-term disability benefits (STD) serve as a financial safety net during the initial phase of your incapacitation, providing crucial support for those experiencing temporary health setbacks. Short-term disability benefits often directly relate to your workplace policies, sick leave entitlements, and initial income replacement.

Short-term disability benefits (STD) are typically available in situations where an injury, condition, or other form of disability will interfere with your ability to work or earn an income for a period of up to six months. Some common examples of scenarios where short-term disability benefits are available can include:

  • A temporary accident-related injury;
  • Short-term illness or disease;
  • Post-surgery recovery;
  • Back or neck issues; or
  • Pregnancy complications.

Applying for Short-Term Disability Benefits

An employer may provide short-term disability benefits to their employees before the disabled employee can receive long-term disability benefits. Short-term disability benefits are typically capped at a specific percentage of your pre-accident or illness weekly salary.

Short-term disability benefits are available almost immediately after an illness or injury. However, your employer might first require you to exhaust any remaining sick days before claiming disability benefits.

Short-Term Disability Benefit Denials and Litigation

If your employer refuses to pay your short-term disability benefits under their benefits plan, or the plan administrator denies or terminates short-term disability benefits, a claim may be commenced against the employer, as the payor, seeking payment of such benefits or salary continuance.

What Are Long-Term Disability Benefits?

Long-term disability benefits (LTD) come into play when your health challenges extend beyond the short-term horizon, impacting your ability to earn an income beyond six months. As a result, LTD claims present a different set of considerations, eligibility criteria, and financial support structures. Depending on the policy, long-term disability benefits will be paid based on a percentage of your pre-disability income. Long-term disability benefits may be available in a variety of cases, including, but not limited to:

Applying for Long-Term Disability Benefits

Long-term disability benefits often require a substantial waiting period of one to three months after the onset of disability before you may qualify to claim benefits. They may also only become payable after short-term disability benefits have been exhausted. Once approved, long-term disability benefit policies typically only pay out benefits for a fixed period following an illness or accident.

After the expiry of such a fixed period, the plan administrator will require additional information to assess whether benefit amounts will continue to be paid out based on whether you remain unable to do any type of work.

Long-Term Disability Benefit Denials and Litigation

An action may be brought against your employer for denial or termination of your long-term disability benefits, among other reasons, such as:

  • Failing to properly enrol you in the long-term disability policy;
  • Failing to support you throughout the long-term disability claims process; or
  • Failing to maintain your long-term disability coverage during a leave of absence or upon termination.

Litigation may also be necessary in cases where:

  • An insurance company has denied your claim or suddenly stopped paying your disability benefits despite your inability to return to work;
  • A decision letter contains information that has been mischaracterized in support of your claim denial; or
  • Your disability benefits claim has not been reinstated following a failed attempt at returning to work.

The Benefit of a Qualified LTD Lawyer

When litigation is necessary to ensure you receive the disability benefits and compensation you are entitled to, each case is highly fact and evidence-specific. As such, a trusted disability benefits lawyer will help you understand the necessary steps and litigation processes required, which may include:

  • Evidence gathering;
  • Commencing a legal action against the appropriate parties;
  • Conducting examinations for discovery;
  • Reviewing how the law applies to your unique circumstances;
  • Participation in negotiation and mediation in an attempt to reach a settlement; and
  • Attending trial if alternative dispute resolution is ineffective.

Timing for Deadlines and Appeals

Appealing a denial or commencing a claim to sue an insurance company must adhere to strict deadlines. The timeline for filing an appeal is generally outlined in your disability policy or a denial letter. When it comes to court actions, there is a general two-year limitation period. This period typically runs from the date on which the insurance company first denied or terminated your claim, or alternatively, the date that your benefits stopped or should have started, had your claim been approved.

Contact Mulqueen Disability Law for Trusted Legal Guidance on Short-Term and Long-Term Disability Claims

At Mulqueen Disability Law, our trusted disability law team, led by Courtney Mulqueen, has extensive experience helping clients navigate the uncertainties that accompany disability claims and appeals. From our office in Markham, Mulqueen Disability Law advocates for disabled clients throughout Ontario. Whether you require assistance making a claim, securing a buyout, appealing a denial, or commencing litigation against your employer or insurance company, we are ready to help. Contact us online or by phone at 416-900-0368 (or toll-free at 833-363-3LAW [3529]) to learn how we can help you.