LTD and COVID-19

Part 2: Tips for applying for disability benefits during COVID-19

For some of us, life during COVID-19 has gone on relatively normally in at least some ways, including work. We may have continued to work through the COVID-19 pandemic, without much interruption. We may have continued to earn our regular incomes.

For many of us however, our jobs may have changed or how we do them may have changed. We may even have had a reduction or an increase in the hours we work and our duties may have increased or decreased, depending on what our job is.

For others, COVID-19 may have changed our lives in immeasurable ways. It may have resulted in being laid off or fired from our job or perhaps we’ve started a new job or started our own business.

Still others may have decided to quit their jobs during this pandemic due to COVID-19 or for some other reason.

Whether you are working right now or not, there is always the risk of becoming disabled from work due to an illness or injury of any kind (not only due to COVID-19). If you have become disabled (for any reason) during the COVID-19 pandemic or if you are concerned that you may become disabled, you may be wondering if you are eligible to receive disability benefits.

We will aim to arm you with information, insights and various TIPS for applying for disability benefits during COVID-19.

What if I become disabled during COVID-19?

Just as in the days before COVID-19, if you are working then there is still always the possibility that you will be forced to stop working due to disability. The difference now may be that the duties of your job may have changed; your income may have changed; and your status as an employee or as self-employed may have also changed.

With all of these possible changes, your options and entitlements to various disability benefits, may have also changed.

Similarly, if you have been laid off, fired, quit your job or recently started a new job, and become disabled during COVID-19, you may wonder what if any benefits are available to you.

If you are or you have become disabled during the COVID-19 pandemic for whatever reason (not only due to contracting the virus), whether you have been working or not, it is important to understand your rights and options as they relate to disability benefits and other social assistance.

You may be wondering…

  • Do I have short-term or long-term disability benefit coverage either privately or through my employer?
  • Am I eligible to apply for disability benefits through my individual or group disability insurance plan?
  • How could my benefits under my disability plan be affected by the recent changes to my job or changes to employment status due to the COVID-19 pandemic?
  • Should I also apply for CERB if I become disabled from work?
  • When should I contact a disability insurance lawyer to help me?

We will aim to answer these questions and provide you with the information, insight and invaluable TIPS you need to navigate your claims for disability benefits during the COVID-19 pandemic.

Do I have short-term or long-term disability benefit coverage either privately or through my employer?

You may or may not have disability coverage. There are many types of disability insurance coverages that provide an income if you become disabled from work (see our previous blog article “What if I Can’t Work due to COVID-19” for more details). You may be eligible for some or all of the following disability benefits:

  • Short-term disability (STD)
  • Long-term disability (LTD)
  • Individual or Private disability
  • Creditor Disability
  • Social Assistance (CPP Disability, ODSP, OW, EI Sickness, CERB)

If you are an employee, your employer may have a group benefits plan. Often under group insurance plans, STD and LTD benefits are provided to employees who become disabled from their jobs if they can satisfy the benefit administrator or insurance company that they are not functionally (physically/cognitively) able to do their job/occupation due to an illness or injury.

TIP: You can check your group benefits booklet or your collective agreement to determine if you have STD and LTD coverage. You should also contact your employer or their human resources department or your union (if you are unionized) to find out if you are covered under your employer’s group disability insurance policy and also ask to be provided with the necessary forms to apply for the benefits.

If you are self-employed you may have purchased a private or individual disability insurance policy from an insurance company or a broker or you might have coverage through your professional or trade organization. You have been paying premiums for this coverage so it is important that you take advantage of it if you need it. There may also be a “Residual Disability” or “Partial Disability” provision in your policy which pay you disability benefits while you continue to work in some limited capacity. You will want to read your policy carefully with respect to your entitlements.

TIP: You probably have a copy of your individual (private) insurance policy (either hardcopy or electronic) or, if you are not able to find it, you can obtain a copy through your broker or the insurance company who insures your disability benefit. You should also be able to obtain claims forms from your broker or directly from the insurance company website. In addition to your medical records, you should also start gathering information about your earnings from previous years, as these will be needed to prove your claim.

You might also have creditor disability insurance. This is different from group or private disability coverage which provides you with an ongoing income. Creditor disability insurance is tied to a debt such as your credit cards, lines of credit or your mortgage. It is something that you have paid premiums for on a monthly or annual basis. If your claim is approved, interest payments on your debt will continue or balances will be paid off so long as you can prove you are disabled from work.

TIP: Contact your mortgage lender or mortgage broker or your bank/credit card company to find out if you have any disability creditor coverage. You can also check your mortgage and credit card statements to see if an insurance premium has been deducted/charged to you for this type of disability coverage.

Finally, there is social assistance. If you become disabled you may be eligible to receive various provincial and federal benefits. You may want to consider your eligibility for these benefits even if you have group or private disability insurance coverage. (Check government websites and our recent blog article, “Should I apply for CERB while receiving LTD benefits?” for more information and to determine your eligibility.)

These social assistance benefits include:

  • Employment Insurance Sickness benefits (15 weeks);
  • Canada Pension Plan Disability Benefits (if your disability is severe and prolonged);
  • Ontario Works and/or ODSP (depending on your household income);
  • Canada Emergency Response Benefit (CERB) (see our recent blog article about CERB, “Should I apply for CERB while receiving LTD benefits?”)
  • There are also various tax credits that may be available to you to offset the income provided to you for your disability.

TIP: Depending on which social assistance benefit you receive, you may or may not have to repay the benefit if your STD/LTD claim is later approved. In some cases, the social assistance benefit may actually reduce your STD/LTD benefit. Either way, a social assistance benefit may help you stay afloat financially while you wait for your group or individual disability benefits to be approved and paid out to you.

Am I entitled to apply for disability benefits through my individual or group disability insurance plan?

If you have any of the disability insurance coverages listed above and you become disabled, you should submit your application as soon as possible. The insurance company will then assess your eligibility for benefits under the group or individual disability insurance policy and provide you with a written decision as to whether you have coverage and whether you meet the definition of disability under the policy. See our FAQs page on our website for more information about applying for disability benefits.

If you were working before you became disabled and you can demonstrate to the insurance company that you are “totally disabled” as defined in the policy (meaning you are not able to do the essential duties of your job), then you should be approved for the disability benefits. If your claim is denied for any reason, you should contact MK Disability Lawyers immediately, to discuss your options.

TIP: There are three forms that make up your application for disability benefits under group plans: a form completed by you, one completed by your doctor and another completed by your employer. During COVID-19 you may have to email the doctor’s form to your doctor and then schedule a a telephone consultation with your doctor in order for your doctor to be able to answer the questions on your disability claims form.

TIP: If you are applying for disability benefits under an individual insurance policy, you will not only need to provide medical claims forms, you will also need to complete additional forms and documentation to provide evidence of your business’ loss of profit and your loss of earnings. It may be wise to solicit the assistance of your accountant to compile the necessary financial documentation to support your claim.

TIP: Both group and individual disability policies may have coverage for “Partial Disability” benefits, meaning that you could be entitled to some benefits if you are only able to work in a limited capacity. It is best to check with your employer or insurance company or broker to find out what disability benefits you might be entitled to.

If you have recently been laid off or your employment has been terminated or you quit your job, you may still have coverage under your group disability insurance plan with your employer. This means that you may still be entitled to disability benefits if you can prove to the insurance company that you are “totally disabled”.

Sometimes the group disability insurance coverage will be extended for a period of time after the date that you were fired or laid off from your job. Sometimes you might be able to demonstrate that you became “totally disabled” while you were still an active employee and had the coverage in place. Your eligibility will depend on the terms of your lay off/termination and also on the wording of your insurance policy and the date you became disabled.

Remember, no two cases are identical and you should seek legal assistance as early as the application stage, if you were no longer an employee for the employer under whose policy you are applying for disability benefits.

TIP: If your insurance company denies your claim on the basis that your disability insurance was terminated before you became disabled OR because they say you were “not actively at work” when you became disabled, you should contact MK Disability Lawyers immediately to discuss your options.

Finally, if you recently started a new job you may or may not have disability insurance coverage under your new employer’s group benefit plan. Some employers and some insurance policies require employees to work continuously for a set period of time (often three months) before they are eligible for disability insurance coverage.

In addition to qualifying for the coverage, if you are new to the benefit plan and your coverage has not been in place for at least 12 months, you might also be subject to the policy’s “pre-existing condition exclusion”. This means that under some disability policies, if you become disabled during the first 12 months of being covered under the policy and your disability is due to a pre-existing condition, the insurance company can deny your disability claim. Again, no two disability cases are the same. We encourage you to contact MK Disability Lawyers if your disability insurance claim is denied based on a “pre-existing condition” exclusion.

TIP: If you recently started a new job and become disabled from a pre-existing condition, your claim may be denied. You might want to consider applying for disability benefits under your previous employer’s plan, as well. In some cases, you might be entitled to coverage under your previous employer’s plan. It is best to consult a disability lawyer to discuss your options. Please also see our blog article, “Can My LTD Benefits be Denied Based on a Pre-Existing Condition”.

How could my benefits under my disability plan be affected by the changes to my job or employment status due to the COVID-19 pandemic?

At this stage in the COVID-19 pandemic, it remains to be seen how disability insurance companies will interpret and apply their disability insurance policies to claims where COVID-19 has resulted in changes to a person’s job before they became disabled.

In normal circumstances and under most insurance policies, the insurance company will assess your claim based on the duties and income of the job you were doing as of your last day worked before becoming disabled.

In this unprecedented time of COVID-19, many people who normally be working at jobs that are demanding (physically and/or cognitively) might now be working at less demanding duties and for less pay. The question is whether the insurance company will assess claims based on the duties and income the person normally receives or the duties and income the person was receiving at the time they became disabled; a time of changes due to COVID-19.

On a strict interpretation of most disability insurance policies, insurance companies could find that you are not disabled from the “easier” job you were doing when you went off work. If you are found to be disabled, the insurer could then calculate your benefit amount on a percentage of the reduced income you were receiving right before you went off work. Arguably, assessing claims this way, is not fair to people who became disabled during COVID-19. As more people apply for and are denied benefits in the coming months and years, this is bound to be an issue that will arise in disability benefit disputes.

TIP: If you have become disabled from a job that was not your usual job or did not provide you with your usual income and you are considering applying for disability benefits, contact MK Disability Lawyers to assist you with your application. Similarly, if your disability claim has been denied based on your ability to do an “easier” job (not your usual job) or your disability benefit amount is based on an amount less than what you would normally be earning, before COVID-19, contact MK Disability Lawyers to discuss your options.

Should I also apply for CERB if I become disabled from work?

The short answer is, possibly. Please see our recent blog about the effect of CERB on disability benefits for more details and visit the government websites to find out if you are eligible for this benefit.

When should I contact a disability insurance lawyer to help me?

If you became disabled during COVID-19 and you are considering applying for STD/LTD or if your STD/LTD has been denied or terminated, or if you have any questions regarding COVID-19 and your disability benefits, we encourage you to contact MK Disability Lawyers to discuss your options.

If you would like to discuss your Long-Term Disability claim with a lawyer, MK Disability Lawyers LLP are experienced lawyers dedicated exclusively to the practice of LTD litigation. We have represented disabled clients with a multitude of disabling conditions, working in various professions, against all major life/health insurance companies in Canada. We would be happy to provide you with a free legal 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.