Ontario LTD Lawyers Advising on Employer Interference in LTD Claims

Disability cases where the employer is involved are complex. Depending on the facts and evidence in your case, there are various claims that can and must be made against the employer when disability benefits are terminated or denied. These are complicated cases with many moving parts and if allegations against the employer are not included (when necessary and appropriate), the larger long-term disability case against your insurance company may fail entirely or may not resolve as well as it would otherwise.

At Mulqueen Disability Law, we have been litigating only short-term disability (STD), long-term disability (LTD) and related employment claims for over 20 years. These are extremely complicated cases that require legal knowledge, skill, and strategy in both litigation and negotiation of disability claims. 

Employer-provided disability benefits in Ontario

Employers may offer long-term disability benefits to cover more serious or chronic conditions that prevent an employee from working for an extended period of time. LTD benefits are normally assessed and paid (insured) by an insurance company. These benefits are paid after a waiting period and after short-term disability and possibly EI Sickness benefits are exhausted.

If an employer provides disability benefits, they have certain legal obligations. For example, the employer must ensure that the benefits are administered fairly and consistently, and that all eligible employees have access to them. The employer must also ensure that the benefits are provided in a timely and efficient manner, and that any claims for benefits are handled fairly and in accordance with the terms of the benefit plan.

Employee eligibility for LTD benefits

To be eligible, to apply for LTD benefits, your employer must have enrolled you in the plan and continued your coverage to the date you became disabled. You must also meet the eligibility requirements for the coverage, as set out in the policy/plan. You must demonstrate that you have been continuously disabled throughout the waiting period and you must submit claims forms (one from you and one from your doctor) and any other information to prove disability. You must do this within the deadline for submitting an LTD claim which is set out in your LTD policy/benefit booklet. See our Applications information and Guides for more information.

Your employer must not interfere in your disability benefits, and must take steps to prevent such interference from occurring. Your employer should ensure that they have clear policies in place regarding disability benefits, and that they provide accurate and complete information to their employees about those benefits. They should also ensure that they are providing reasonable accommodations to employees with disabilities, and that they are not retaliating against employees who claim disability benefits.

Employer obligations to employees for LTD coverage

There are many things your employer should do to ensure that you are able to make an LTD claim under your group LTD policy/plan, including the following:

  • They should provide you with the enrolment forms for their group benefit plan in a timely manner, to ensure that you are enrolled in the group benefit plan and have LTD coverage in place, as soon as you become an eligible employee.
  • They should provide you with details of your group benefit coverage, usually by providing you with a benefit booklet or the insurance policy if you request it.
  • If you become disabled, they should remind you to apply for LTD when you are approaching the end of your STD period.
  • They should offer to provide you with the LTD claims forms or direct you to contact the LTD insurance company or their benefit administrator for assistance.
  • They should complete their part of your LTD claim forms in a timely manner. Their form is the Employer’s Statement or Plan Sponsor Statement which provides the insurance company with details of your job and income.

If your employer fails in their obligations to you in terms of enrolling you in their LTD plan or maintaining your LTD coverage for periods they are legally required to or if they do not help you with your LTD claim, and your LTD claim is denied as a result, we will need to bring your employer into your LTD court action.

Employer interference in employee LTD claims

When a disability claim is denied, sometimes the employer is to blame.

Interfering with an employee’s disability benefits can take many forms and can occur in various ways. Here are a few examples of how employers might interfere with their employees’ disability benefits:

  • Denying or delaying benefits: Employers may deny or delay an employee’s request for disability benefits, even if the employee is eligible for those benefits under the terms of the benefit plan. This may occur because the employer disagrees with the employee’s diagnosis, or because the employer believes that the employee is not truly disabled or if they simply do not want to support their employee’s benefit claim.
  • Retaliating against employees who claim benefits: Employers may retaliate against employees who claim disability benefits by firing them, demoting them, or otherwise punishing them. This type of retaliation is illegal and can result in significant legal consequences for the employer.
  • Failing to provide reasonable accommodations: Employers may fail to provide reasonable accommodations to employees with disabilities, such as modified work hours or a different work environment, which can prevent employees from being able to perform their job duties and lead to a claim for disability benefits.
  • Providing inaccurate information: Employers may provide inaccurate or incomplete information to employees about their disability benefits, such as the amount of benefits available, the eligibility requirements, or the claims process. This can lead to confusion or frustration for employees, and can prevent them from receiving the benefits to which they are entitled.

It’s important for employees to be aware that they may need to sue their employers for disability benefits or damages in lieu of benefits if their claim is denied.

Human rights & wrongful/constructive dismissal

Under human rights laws, employers have an obligation to accommodate employees with disabilities to the point of undue hardship. This may include providing disability benefits as part of an accommodation plan to enable an employee with a disability to remain in the workforce. They must also support an employee’s return to work efforts by offering accommodations in the workplace (short of undue hardship) to allow the employee to gradually return to work or to perform modified duties or an alternative job.

If an employer terminates your employment or forces you to resign or fails to accommodate you, contact us right away. Do not resign from your job or abandon your job by not communicating with your employer. Sometimes employees believe that they have no choice but to resign when they become disabled. Contact us immediately if you believe that your employer has terminated your employment or made it impossible for you to do your job, knowing you are unwell or disabled.

Mulqueen Disability Law supports disabled employees with LTD/STD claims in Markham, the Greater Toronto Area, and York Region

You should be able to count on your employer if you become disabled. If your STD/LTD claim has been denied because of something your employer did or failed to do, or you are uncertain of your eligibility for disability benefits after being terminated, Mulqueen Disability Law can help. For over two decades, we have advocated for employees suffering from disabilities, including invisible conditions such as anxiety, depression, PTSD, workplace stress/burnout, chronic pain, immunological conditions, and neurological issues.

With offices in Markham and Toronto and the ability to offer our support virtually, Courtney Mulqueen and the team at Mulqueen Disability Law provide flexible, accommodating legal services to disabled clients throughout Ontario. To schedule a free, confidential initial consultation, please contact us online or by phone at 416-900-0368 (or toll-free at 833-363-3LAW [3529]).