The lawyers at Aaron Waxman & Associates are experienced with Disability, Personal Injury and Employment claims.
You may have made an application for long-term disability (LTD) benefits as a result of an illness or injury that prevents you from working for a prolonged period of time. Your benefits were approved, but you are wondering how long you will be receiving benefits for.
This is the third blog in our new long-term disability blog series. This blog post will provide you with an overview of the various factors that determine how long LTD benefits will be paid to you.
LTD benefits are a form of income replacement paid to you when you are unable to work due to injury or illness. This benefit pays you a percentage of your monthly income.
The most important information you need to know is contained in your policy, this is why it is very important to review your policy, and if you do not have a copy, to request it from your employer. This includes things like how your policy defines disability (own occupation and any occupation) and at what age the policy ends.
Important factors that can affect the length of time benefits are paid include:
The terms of your policy
The duration of your LTD benefits will depend on your insurance policy. Many policies terminate at age 65, but there are policies that have defined periods for payment of LTD benefits, where benefits may only be paid for a maximum of 5 or 10 years.
The change of definition
Your insurance company may find you meet the own occupation test (typically 2 years, but be sure to check your policy), and not the any occupation test and terminate benefits at the change of definition.
For reference, the own occupation period is the period of time of where the definition of total disability relates to your inability to perform the duties of your own occupation as a result of illness or injury. The own occupation period in most policies is typically 2 years. When the definition changes to any occupation, in order to be eligible for benefits, you must show that you are unable to perform the duties of any occupation for which you are or may become qualified for by education, training and experience as a result of illness or injury.
At any point in time during the claim, if the insurance company feels that medical evidence does not support that you are totally disabled, benefits could be terminated. The insurance company is looking for evidence that supports your restrictions and limitations and is medically supported by your treating physicians and test results where applicable.
The insurance company expects that you will seek and attend reasonable treatment and be under the care of appropriate physicians/specialists. For example, if you are off work due to a psychological illness, they will expect you to be treated by a psychiatrist or to attend cognitive behavioural therapy and take prescribed medications. If the insurance company’s opinion is that treatment is less than optimal and you are not seeking proper treatment, they might use that as a reason to terminate benefits.
Rehabilitation Plans & Return to Work Plans
If a rehabilitation program or gradual return to work plan has been arranged, the insurance company expects you to make reasonable efforts to attend treatment and participate in the programs. An insurance company might terminate benefits based on failure to comply with a rehabilitation plan or a return to work plan without supporting medical evidence.
If you or someone you know has been denied long-term disability benefits, it is important to seek legal advice. A lawyer can help you understand your rights and legal options. Our law firm offers a free initial consultation with a licensed lawyer, that can be arranged at a date and time that is convenient for you.
* This blog is for informational purposes only and is not meant to substitute legal advice. Please read our disclaimer for further information.
* All of our lawyers are licensed by The Law Society of Upper Canada
* Office in Toronto and able to represent people in the province of Ontario