7 Keys to Navigate Your LTD Claim in Ontario
By: Kevan Wylie
When it comes to Long-Term Disability (LTD) claims, understanding the nuances of the process is crucial. At Vice & Hunter, we have successfully assisted clients from diverse professions—including teachers, first responders, public servants, and healthcare workers—in navigating the complex world of LTD lawsuits. Below are seven key points to help you better understand your LTD claim and what steps you should take to protect your rights.
1. Know Your Workplace Insurance Benefits
Many employees with private insurance through their employer are entitled to both Short-Term Disability (STD) and Long-Term Disability (LTD) benefits. These benefits are designed to provide financial support when you are unable to work due to serious health conditions, whether physical, mental, or a combination of both. If you experience a life-altering diagnosis, injury, or mental health issue that impacts your ability to perform your job, it’s essential to review your policy. Understanding your access to these benefits can provide much-needed peace of mind during challenging times.
2. Timeliness Is Crucial When Filing Your Claim
If you are medically unable to perform the duties of your job, it is important to submit your claim for STD and LTD benefits without delay. Most claims are initiated by completing forms provided by your employer’s human resources (HR) department. It’s vital to adhere to the timelines outlined in your LTD policy, as failing to do so could jeopardize your eligibility. Being proactive and submitting your application as soon as you realize you cannot work can help prevent unnecessary delays in receiving benefits.
3. Understand the Elimination Period
Nearly all LTD insurance policies have an Elimination Period, which is a waiting period that begins when your disability occurs and ends when benefits start. The length of this period can vary depending on the specifics of your policy, but it is often around 90 to 120 days. Because the Elimination Period serves as a built-in delay, starting your application as early as possible ensures you’ll receive benefits soon after this period ends.
4. You May Be Required to Pursue Other Benefits
If your LTD claim is approved, your insurance provider may require you to apply for additional benefits, such as Canada Pension Plan Disability Benefits (CPP-D). Insurance companies often include this requirement in policies as a way to offset their financial responsibilities. Navigating CPP-D can be complex, especially if your initial application is denied. Working with a knowledgeable lawyer can simplify this process, ensuring your rights are protected and appeals are handled effectively.
5. Taxation of LTD Benefits
Whether your LTD benefits are taxable or non-taxable depends on the specific terms of your policy and who pays the premiums. If your employer pays the premiums, your benefits will generally be taxable. If you cover the premiums yourself, the benefits are usually non-taxable. This distinction is important for financial planning, as the tax implications can significantly impact your income during your period of disability.
6. Prepare for the Two-Year Transition
Most LTD policies provide benefits for the first two years if you are deemed unable to perform your “own occupation.” However, after the two-year mark, many policies introduce a stricter standard, requiring proof that you are unable to perform any occupation to continue receiving benefits. This shift, known as the change of definition date, often leads to claim denials. Insurance companies tend to deny coverage at this stage, arguing that claimants are capable of working in some capacity. If this happens to you, consulting with an experienced LTD lawyer is critical to understanding your options and fighting for your benefits.
7. Act Quickly If Your Claim Is Denied
If your claim is denied, don’t delay in seeking legal assistance. Some insurers may encourage claimants to pursue an internal appeal process. While this might seem like a logical step, it’s important to understand that these appeals are reviewed by the same insurance company that initially denied your claim. More importantly, the two-year limitation period under Ontario’s Limitations Act, 2002 continues to run during this time. If you wait too long to take legal action, you risk losing your right to sue for the denied benefits. A lawyer experienced in LTD claims can help you determine the best course of action and ensure your rights are protected.
Why Legal Guidance Matters
Long-Term Disability claims can be stressful and overwhelming, especially when your focus should be on your health and recovery. Whether it’s ensuring your claim is submitted correctly, appealing a denial, or litigating against an insurer, having the right legal team in your corner can make all the difference. At Vice & Hunter, we have a proven track record of success in representing clients whose LTD claims have been wrongfully denied.
If your LTD claim has been denied, don’t hesitate to reach out to us for an initial consultation. We’re here to provide you with the guidance and advocacy you need to secure the benefits you’re entitled to.
This information is for general purposes only and should not be considered legal advice. For personalized assistance, consult a qualified lawyer.
