When illness or injury prevents you from working, knowing how to access your employer-provided disability benefits can make all the difference. Whether you’re dealing with a physical condition, chronic illness, or mental health challenges, short-term and long-term disability benefits exist to help you recover without financial hardship. Here’s what every employee in Ontario should know about these benefits.
What Is Short-Term Disability?
Short-term disability (STD) benefits offer income replacement when a medical condition temporarily prevents you from working. Benefits typically cover 60% to 85% of your salary for up to 17 to 26 weeks, depending on your plan. Some plans are insured by a third party, while others are self-funded by the employer.
Typically, you apply for STD through your employer’s insurance provider. A doctor’s note and claim forms will be required, and the insurer, not your employer, will assess the medical evidence.
What Is Long-Term Disability?
Long-term disability (LTD) benefits apply when your condition is expected to last much longer. LTD coverage typically begins after STD ends and can last up to age 65, depending on your insurance policy. These applications are more complex and usually require detailed medical support from a specialist such as a psychiatrist or rheumatologist.
You may need to apply for LTD well before your STD coverage ends to avoid any interruption in income. Many employees are unaware that insurers handle LTD claims, not the employer, which makes understanding your policy crucial.
When Should You Apply For Employer-Provided Disability Benefits?
For both STD and LTD, early application is key. Apply as soon as you know your condition will prevent you from working. Missed deadlines can delay or derail your benefits.
- Short-term disability applications require medical documentation from your primary physician.
- Long-term disability applications often require reports from a medical specialist and coordination with your specialist and insurer.
What If You’re Denied?
- STD Denials: If your short-term disability claim is denied, you have the right to appeal through the insurer’s internal process. A denial often means the medical report wasn’t detailed enough. A lawyer can work with your doctor to provide clearer medical evidence.
- LTD Denials: Long-term disability denials may involve more complex legal issues, especially when the insurer claims you’re fit to work despite medical support. In these cases, legal action may be required against the insurer to enforce your rights under the policy.
In both cases, requesting a written explanation for the denial is essential. A disability lawyer can assess whether your claim was denied in bad faith or in violation of policy terms.
Common Challenges
- Premature Termination of Benefits: If your doctor says you still can’t work but your insurer ends benefits, this may warrant legal action.
- Pressure to Return to Work: Some employers pressure employees to return once STD is denied, even if your doctor disagrees. You may have rights under the Human Rights Code, including the right to accommodation.
- Lack of Communication: When doctors, insurers, and employers aren’t aligned, delays and misunderstandings are common. Keep records of all communication.
Frequently Asked Questions
1. What should I do if my disability claim is denied?
Start by requesting written reasons. Then speak to a lawyer to review the decision and guide your appeal. A lawyer can also help your doctor submit stronger medical evidence.
2. How are mental health conditions treated in STD and LTD claims?
They are handled the same as physical conditions, but LTD usually requires documentation from a licensed specialist (e.g., psychiatrist), while STD can be certified by your family doctor.
3. I was injured at work- should I apply for STD or WSIB?
Injuries that occur on the job may fall under WSIB. However, if short-term disability benefits are offered through your employer, you may also apply for those benefits separately.
4. What if my claim was denied, and my employer is coding me as LWOP?
LWOP stands for leave without pay. If your doctor says you cannot work, your employer must hold your position for a reasonable period. If STD is denied, your employer may still have legal obligations, especially if you later apply for LTD.
5. My insurer says they’re waiting on forms from my employer. What can I do?
Once you and your doctor have submitted your parts, your employer must complete an Employer Statement (example). If they delay, a lawyer can step in to ensure your claim is processed fairly.
Legal Support for Disability Claims in Ontario
Short-term and long-term disability claims can be complicated and stressful, especially when benefits are denied or employers fail to accommodate. Our disability lawyers help employees across Ontario assert their rights and access the benefits they’re entitled to.
Book a no-charge initial assessment: https://leckerslaw.com/contact-us