Disability claims can be overwhelming. Interpreting the jargon in an insurance policy can be a nightmare. The rules, eligibility requirements, and policy definitions are extremely complicated.
If you’ve suffered a serious injury that leaves you unable to work, you need income support. But you may be unsure of whether you qualify for disability benefits and feeling lost about where to begin.
Understanding the difference between short-term and long-term disability in Ontario is a great place to start. Here are the key distinctions between short-term disability (“STD”) benefits and long-term disability (“LTD”) benefits, and how these differences may impact the legal aspects of your claim.
Your disability insurance policy holds the answers
Before we get into a general discussion of the key differences between short-term and long-term disability, it’s important to emphasize that your specific insurance policy will be the most important source of information.
The coverage to which you are entitled depends on the specific wording of your disability insurance policy. Our Barrie and Collingwood long term disability lawyers can review your disability insurance policy and explain the legal details, including your different rights and coverage entitlements under your STD and LTD plans.
Understanding the differences between STD and LTD claims
The main difference between STD and LTD benefits are as follows:
1. Duration
As the name suggests, short-term disability benefits are intended to cover a shorter, more temporary period while you are unable to work. STD benefit coverage typically provides benefits for up to three to six months while you're sick or injured, depending on the policy.
Long-term disability benefits, on the other hand, are paid for a much longer period. Some policies provide LTD coverage to a set age (e.g., retirement age), or for a defined coverage period (e.g., a maximum of 2 years, 5 years, 10 years) provided you continue to qualify as “disabled” as defined by your specific policy.
2. Availability
Not all disability plans provide STD benefit coverage. If your policy only provides LTD benefit coverage, you will need to look to other sources such as Employment Insurance (“EI”) Sickness Benefits or an employer-paid sick leave to help you out financially during the waiting period. (See the next section for more on waiting periods).
Another point to note is that there is no overlap between STD and LTD coverage. In other words, the two types of benefits are not available at the same time. LTD coverage only begins after short-term disability benefits or other sources such as EI benefits run out.
3. Waiting periods
All disability insurance policies have what is known as a waiting period, “elimination” period, or “qualifying” period. This refers to the set period of time you must wait between the start of your disability and the eligibility date when you start to receive benefit payments.
The key difference between STD and LTD is the length of the waiting period. Because STD benefits are intended to cover brief or more temporary illnesses or injuries, the waiting period is shorter. Depending on the terms of the policy, the waiting period for STD benefits can be as little as one day but may be up to two weeks. The waiting period for LTD benefits is considerably longer, typically three to six months (though of course, it varies by policy).
4. Payments
Payments under both STD and LTD insurance plans are typically calculated as a percentage of your gross pre-disability income. The exact percentage to which you are entitled will be set out in your policy.
Your entitlement will almost certainly be different under STD vs. LTD, with LTD payments being at a lower percentage. For example, your STD plan may cover 50% or 100% of your pre-disability earnings, while your LTD plan may cover 60%, 70%, or 80% of your pre-disability earnings.
Payment frequency may also differ. Short-term disability payments are usually weekly or biweekly. Long-term disability benefit payments are usually monthly.
5. Changing definition of “disability”
To qualify for STD or LTD benefits, you must meet the definition of “disabled” or disability as set out in your policy. The standard definition typically looks at whether you are “totally disabled,” which means you can’t perform the essential duties of your job because of your illness or injury.
When you apply for STD benefits, you’ll need to provide medical evidence to the insurance company to substantiate that you are totally disabled. The definition doesn’t change throughout the STD coverage period.
The situation is different when talking about LTD benefits. Most LTD policies change the definition of what it means to be “totally disabled”, usually at the two-year mark. So, you will be eligible for up to two years of LTD coverage if you provide medical evidence to prove to the insurance company that you aren’t able to perform the main duties of your regular job (the “own occupation” test).
If you are unable to return to your regular job after being on LTD for two years, you will only be eligible for continued benefits if you provide medical evidence to prove that you’re unable to perform any job for which you are reasonably suited, based on your training, experience, and education (the “any occupation” test).
Barrie And Collingwood Long-Term Disability Lawyers Are Here To Help
At Littlejohn Barristers, our lawyers have the knowledge and experience to give you the help you need to claim the money that is rightfully yours. We can review your insurance policy and help you file a long-term disability claim. Let us navigate the legal details and get compensation for you.
Sometimes, insurance companies deny legitimate claims. If your insurance company denies your claim, we can review your situation. Our lawyers will look through your file and insurance policy. We will work with you to get the benefits you are entitled to.
Call us today at 705-725-7355 to set up a free initial consultation with a long term disability lawyer in Barrie. If you are looking for long term disability lawyers in Collingwood, we welcome you to make an appointment to meet with our staff at our law firm office located at 10 Schoolhouse Lane in Collingwood.