Non-Evidence Maximum: What It Means for Your Disability Insurance Coverage

If you have group disability insurance through work, you’ve probably come across the term Non-Evidence Maximum (NEM) or non-evidence limit in your benefits booklet. This number plays a big role in how much disability coverage you actually receive — and how much extra medical information the insurance company might require from you.

Below is a simple, clear breakdown of what the Non-Evidence Maximum means, how it affects long-term disability (LTD) benefits, and what your rights are if your LTD claim is denied.

What Is a Non-Evidence Maximum?

The Non-Evidence Maximum is the highest amount of disability insurance coverage you can receive without providing medical evidence.

In other words:

• It’s the maximum monthly LTD benefit automatically approved
• No medical questionnaire, doctor’s forms, or health history required
• It applies to all employees covered under a group insurance plan

Why Insurance Companies Use a Non-Evidence Maximum

Insurers use the NEM to reduce risk. It helps them provide basic disability coverage to everyone in the workplace, even if someone has pre-existing medical conditions.

Key reasons insurers set a Non-Evidence Maximum:

• Keeps group plans affordable
• Limits risk while ensuring basic coverage for all employees
• Allows additional coverage if you provide medical evidence

How the Non-Evidence Maximum Affects Your LTD Benefits

Your monthly LTD benefit is usually a percentage of your income — often 60% to 70%.

But if the amount you’re entitled to exceeds the NEM, you’ll only receive the automatic portion unless the insurer approves the rest through Evidence of Insurability (EOI).

Example

• Your LTD policy pays 66.67% of your salary
• That works out to $4,000 per month
• Your plan’s Non-Evidence Maximum is $2,500 per month

You will automatically qualify for $2,500.
To access the additional $1,500, the insurer may require medical evidence.

Do You Need to Apply for Extra Coverage Above the NEM?

Most plans do not automatically provide coverage above the Non-Evidence Maximum.

To increase your disability coverage:

• You typically must complete an evidence of insurability form
• The insurer may request medical records
• Approval is not guaranteed

Common Problems Employees Face With the Non-Evidence Maximum

Many Canadians discover NEM issues after they become disabled and need to claim benefits. Some experience:

• Lower LTD payments than expected
• Denials for coverage above the non-evidence limit
• Confusion about whether they ever received the chance to apply for more coverage
• Lack of proper explanation from employers or insurers

Can a Non-Evidence Maximum Affect a Disability Claim?

Yes — and it often does.

Your insurer may:

• Approve LTD payments up to the NEM only
• Deny payments above the limit
• Claim you never submitted the required medical evidence
• Say you were not eligible for extra coverage

But insurers and employers must clearly communicate:

• What your NEM is
• Whether additional coverage is available
• What you need to do to apply for that extra coverage

If they failed to explain this properly, the insurer may still be responsible for paying the higher amount.

What to Do If Your LTD Benefits Are Lower Because of the NEM

If your disability benefits are less than what you expected — or the insurer says you’re capped at the Non-Evidence Maximum — take these steps:

1. Review your benefits booklet or group policy
2. Check old emails or onboarding documents
3. Ask HR for confirmation of your NEM
4. Request the insurer’s explanation in writing
5. Speak to a disability lawyer before accepting a lower payment

You may still be entitled to the full benefit amount, especially if you were never given a fair chance to apply for coverage above the NEM.

When to Contact a Disability Lawyer

If your LTD benefits have been reduced because of a Non-Evidence Maximum — or your insurer is refusing to pay amounts above the limit — our team can help.

At Samfiru Tumarkin LLP, our long-term disability lawyers helped thousands of Canadians challenge unfair LTD decisions and get the compensation they’re owed.

There are no upfront fees. You don’t pay unless we win.

📞 Call us at 1-855-821-5900, email help@disabilityrights.ca, or use our online form for a FREE consultation.