Short-term Disability Claims

Short-term disability insurance benefits are income replacement benefits available to covered individuals when they cannot work due to illness or accident. If your short-term disability benefits have been denied or cut-off, it’s important to speak to a disability lawyer as soon as possible.

Read on to learn more about short-term disability claims, and how you can get the help you need if your claim for benefits is denied or cut-off in Canada.

BASIC INFORMATION

EMPLOYMENT AND STD

DENIAL AND APPEAL

What is short-term disability insurance?

Short-term disability (STD) insurance is a type of disability insurance that provides income replacement for individuals who are unable to perform the essential tasks of their occupation due to reasons of illness, injury, or hospitalization.

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What are short-term disability benefits?

Short-term disability benefits can be obtained through a group benefit plan or through private insurance. STD benefits can sometimes be used to carry you through until long-term disability benefits are granted, as STD benefits are only available for a specific period of time. In this way these benefits may help you while you are waiting to have your long-term disability benefits start.

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What types of short-term disability benefits are there?

Group Insurance plans

Short-term disability benefits are typically obtained through a group benefits plan through an individual’s employer. In this case, benefits are provided in the form of weekly or bi-weekly payments as a percentage of an individual’s weekly income.

Private Insurance plans

Disability benefits can also be obtained through an individual’s own insurance policy purchased directly from an insurance broker or insurance provider. These private insurance plans may provide more limited coverage and be less expensive to obtain.

Government-funded plans

Benefits may also be obtainable through various government disability support programs, such as through Canada Pension Plan (CPP Disability), the Quebec pension plan, Employment Insurance (EI), and Worker’s Compensation (WSIB) plans. These plans may provide more limited benefits than a group or private insurance plan.

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How do you qualify for short-term disability?

If you have short-term disability insurance coverage under your employer’s group plan or through private insurance, and you meet the definition for total disability as defined by your insurance policy, you qualify for short-term disability benefits.

If you are unsure if you are covered, talk to your employer about their group disability insurance plan. You can obtain detailed information about your group benefits plan by requesting a copy of your benefits booklet from your employer. Be sure to also request a copy of your policy from your insurance provider and review their definition of disability, and the medical conditions covered under your plan. Depending on the cause of your disability, there may also be a waiting period before you can apply for benefits.

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How much does short-term disability pay?

Short-term disability benefits vary depending on your policy but should ultimately provide income support for between 50%-100% of your income. Review your short-term disability policy to find out more about how much of your income is covered by your disability benefits, and what type of medical documentation is needed to grant your short-term disability benefits.

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How long does short-term disability last?

Short-term disability benefits are available for a specific period of time. How long your benefits last will depend on your policy. It may be as little as 15 weeks or as much as 52 weeks. It is important to review your short-term disability policy to understand the length of the period you may be covered.

Short-term disability benefits can sometimes be used to carry you through until long-term disability benefits are granted. STD benefits may help support you while you are waiting to have your long-term disability benefits start.

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What medical conditions are covered under short-term disability?

Examples of medical conditions which could be covered under short-term disability policies include:

• Anxiety
• Depression
• Brain injuries
• Chronic pain
• Fibromyalgia
• Heart disease
• Arthritis
• Headaches and migraines
• Lyme disease
• Multiple Sclerosis
• Mental health issues
• Mood dysregulation
• Psychoses
• Schizophrenia
• Schizoaffective disorder
• Social Anxiety Disorder
• Panic Disorder
• Bipolar disorder
• Bulimia
• Auto-immune disorders
• Neuropathic pain
• Alzheimer’s
• Dementia
• Muscular Dystrophy
• Back pain
• Recovery from surgery
• Recovery after an injury

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How do you apply for short-term disability benefits?

To apply for short-term disability benefits through a group plan, contact your plan administrator. If you are applying through an individual plan, contact your broker or insurance company.

The application will include three forms to be filled out by three separate parties:

• the employee statement
• the physician’s statement
• the employer statement.

Provide your doctor with the physician’s statement and request that they fill it out and include any information relating to the nature of your disability and the treatment that is being followed. Your employer will need to fill out the employer’s statement with information detailing your position, salary, hours, and responsibilities.

Once your application forms are complete, submit them immediately to ensure that your claim is processed as soon as possible. When your application is processed by your insurer, you will be assigned a case manager who may need to ask you questions about your disability, your treatment, and how your symptoms interfere with the essential tasks of your occupation. Once your case manager has decided whether to approve your claim, you will be informed in writing of their decision.

As some disabilities can be prolonged and require longer periods to recover, you may want to consider transitioning to long-term disability benefits once your short-term disability benefits run out.

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EI sick benefits and short-term disability

If short- or long-term disability is not part of your coverage, you may be able to seek employment insurance (EI) sickness benefits. These benefits are less comprehensive than group disability plans and can take longer to obtain. Since EI sickness benefits function as income replacement when an employee is injured or sick, they are taxable benefits. Depending on the plan, short-term disability benefits are usually not taxable to the employee. If you do have short-term disability coverage, you cannot receive EI sickness benefits and short-term disability benefits at the same time.

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How to go from short-term to long-term disability

If your short-term disability benefits are coming to an end and you are still unable to return to work, you may be able to access long-term disability benefits. You will need to make a separate application for long-term disability benefits. Before your short-term disability benefits end, request an application for long-term disability from your insurance provider.

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Going from short-term disability to long-term disability benefits

However, often short- and long-term disability benefits are not paid out by the same entity, so there is a possibility that despite your legitimate and ongoing disability, your application for long-term disability benefits may be denied. If this happens to you, it is critical that you reach out to an experienced disability lawyer at Samfiru Tumarkin LLP for a free consultation and find out how we can help you secure the compensation you are owed.

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What are my employment rights while on STD?

It is illegal to fire an employee because they are taking a medical or disability leave from work; an employee who is fired because of their disability would be owed human rights damages. However, an employer can let an employee go at any time and for any reason, as long as it is not discriminatory, and severance is paid.

Use our Pocket Employment Lawyer to find out if your human rights have been violated.

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Can I get fired while on short-term disability?

An employer is within their right to dismiss an employee at any time, provided the employee is compensated with severance pay, and the reason for dismissal is not discriminatory. Firing an employee because they are on short-term disability would be a human rights violation. If you are fired while on disability leave, you should contact an employment lawyer at Samfiru Tumarkin LLP immediately.

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Can I work another job while on short-term disability?

If your short-term disability (STD) insurance policy defines your disability as being unable to perform the essential tasks of your own occupation, you may be able to work another job as long as it is not similar to your current employment. However, you should speak to an employment lawyer before you undertake another job while on disability, as your employer may assume that you have resigned.

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Are you experiencing extreme stress due to work?

You may qualify for short-term disability benefits if you are experiencing excessing stress due to work. If extreme stress is left untreated, serious mental health problems like anxiety and depression can result.

LEARN MORE
• Stress leave rights for Ontario employees

If you have developed symptoms of extreme stress or mental illness, speak to your doctor as soon as possible. It is also advisable to speak to a disability lawyer to help you decide the type of benefits you will pursue and to improve your chances of getting benefits.

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Why are short-term disability claims denied?

An application for short-term disability benefits could be denied for several reasons.

• Lack of medical evidence: Some illnesses and disabilities are considered ‘invisible illnesses’, as they are resistant to objective medical testing, and claimants or medical professionals may simply be unable to supply the proof of a disability the insurance company is looking for. If your application for benefits was denied due to a lack of objective medical evidence, there are ways to overcome this hurdle, and you should speak to an experienced disability lawyer at Samfiru Tumarkin LLP to secure the compensation you’re entitled to.
• Not seeking proper medical treatment: One of the most common reasons for denial of benefits is that the claimant has not sought proper medical treatment. If your medical doctors have prescribed a treatment protocol, it is critical that you follow the recommendations of your medical team. Even if you are hesitant or skeptical about a treatment being effective for you, not following your doctor’s recommendations could leave you vulnerable to a denial from your insurance provider.

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I’ve been denied my benefits – now what?

Even if your claim includes everything your insurance policy requires to make an application for benefits, your claim can still be denied. At this point you have three options:

• Walk away and give up the benefits you are legally entitled to;
• Appeal the denial
• Start a legal claim for full compensation with the help of an experienced disability lawyer.

If you’ve been denied short-term disability, you may be extremely frustrated with the process. Our firm provides free consultations to discuss your options, whether it is short-term or long-term disability; we will review your case, advise you of your rights, and get the compensation you deserve.

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Should I appeal a denial for short-term disability?

No. Insurance companies generally use their internal appeal process to frustrate individuals and prolong their efforts to get their benefits. They may use the appeal process to run out the clock on your time limit to file a claim for compensation; you have two years from the moment your benefits are denied to take legal action.

If your short-term disability claim is denied, contact a member of our team to arrange a free consultation to discuss your case. An experienced long-term disability lawyer at Samfiru Tumarkin LLP will review the facts, inform you of your options, and help you get the compensation you are owed.

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How do I appeal a denial for short-term disability?

If you’re denied, you should contact your insurance company to find out more about their specific appeals process.

However, before you consider appealing, you should speak to a long-term disability lawyer to find out more about your options. The team at Samfiru Tumarkin LLP offers free consultations for individuals interested in learning more about their disability rights.

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What happens after I’ve retained you?

We will communicate with the insurance company for you. You do not have to receive any letters or communication from your insurance provider once we have been retained. We take over the case and make sure all the required medical documentation – and any other required documents – are provided to your insurer.

We will remain in constant contact with you as we work to secure the compensation you are legally owed.

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How a disability lawyer at our firm can help

A disability lawyer can help you interpret your insurance policy and understand your rights. Disability policies are complex and written in confusing ways. We can help you cut through the legal jargon and understand what the best course of action is to ensure you get your benefits.

Don’t give up. That is what the insurance company wants you to do. They may also encourage you to appeal the denial. Do not go through the insurance company’s appeals process! In most cases, your appeal will be unsuccessful, and your insurer will use this tactic to run out the clock on your time limit to file a claim for full compensation.

If your disability claim is denied in Canada, you need to contact the experienced short-term disability lawyers at Samfiru Tumarkin LLP immediately at 1-855-821-5900 for a FREE CONSULTATION. We will review the facts of your situation, tell you if you have a case, and take the fight to the insurance company on your behalf. Don’t let them walk away with the money that they owe you in your time of need.

Get the advice you need, the compensation you deserve.