Short-term Disability Claims in Ontario (2024 Guide)

Discover key information on short-term disability (STD) claims in Ontario in our detailed guide.

Learn what STD is, how it compares to long-term disability, and what conditions qualify. Our guide also helps you understand the types of disability benefits, how to apply for STD, reasons for denial, and the next steps after an STD claim denial in Ontario.

Gain valuable knowledge from Samfiru Tumarkin LLP’s extensive experience to navigate the STD claims process more confidently and effectively.

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What is short-term disability in Ontario?

Short-term disability (STD) in Ontario is a type of insurance coverage that provides income replacement benefits to employees who are temporarily unable to work due to a non-work-related illness or injury. These benefits typically cover a portion of the employee’s salary during the disability period.

Short-term disability benefits help by allowing you to focus on your health and recovery when you are temporarily unable to work, reducing financial stress. It ensures that you can maintain a sense of normalcy and security despite facing health challenges.

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Who is eligible for STD in Ontario?

Eligibility for short-term disability benefits in Ontario generally depends on the terms of the insurance policy or the employer’s disability plan. Typically, employees must:

• Be diagnosed with a qualifying medical condition.
• Provide medical documentation to support their disability claim.
• Have worked for the employer for a specified period, if stipulated by the policy.

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Difference between STD and Long-Term Disability?

Short-term disability (STD) and long-term disability (LTD) insurance in Ontario both provide income replacement for employees unable to work due to illness or injury, but they differ in duration and scope.

STD typically covers a percentage of an employee’s salary for a short period, usually up to 26 weeks, for temporary disabilities. In contrast, LTD offers benefits for extended periods, often until recovery or retirement, for more severe, long-lasting conditions. While STD benefits are generally offered immediately after a short waiting period, LTD benefits often begin after STD benefits are exhausted or a longer waiting period is met.

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Qualifying medical conditions for STD

In Ontario, STD insurance typically covers a wide range of medical conditions that temporarily prevent an employee from performing their job duties. The specific conditions covered can vary based on the terms of the insurance policy or employer’s plan. Common medical conditions that qualify for STD include:Each insurance policy may have specific criteria and documentation requirements for these conditions.

• Serious Illnesses: Severe infections, respiratory conditions, digestive disorders, cardiovascular issues
• Injuries: Broken bones or fractures, surgeries requiring recovery time, significant sprains or strains
• Mental Health Conditions: Severe depression, anxiety disorders, acute stress disorder
• Pregnancy-Related Complications: High-risk pregnancies, postpartum recovery complications, Severe morning sickness (hyperemesis gravidarum)
• Musculoskeletal Disorders: Severe back pain, joint disorders, repetitive strain injuries
• Neurological Conditions: Migraines or severe headaches, concussions, epilepsy with frequent seizures, and other neurological disorders

Each insurance policy may have specific criteria and documentation requirements for these conditions. Employees usually need to provide medical evidence from a healthcare professional to support their claim for STD benefits.

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When can I start collecting STD benefits?

You can start collecting short-term disability (STD) benefits typically after a waiting period of 1 to 14 days. This waiting period, also known as the elimination period, is the time between the onset of your disability and when you become eligible to receive benefits. During this period, you may need to use sick leave or unpaid leave.

Once the waiting period is over and your claim is approved, you will begin receiving STD benefits according to the terms of your policy.

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How much does STD pay in Ontario?

In Ontario, STD benefits generally pay 50% to 75% of your regular salary. The exact amount and any maximum limits depend on your employer’s plan or insurance policy. Some plans may have a maximum weekly benefit limit.

To find the specific details of your STD coverage, you should review your employer’s plan documents or contact your insurance provider.

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How long does STD last in Ontario?

In Ontario, STD benefits typically last up to 26 weeks. Some policies may offer benefits for longer periods, depending on the terms.

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How to apply for short-term disability benefits in Ontario

To apply for short-term disability benefits in Ontario, follow these essential steps to ensure your claim is thorough and effective:

1. Confirm coverage

Start by confirming you have STD coverage through your employer or an independent insurance policy.

2. Notify your employer

Inform your employer about your disability as soon as possible. They will provide you with the necessary forms and instructions for filing a claim.

3. Get a diagnosis

Consult with your doctor to obtain a clear diagnosis of your condition. A well-documented medical diagnosis enhances the validity of your claim.

4. Gather medical documents

Collect comprehensive medical documentation from your healthcare provider. This should include details about your diagnosis, symptoms, treatment plans, and how the condition affects your ability to work.

5. Complete the application form

Carefully complete the application forms for STD benefits provided by your employer or insurance company. Ensure all sections are filled out accurately to reflect the impact of your disability on your work capabilities.

6. Submit your application

Submit your completed application form along with all necessary medical documents and any other required information to the insurance company or your employer’s HR department.

7. Follow up

Regularly follow up on the status of your application. Be prepared to provide additional information if requested by the insurance company.

8. Review decision

Once a decision is made regarding your claim, review it carefully. If approved, make sure you understand the terms, amount, and duration of the benefits.

6. Seek legal advice

If your STD claim is denied, contact the Ontario STD disability lawyers at Samfiru Tumarkin LLP for a FREE consultation. Our experienced legal team can help you navigate the legal process and work towards securing your STD benefits or compensation from your insurer.

Our firm has spent decades successfully advocating on behalf of thousands of Canadians and winning STD benefits when their disability claims are denied.

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Why are STD claims denied in Ontario?

Short-term disability claims in Ontario can be denied for several reasons:

• Insufficient Medical Evidence: Lack of comprehensive medical documentation supporting the disability claim.
• Pre-Existing Conditions: The disability is related to a condition that existed before the coverage began, which may be excluded from the policy.
• Failure to Meet Policy Definitions: The medical condition does not meet the insurance policy’s definition of a disability.
• Incomplete Application: Missing or incorrectly filled out forms and required documentation can lead to denial.
• Non-Compliance with Treatment: Not following prescribed medical treatments or failing to attend medical appointments.
• Late Filing: Submitting the claim after the deadline specified in the insurance policy.
• Insufficient Work History: Not meeting the employment duration requirements set by the policy.

Understanding these common reasons can help in preparing a thorough and accurate claim, reducing the likelihood of denial.

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What happens if my STD claim is denied in Ontario?

If your STD claim is denied in Ontario, don’t lose hope. The first step in this challenging situation is to contact Samfiru Tumarkin LLP, a trusted name in handling STD claims effectively and compassionately. Our experienced STD lawyers in Ontario are equipped to offer strategic advice tailored specifically to navigate the complexities of your case.

A denial can be disheartening, especially after investing significant effort in gathering necessary documents to support your claim. However, it’s not the end of the road. Immediate action is essential. By reaching out to our team, you ensure that your case receives the attention and expertise it requires. While appealing the denial through your insurance company is an option, it is often not the most advantageous one for several reasons.

Choosing Samfiru Tumarkin LLP means choosing a proven, strategic approach. Our dedicated team specializes in managing disability claims across Ontario and Canada, providing personalized guidance and unwavering support throughout the process. Remember, you’re not alone. We are committed to fighting for your rights, ensuring that you receive the benefits you rightly deserve, and making the journey as stress-free and successful as possible.

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How to appeal an STD claim denial in Ontario

We understand how disappointing and challenging it can be when your short-term disability (STD) claim is denied. It might feel like a setback, but remember, you still have options.

One such option in Ontario is the STD appeal process offered by the insurance company. At first glance, this might seem like a promising route — a chance to present your case again, hoping for a favourable reevaluation.

However, you’re asking the very same entity that denied your claim to overturn their own decision. Based on our extensive experience, successful STD claim appeals are rare. Insurance companies often use the appeal process to wear you down and eat up the limited amount of time you have to file a legal claim for proper compensation.

Having a knowledgeable ally in your corner, like an STD lawyer at Samfiru Tumarkin LLP, can improve your chances of winning your benefits or compensation.

If you have been denied STD in Ontario, call our team for a FREE consultation before you file an appeal with the insurance company. Once we review your situation, we will tell you if filing a legal claim is a stronger option than spending time submitting multiple appeals.

If you do decide to file an STD appeal in Ontario, here’s a guide to help you through it:

1. Understand the reason for denial

Begin by carefully reading the denial letter. It will provide specific reasons why your STD claim was denied. This information is crucial for your appeal.

2. Get to know your policy

Try to understand the key parts of your insurance policy, especially those that talk about how you can appeal a denial. Make sure you are clear about the timelines you need to follow.

3. Collect more information

It might be helpful to gather more medical information or opinions that support your claim.

4. Write an appeal letter

Write a letter explaining why you think the denial was wrong. Try to be as clear and simple as possible.

5. Submit your appeal

Make sure you send your appeal and any extra information as soon as possible, keeping within any deadlines.

6. Keep track of your claim

Be sure to check on the status of your appeal. It’s also important to be ready to give any extra information to the insurance company if they ask for it.

7. Contact Samfiru Tumarkin LLP if you lose your appeal

If your appeal for STD benefits isn’t successful, don’t lose hope. Contact our team immediately for a FREE consultation to find out what your next steps should be.

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Our experience, your advantage

Some of our lawyers once worked for insurance companies. We know how they think, why they deny legitimate disability insurance claims from people who are too sick or injured to continue working – and we know how to obtain the compensation you are legally entitled to.

Because our firm has a leading reputation in Canada as effective and tenacious advocates, insurance companies are more likely to pay you what you are rightfully owed. Don’t walk away from your rights. That’s what the insurance company wants you to do. Contact us for a free review of your case, and get the answers and assistance you deserve.

The disability lawyers at Samfiru Tumarkin LLP are nationally recognized leaders in insurance and disability law. We provide the public with access to their legal rights through programs like our ongoing Disability Law Show on TV, online resources (including FAQs on long-term disability), livestreams, more than one thousand media interviews, and constant advocacy.

Contact Canada’s most positively-reviewed disability law firm today at 1-855-821-5900 for a free consultation. You can also submit any questions you have about your STD rights to help@disabilityrights.ca, and a short-term disability lawyer at Samfiru Tumarkin LLP will answer them promptly.