Denied or Cut off Long-Term Disability Benefits?

7 Tips for Pursuing Your Disability Claim

Tip 1 - Do Not Quit Your Job!

If you are unable to perform your regular work duties due to injury, illness or sickness, do not quit your job.

Instead, book an appointment with your family physician or a walk-in clinic and request a medical note for your employer.

Tip 2 - STD benefits (Short Term Plan) or Medical EI

If you are an employee and part of a group benefit plan, ask your employer/HR manager for an application form to apply for Short-Term Disability benefits.

If you do not have a short term plan then apply for Medical Employment Insurance benefits through Service Canada at https://www.canada.ca/en/services/benefits/ei/ei-sickness/apply.html

If you are injured at work, apply to WorkSafe BC at https://www.worksafebc.com/en.

If injured in a motor vehicle accident, apply to ICBC for wage loss benefits at https://www.icbc.com/claims/injury/Pages/default.aspx.

If you are a professional or self-employed, ask your broker for assistance making an application for income replacement benefits under an individual policy.

Tip 3 - Get Informed

Gather together a copy of your employment contract (if any), written work policies concerning medical leave, sick leave, or disability, collective agreement booklet or plan wording, employee benefit booklet, and group plan insurance policy wordings or individual plan policy wordings.

Review and note any terms or requirements that may apply to you taking extended time off work for illness or injury.

If you are a member of the union, set up an appointment with your union representative to discuss all steps required to make a claim or pursue an appeal under the terms of the collective agreement. The union may be your advocate or appoint legal counsel to represent you in the process.

If you do not have a complete copy of the disability benefit plan or insurance policy wordings, request a complete copy from your employer or union.

Tip 4 - Make Application for Long-Term Disability Benefits

Whether you are approved for Short Term benefits or Medical EI benefits or not, if you continue to be unwell and unable to return to your usual or regular work duties, or your doctor recommends you remain off work, you must apply for Long-Term disability benefits.

Obtain the LTD application forms from your employer/ HR manager or broker usually within 4 months of your last day worked (up to 1 year or longer for some union plans).

If you do not have LTD benefits, apply for CPP Disability benefits from Service Canada if your disability is severe and prolonged such that you are unlikely to work again at https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit.html

In other cases, apply for provincial programs as available such as Persons With Disabilities benefits at https://www2.gov.bc.ca/gov/content/family-social-supports/services-for-people-with-disabilities/disability-assistance

Tip 5 - Medical Follow Up

Most disability plans and policies require you to remain under the regular care of a physician and to engage in customary treatment for your disability.

Some policies also provide rehabilitation benefits or requirements to participate in a return to work program where appropriate.

If you do not have a proper medical diagnosis for your disability, ask your family doctor to refer you to other medical specialists or for testing as needed.

A working diagnosis is typically required by the insurer before they will approve benefits.

Tip 6 - Be Proactive

Do not expect the disability insurer to look out for your interests.

The insurer does not have to prove your claim, you do.

You must be proactive and an advocate for yourself, making sure you gather and submit your medical records and medical opinion needed to prove your claim at your cost.

If your application is incomplete, vague, or lacks supportive medical opinion as to why you cannot work due to ongoing disability, you may be denied benefits.

If the diagnosis and prognosis suggests you will not work again, then you need to apply for CPP Disability benefits whether or not you have received the other benefits.

Tip 7 - Do Not Delay!

If your application for any benefit has been denied or cut off by an insurer, trust, or government program, you must take steps to appeal that decision within the deadline provided.

WorkSafe BC and Service Canada will provide you with an appeal deadline in their denial letter.

If you are in a union, there may be time limits to appeal to a labour relations board, a medical review panel, or a claims review committee hearing.

There are also time limits for filing an action in court against an insurer or trust plan where allowed. In general, it is two years from the date you were last paid, or ought to have been paid, or the date of the denial, whichever is earlier.

Some plans or policies may extend this date beyond the two years, but most do not.

Do not miss these deadlines! If you do, you may be prevented from pursuing or collecting your benefits even where you have been wrongly denied.

If you are uncertain how to proceed, call for a FREE initial legal consultation, and protect your right to compensation.

If you have any questions please call Scott Taylor, at (604) 534-6361 or scott@thetlg.ca.