What you need to know about Long Term Disability Benefits

Paciocco & Mellow can assist you with your long-term disability claims. We have successfully helped many clients with their long-term disability claims. 

Our next post will discuss why it is important to have a lawyer represent you when you have a long-term disability claim. This post will provide you with a general overview of long term disability benefits (LTD benefits). 

 

What are LTD benefits? 

LTD benefits are a form of insurance that pays you a portion of your income if you become disabled and are unable to work. LTD benefits can be paid for by your employer, both the employer and employee or a self-employed person can take out a policy. 

LTD benefits can cover anywhere from 50% to 80% of your pre-disability salary. 

LTD benefits can be paid up to age 65, unless the plan has a limited time frame that states otherwise. 

Handwritten Insurance Claim Form with pen and calculator

Are LTD benefits taxable? 

It depends on who pays for the coverage. 

If the employer pays for the policy in full, the benefit is taxable. 

If the employee contributes to the LTD policy, the benefit is non-taxable.

 

When can I expect to receive benefits? 

It depends on your policy. There is an elimination period that can be up to 180 days (6 months).

 

What can I do until the elimination period is over? 

Some employers may offer short-term disability benefits. These benefits can be accessed after a shorter waiting period and can bridge the gap until you have access to LTD benefits. 

If you do not have access to other benefits, you can apply for EI Benefits or EI Sickness Benefits which can provide up to 15 weeks of benefits.

 

How do I know if I qualify for LTD Benefits:

If you are unable to do all the duties of your current job, or substantially unable to do them, you may meet the test for disability. 

You will need to consult your policy to find out what the exact definition of “disabled” is.

 

What does Completely Disabled mean? 

Some policies may use the term “completely” disabled or “totally” disabled, meaning that a person who was employed is no longer able to carry out their normal duties at work. 

This does not mean that you are physically disabled per se, but means that due to illness or injury, you are unable to work and it makes no sense to continue working as you must focus on recovery.  It is more of a ‘common sense’ definition.

 

What do the terms Own Occupation and Any Occupation mean? 

Most policies, for the first 24 months (2 years), use the “own occupation” test- meaning you are entitled to claim for long-term disability benefits under the policy if you are unable to perform the essential duties of your own occupation

After 24 months, the test becomes “any occupation”- whether you are able to perform any occupation for which you are reasonably qualified or could be reasonably qualified for by way of education, training or experience

It is important to review your policy, with your lawyer to determine at what point the “any occupation test” applies. Some policies may use the test from the outset. 

 

Can my insurer deduct other benefits from my monthly LTD payments? 

If you are in receipt of other monthly benefits such as WSIB (Worker’s Compensation Benefits), disability benefits received from the government (EI, EI Sickness Benefits, ODSP, CPP Disability Benefits), Criminal Injuries Compensation Board Benefits or any wages from your employer (termination or severance pay), your insurance company will reduce your monthly payment by these amounts. 

Why? Because most LTD policies have clauses that allow them to do so- in other words, it is written in the policy that they can deduct these amounts from your monthly payment.  Most LTD policies are actually intended to “top up” your other disability benefits (if you have access to other benefits). 

You should also be aware, that if you receive CPP Disability Benefits, and receive a benefit for your child/children, some LTD policies include this amount in what they are allowed to deduct from your monthly benefit. 

With respect to CPP Disability Benefits, in many policies, it may stipulate that an insured person has to apply for CPP Disability Benefits. 

Some insurers may be satisfied with an application that is denied, some insurers may require that an appeal be made. This is why it is important to have proper representation. The lawyers at Paciocco & Mellow can help you with your CPP Application. 

Be sure to review your policy carefully and always provide your lawyer with a copy of your policy so they can be sure that you are receiving the proper  monthly payment. 

The law firm of Paciocco & Mellow prides itself on its reputation of excellent service and client satisfaction. 

A long-term disability claim is an overwhelming process and we aim to provide reassurance to our clients. 

If you require help applying for long-term disability benefits, or if your long-term disability claim has been denied, please contact the experienced Windsor personal injury lawyers at Paciocco & Mellow at (519) 915-SORE (7673). We will be there to assist you with a free, no obligation initial consultation. 

The law firm of Paciocco & Mellow aims to help provide you with Peace of Mind at a Difficult Time.

Personal Injury Claims: Myths & Facts

Pursuing a personal injury claim may seem intimidating, that’s why it is important to hire the right lawyer. 

Previously, we discussed the importance of hiring an experienced personal injury lawyer, like the Windsor personal injury lawyers at Paciocco & Mellow. 

Here are a few myths that we want to put to rest about personal injury cases. 

Myth: You cannot attempt a return to work while your case is ongoing as it will damage your claim for income loss or pain and suffering. 

Reality: You may be eligible to participate in a work-hardening program, or a graduated return to work program if your pre-accident employer will allow for modified duties and modified hours. A work-hardening program will allow you to build strength and stamina to return to the workforce. 

Attempting a return to work, either at your pre-accident employer or attempting to find alternative employment by going to job interviews, submitting resumes or working with an employment agency shows both your accident benefits insurer and the at-fault party’s insurer that you are mitigating your damages. 

It does not mean you have made a full recovery or that your injuries or symptoms have disappeared, you may be returning to work out of financial necessity, therefore it does not affect your claim for pain and suffering. 

It does not have a negative impact on your claim for income loss. During your rehabilitation and recovery, you suffered a loss of income; this is your claim for past loss of income. You will also have a claim for future loss of income. Even if you return to work at a reduced capacity and are earning income, you continue to suffer a loss of future earnings. You are unable to work at the same capacity as before. 

Myth:  You have no case if you were at fault for the accident 

Reality: Under Ontario law, if you are involved in a motor vehicle accident, as a motorist, you are entitled to Statutory Accident Benefits (no-fault benefits) through your own insurer. 

Accident Benefits will provide you with immediate benefits- benefits such as medical and rehabilitation expenses, attendant care expenses and income replacement benefits. 

It is important to remember that income replacement benefits only cover 70% of your gross weekly income, up to a maximum of $400 per week. 

There are limitations on medical and rehabilitation expenses and attendant care expenses: 

  1. Minor injury – a maximum of $3,500 will be paid for medical and rehabilitation expenses (no attendant care expenses available);
  2. The “In-between” category- more serious injuries that require further rehabilitation – a maximum of $50,000 for medical and rehabilitation expenses, for up to 10 years after the collision and $36,000 for attendant care expenses;
  3. Catastrophic injury- a maximum of $1,000,000 in medical and rehabilitation benefits over your lifetime and $1,000,000 for attendant care. 

You must notify your insurance company within 7 days of the accident (or as soon as you are able to) and complete an application for accident benefits within 30 days of receiving the forms. The sooner you submit your application, the sooner you can expect to receive benefits. 

Myth: I have to be an occupant of an automobile to be eligible for no-fault accident benefits 

Reality: Pedestrians and cyclists who were injured in an accident involving a motor vehicle may also be entitled to accident benefits. They can claim accident benefits through a policy they are covered under (their own policy, spouse, or parent) or if they do not have access to an insurance policy, they will make a claim for accident benefits through the insurance company of the vehicle that struck them. 

If the accident involved a collision between a pedestrian and an automobile or a bicycle and an automobile, accident benefits are likely to be made available to the pedestrian or cyclist. 

Myth: You always have to go to court in order to settle your case 

Reality: There are alternatives to going to trial. In many jurisdictions, the courts are overbooked and as a result, trials are being booked 1-2 years in advance. There are also many risks to proceeding with a trial, such as whether or not there will be a jury and the expense of a trial.

 Your lawyer can engage in settlement discussions and arrange a settlement meeting with the insurers involved in your case to settle your claims. Some cases, if they are straightforward and if liability is straightforward can be settled at the adjuster level, without having to get defence counsel involved. 

A very popular option is mediation. Mediations is a welcome alternative to going to trial and many cases do settle at a mediation. A mediator is a neutral third party (usually a former lawyer) who helps facilitate settlement between the parties.  If you have commenced more than one action in the court, for example, a court action against the at-fault party, against your accident benefits insurer and long-term disability insurer, you could ask them all to participate in mediation, known as holding a “global” mediation. 

Myth: Insurance companies will treat you fairly, with or without a lawyer when it comes to negotiating a settlement 

Reality: Insurance adjusters/insurance companies will act differently when the offer a settlement amount to an unrepresented party than they would a represented party. 

Insurance adjusters too often take the view that unrepresented parties would not be aware of their rights or not understand what would encompass a fair settlement, be it a settlement for accident benefits or for a bodily injury claim (claim for damages from the at-fault party’s insurer). 

Having a personal injury lawyer represent you during settlement negotiations would allow you to know your rights and they will inform you what is a fair amount for settlement. You would be informed of what you are entitled to legally receive for accident benefits as an insured person. 

With respect to a settlement from the at-fault party’s insurer, having a lawyer negotiate a settlement for you provides an advantage.  A lawyer will take certain factors into consideration before negotiating a settlement including loss of income, any medical expenses or housekeeping expenses not covered by accident benefits as well as out of pocket expenses. 

It is better to go into settlement negotiations with an educated perspective. 

The lawyers at Paciocco & Mellow are here to help you with your personal injury claims. Do not hesitate to contact us for assistance with accident benefits claims, car accident claims or long-term disability claims. We are available to help you through your difficult time.