Long-term disability laws in Canada offer many protections to individuals who develop an illness or injury that prevents them from being able to work for a long period of time.

What Are the Long-Term Disability Requirements?

When a person suffers an injury, illness or other disability that prevents them from working, they may qualify for long-term disability payments. Long-term disability payments generally begin once a person exhausts their short term disability insurance, sick leave benefits, and EI benefits. Most long-term disability payments will replace approximately 60 to 70 percent of your regular income.

The requirements to qualify for long-term disability payments depend on the terms of your insurance policy.

Who Pays Long-Term Disability?

In Ontario, there are four different types of long-term disability coverage. Depending on the type of coverage you have, long-term disability payments may be provided by a long-term disability insurance provider, the Workplace Safety and Insurance Board, Canada Pension Plan Disability Benefits, or the Ontario Disability Support Program.

Long-term disability coverage from a private insurance company is provided through a contract. It can be provided through your employer or you may obtain private coverage on your own. The long-term disability insurance contract will govern your rights and responsibilities under the plan.

The Workplace Safety and Insurance Board is a type of government insurance that employers pay into. This insurance policy provides coverage to employees who are disabled due to work-related injuries.

Canada Pension Plan Disability Benefits provide coverage that extends from the time of your injury into your retirement. Once you reach the age of 65, the CPP coverage will turn into a regular pension. The long-term disability payments you receive from CPP depend largely on how much you have contributed to the CPP. All Canadian workers are covered by the Canada Pension Plan.

The Ontario Disability Support Program provides coverage for individuals who have not been able to enter the workforce due to a disability or who have significant financial needs when they become injured. To qualify for this type of coverage, an individual must provide proof of their financial need.

In Canada, most long-term disability payments are from the Canada Pension Plan and private long-term disability insurance companies.

What Are the Long-Term Disability Laws?

In Canada, the Canada Pension Plan is typically treated as the first payer of long-term disability payments by private insurance companies. CPP benefits are typically deducted from the amount the private insurance company pays. This payment situation is permitted under the Canada Pension Plan Act and the Canada Pension Plan Regulations. These laws also allow private insurance companies that have advanced payments to individuals who are waiting for their CPP application approval to be reimbursed directly by CPP once the applicant’s CPP claim is approved.

Private insurance companies are also required to act in good faith when making decisions about long-term disability payments. Insurance companies are typically motivated to keep their costs down and may make bad faith long-term disability insurance denials or require policy holders to jump through unreasonable hoops to get benefits.

If you believe you had a legitimate claim for long-term disability denied, or if you suspect your benefits were wrongfully reduced or terminated, it is a good idea to seek a legal consultation to find out what you can do to protect yourself and get the full amount of compensation you deserve.

How Do the Long-Term Disability Laws Protect Me?

Long-term disability laws protect individuals in several ways, regardless of the type of long-term disability coverage you have. 

Employers are required to take reasonable steps that are necessary to accommodate your disability. These accommodations can take a number of different forms depending on your specific situation. However, there are limits to the types of accommodations your employer may be required to make, such as if the measures would be unduly expensive or disruptive to the business.

Individuals with disabilities are also entitled to basic dignity. Long-term disability laws require employers and service providers to respect the right to privacy about their medical condition, and to refrain from requiring unreasonable measures that may be considered degrading, such as unnecessary drug testing.

Long-term disability coverage providers are prohibited from discriminating against individuals based on age, sex, pregnancy, or marital status when determining which benefits you receive.

If you are receiving long-term disability payments, you may be required to undergo medical examinations and treatment as part of your plan of care. This process helps to ensure that you are receiving proper care for your condition and also allows the long-term disability coverage provider to verify your physical status. However, long-term disability laws designate a right for individuals not to go through unnecessary medical examinations.

If you believe your rights have been violated, check your policy for how to make a complaint or file an appeal. You can also submit a human rights complaint with the Ontario Human Rights Commission.

A long-term disability lawyer may also be able to assist you.

Why Was My Long-Term Disability Denied?

There are many reasons why a claim for long-term disability payments might be denied. Insurance companies typically have strict requirements, such as visiting a specific doctor, submitting detailed documentation about your condition, and requiring regular monitoring by a medical professional.

If your insurance company has denied your benefits, the letter should explain the reason. Unfortunately, insurance companies do not always operate in good faith when they deny a claim. If you believe your benefits were wrongfully denied, reduced or terminated, contact a long-term disability lawyer for a consultation.

Do I Need a Long-Term Disability Lawyer?

If your long-term disability payments were reduced or denied, a lawyer can help evaluate your policy and the stated reasons for denial or reduction of payment. A long-term disability lawyer is knowledgeable about the law and can help you put together the necessary evidence and other documentation to support your claim so you can get the compensation you deserve. Submit your information now to see if you qualify for a free legal consultation.