What is Long Term Disability in Canada?

Long term disability insurance in Canada covers health conditions that leave you unable to work for an extended period of time; however, the specific definition of “disability” will vary depending on your insurance company and the plans offered, according to the Government of Canada.

According to the Government of Canada, long term disability generally kicks in after benefits under short-term disability or the Employment Insurance (EI) program ends.

According to the Mood Disorders Association of Ontario, “Long-term disability (LTD) insurance is designed to provide replacement income should you become disabled from work. Often, LTD coverage is bundled together with short-term disability coverage (which may cover, for example, only the first six months of disability) under a group insurance plan provided through your employer. If you have a private life or accident and sickness policy, you may have LTD coverage as well.”

The advocacy organization goes on to point out that LTD coverage generally provides benefits for any type of injury that leaves the policyholder unable to work. Most policies use the term “total disability” to describe conditions that leave policyholders unable to work; however, the Mood Disorders Association points out that “total disability” does not require a person to be completely debilitated in order to access their benefits.

Instead, policyholders must establish that they are unable to reasonably complete or participate in their job functions in order to effect a cure of the condition or prolong life.

Long term disability qualifications in Canada can depend on the following factors:

• Occupation, whether it is regular or your own
• Offsetting benefits, such as other insurance plans
• Your medical condition

Some may wonder, “does mental health qualify for long term disability” or “what does long term disability insurance cover”? It can, unfortunately, be more complex to make a claim for long term disability insurance for a mental health condition than a physical one.

How Does Long Term Disability for Mental Health Work?

According to Global News Canada, one in three workplace disability claims concern an individual’s mental health. However, getting a long term disability claim for mental health conditions approved can be difficult.

To make any disability claim, workers must establish that they cannot work and are permanently disabled due to an injury or illness. Supporting documentation from a medical professional, such as a person’s family doctor, is often used to support long term disability claims. Experts tell Global News Canada reporters that this type of documentation may not be enough for a claim related to a mental health condition.

How Do I Qualify for Long Term Disability for Mental Health?

Long term disability rules vary depending on the insurer, but experts recommend that those making a claim for a mental health condition be sure that their doctor describes the condition in terms of the claimant’s job description and provide a medical diagnosis.

For long term disability mental health claims, the medical diagnoses should be based on the Diagnostic and Statistical Manual of Mental Disorders. Experts also recommend getting a referral to a specialist to build a stronger case. 

How Can I Apply For Long Term Disability for Mental Health?

Those who wish to make long term disability mental illness and related claims should start by carefully reading and understanding their insurance policy. You should understand what “total disability” requires under your insurance policy.

Claim processes vary for each policy, but all require documentation supporting the claim, including medical records. Experts warn that, for mental health-related long term disability claims, claimants should anticipate some push back, either in the form of a denial or request for more supporting documentation. An experienced long term disability lawyer can help you through this process.

Experts have identified a number of tips for those who are applying for long term disability benefits for a mental health condition.

Long term disability for anxiety claims should keep in mind there are five major types of anxiety disorders that are diagnosed, including, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobias, and post-traumatic stress disorder. Documenting evidence of an anxiety disorder can be difficult because it can be based on subjective criteria on behaviors that occur outside of a medical setting. However, it is estimated that anxiety disorders result in a $50 billion hit to Canada’s economy in the form of lost productivity each year.

What is the Long Term Disability Elimination Period?

A long term disability elimination period refers to the time a policyholder must wait before receiving benefits after making a claim. The amount of time depends on the policy, but is usually approximately 17 weeks.

How is Long Term Disability Calculated?

Long term disability is meant to replace your monthly income if you are unable to work due to your disability. The exact amount will be dependent on your income and the terms of your long term disability policy along with other sources of income, such as Employment Insurance benefits.

How Difficult is it to Keep Long Term Disability Benefits?

Certain disabilities require that the policyholder provide evidence that they continue to suffer from the disability and that they are unable to work. Called the “change of definition,” most policies require after two years that policyholders demonstrate that their disability makes them unable to participate in any type of work, rather than the occupation they had before their disability.

For some mental health conditions that result in hallucinations, paranoid behavior, or other behaviors, establishing an inability to work in any occupation can be straightforward. Other claims, such as a long term disability depression claim, ongoing documentation of the mental health condition will be required.