top common misconceptions about long-term disability benefits

there are numerous myths and misconceptions about long-term disability benefits – so let’s uncover them!

by nainesh kotak

published dec 12, 2024

3 minute read

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3 minute read

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how long you are entitled to receive long-term disability benefits depends on the wording of your insurance policy. getty images

there are numerous myths and misconceptions about long-term disability benefits. so let’s uncover some of those myths!

myth #1: canadians believe is that long-term disability (ltd) benefits provide 100 per cent of their pre-disability income.

however, the truth is that benefits typically provide a percentage of your pre-disability income, which can help cover living expenses while you are unable to work.

most ltd insurance policies pay between 60 and 80 per cent of your pre-disability income. the exact amount varies according to your policy and the severity and type of disability.

myth #2: ltd benefits only last a certain period of time.

that is true, to a point. how long you are entitled to receive long-term disability benefits depends on the wording of your insurance policy. most policies provide for disability payments up to age 65, if you meet the definition of total disability. some policies have shorter benefit periods and a few provide for payments beyond age 65.

you must have completed the required waiting period, also known as the elimination period, which is the time you must be continuously disabled before you are eligible to receive ltd benefits. this period is typically specified in your insurance policy and can range from 90 to 180 days.

myth #3: if your disability claim is denied, there is no recourse.

one of the most common reasons for the denial of long-term disability claims in ontario is insufficient medical evidence. insurance companies require comprehensive documentation from healthcare providers to substantiate the severity and impact of the disability. if the medical records are incomplete or do not clearly demonstrate the extent of the disability, the claim is likely to be denied.

another frequent reason for denial is the failure to meet the policy’s definition of disability. each insurance policy has specific criteria that define what constitutes a disability. if your condition does not align with these criteria, the insurance company may reject your claim.

whatever the reason for your claim denial, disability insurance companies may offer an internal appeal process. however, often it is waste of time, as insurers rarely change their decision through this appeal. a more effective solution may be to have a disability lawyer commence a lawsuit against the insurance company.

an experienced disability lawyer will thoroughly review the initial claim and the insurance company’s denial letter. this helps to understand the insurer’s rationale and pinpoint any weaknesses or gaps in the original application that need to be addressed.

myth #4: you are required to participate in assessments or a return-to-work plan, if requested by the insurer.

it is true that insurers may request an independent medical examination. being prepared for these examinations by understanding what to expect and providing consistent information can help ensure that the ime supports your claim.

as for a return-to-work plan, no injured employee should be punished for a failed attempt to return to work, but that too often happens.

a return-to-work attempt could prove premature if it re-aggravates your injury or prompts a relapse of your medical condition. recoveries don’t always progress in a straight line and setbacks are to be expected.

when insured people seek legal expertise following a reinstatement denial as a result of a failed return to work, the next steps can be to obtain updated or fresh assessments from their medical providers, in order to support their claim of a recurrent disability.

sometimes, a failed return to work actually ends up being very good for your legal case, since it demonstrates to your insurer your willingness to resume some form of employment.

nainesh kotak, is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he also serves as the chair of the long-term disability section of the ontario trial lawyers’ association.