Short Term Disability Ontario: Know Your Rights

Short Term Disability Ontario

Short-term disability insurance is an income replacement for employees while away from work for a brief, defined period and are unable to perform their own job due to disability or illness. Read on to learn about your options regarding short term disability.

Who qualifies for short-term disability?

As long as an employee has short-term disability benefits coverage at the time they become disabled, they are qualified to receive short-term disability benefits. The medical conditions covered by a policy range from physical to psychological, cognitive, or emotional. Many group benefits plans include short-term disability benefits. To confirm whether you have coverage, you should review your group benefits policy.

How much does short-term disability insurance pay?

The amount of your short-term disability benefits is dependent on your plan. There are some that offer a full income replacement; however, many only cover a portion of your salary. The short-term disability benefit may range from 60% to 100% of your salary.

How long can you stay on short-term disability?

The duration of short-term disability benefits is commonly up to 6 months of coverage, however it is dependent on the insurance policy. Some plans even cover up to 52 weeks of benefits.

How do I apply for short-term disability?

To apply for short-term disability, you will need to request the application forms from your employer or directly from the insurer. Often, the forms are made available online on the benefit provider’s website. There are 3 parts of the application that will need to be submitted:

  1. The Employee Statement;
  2. The Attending Physician’s Statement; and
  3. The Employer Statement.

You will need to fill out the employee’s statement and have your doctor fill out the attending physician’s statement. Your employer will need to fill out the employer’s statement. It is important that all 3 parts of the application are completed and submitted to avoid delays in your application being processed.

Once your application is received by the insurer, they will assign a case manager to make a decision about your claim. Often, the case manager will call you to ask about your symptoms, any points in your application they need clarification on, your treatment plan, and any medications you may be taking. Once they have finished gathering information, they will either decide to approve or deny your short-term disability application. You can expect to be notified in writing of their decision.

What if your short-term disability claim is denied?

An employee may be denied short-term disability benefits for many reasons, one of which may be that the insurer does not believe they are totally disabled and eligible under the short-term disability policy. Even if the employee has ample documentation to support their claim for benefits including medical records and doctor notes, it may be deemed insufficient.

A worker who has been denied short-term disability benefits has two options:

  1. The first option is to appeal the decision with the insurer. Typically, you can appeal up to 3 times, and each one must be done within 90 days of the decision (make sure to review the appeal deadline specified in the denial letter). It is important to note that unless your physician can provide significantly different documentation to support your claim, it may not the best choice to appeal the decision.
  2. The second option is to commence a lawsuit against the insurance company for wrongful denial of disability benefits. To achieve the best outcome, it is preferable to retain legal representation. This will take the stress off of you and allow you to focus on your recovery.

If your short-term disability application is denied, don’t waste time arguing in appeals with the insurer. Instead, you could hire an employment lawyer at Monkhouse Law to assist you with going through the Court, which is a higher authority. Be sure to act fast in consulting with us about your options given the insurer’s internal appeal deadlines and the legal limitation deadline of 2 years which will need to be considered.

Can I get both EI sickness benefits and short-term disability benefits?

You may be eligible for employment insurance sickness benefits while you are unable to work but you cannot receive EI sickness benefits and short-term disability benefit payments at the same time. If you do, you will have to repay the EI sickness payments you received. If your short-term disability benefits have ended, however, you may apply to receive EI sickness benefits at that point.

What if I was terminated while on short-term disability?

While an employee can be terminated while on disability leave or sick leave, provided you are given termination or severance pay, it is discriminatory under human rights legislation to terminate an employee due to their disability. Under the Human Rights Code of Ontario, an employer is required to accommodate an employee to the point of undue hardship.

If you are terminated from your job while on disability leave, you should contact a Short Term Disability Lawyer at Monkhouse Law as soon as possible for advice about your claims and whether the termination may have been discriminatory.

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