What is Long Term Disability? If you are injured or become sick to the point where you are unable to return to work, long term disability insurance provides you with some protection by providing you with a portion of your income over the period for which you are considered totally disabled and unable to work.
Short term disability provides you with replacement wages in the event that you are temporarily unable to work, whereas long term disability provides more permanent income replacement to assist with your total disability. An individual is considered totally disabled when he or she is unable to do some of the tasks of his or her occupation. A total disability does not mean absolute physical or mental inability to perform one’s duties.
In understanding your long term disability policy and the application process, it helps to start at the beginning, with the definitions of the two different types of disability that are covered in your policy:
1. Own Occupation
This category is for individuals who are disabled and unable to perform any of their regular duties at their own current position but may be able to work in a different occupation.
2. Any Occupation
This category is for individuals who are disabled and are unable to perform the regular duties of any occupation for which they are suited.
Many policies will initially categorize you as Own Occupation for a period of twenty-four (24) months. At the end of your Own Occupation coverage, there will be an assessment to see whether you are eligible to continue on long term disability benefits and thus moved into the Any Occupation category which would result in your benefits being discontinued because you are deemed able to work. Your benefits may also be discontinued at that time if you are not providing proper medical documentation in support of your claim.
If you were on long term disability and then cut off your benefits, you should contact us today at (416) 907-9249 for a free consultation because it may be that your LTD coverage ended too soon.
LTD Policy Clauses
In addition to the types of coverage you are entitled to, there are certain clauses within your LTD policy you should pay special attention to:
1. Pre-Existing Conditions
In many LTD policies, there may be clauses that exclude or restrict you from receiving benefits if you have a pre-existing condition. This is often included in policies in order to protect the company from a high claim payout. Typically, pre-existing conditions become an issue if a disability occurs a short time after coverage begins. The insurer may then investigate to see whether your entitlement to benefits is excluded.
2. Exclusions and Limitations
There is often a list of exclusions and limitations within your LTD policy. If any condition applies to you, you may not be eligible for benefits.
For example, some common exclusions are self-inflicted injuries such as alcoholism or suicide attempts.
3. Qualifying Period, Waiting Period or Elimination Period
This is the period of time between the onset of your disability and the time you are eligible for benefits. Once this period is satisfied, you will be eligible to receive your benefits at the end of the following month.
For example, if it states in your policy that there is a 90 day waiting period, this means you are four (4) months away from receiving your benefits.
If you have been denied long term disability or cut off from your long term disability benefits, it is important to meet with a long term disability lawyer to review your case. Contact Monkhouse Law today.