COVID-19 and Short-Term Disability Claims

On March 17, 2020 the Government of Ontario enacted an order declaring an emergency under the Emergency Management and Civil Procedures Act to try to prevent further spread of the novel coronavirus and to protect the health and safety of its citizens. The order has been extended multiple times.

What is Short-Term Disability Insurance?

Short-term disability (STD) benefits are meant to provide you with income replacement for a fixed period of time. Usually there is a short waiting period before benefits begin (i.e. 1 or 2 days). STD benefits can be paid anywhere from 15 to 26 weeks on average, depending on your policy. Most policies typically pay between 55-75% of weekly earnings.

What is COVID-19?

COVID-19 is a coronavirus, which is a large family of viruses that causes illnesses ranging from the common cold to more serious respiratory infections like bronchitis, pneumonia or severe acute respiratory syndrome (SARS). COVID-19 is a novel coronavirus which was not previous seen in humans before.

Currently, there are no specific treatments or vaccine to protect against coronaviruses.

Coronavirus has been added as a designated disease reportable under Ontario’s public health legislation.

Who is Most at Risk?

The current risk to Canadians for contracting COVID-19 is considered high.

The symptoms of the coronavirus can be mild to severe. People who are at risk for severe cases include those with weaker immune systems and with chronic diseases such as diabetes, cancer, heart, renal or chronic lung disease. Complications from COVID-19 can lead to serious conditions like pneumonia, kidney failure (and in some cases, death).

Employees who are particularly vulnerable to contracting COVID-19 due to pre-existing disabilities, illnesses or conditions may be feeling distressed about the virus due to their higher risk of contracting the virus.

Someone who contracts the virus may experience a prolonged recovery and require an extended period of time off work.

​Those who experience mental health conditions such as anxiety disorders may also be experiencing exacerbations of their symptoms. First responders/front line responders and medical/health care workers may be experiencing increased stress, traumatic stress, overwhelm and other psychological symptoms during this time.

Applying for STD Benefits

Employees who contract COVID-19 or are affected by it may be eligible to claim benefits under a salary continuance/short-term disability (STD) benefits plan.

Obtain a copy of your policy (if you can)

If you don’t already have a copy of your benefits booklet or STD policy, or access to it, you should request it so you can be familiar with the terms of your policy and know who the key contacts are and what is required on your part in the event of a claim.

What are salary continuance/STD benefits?

Salary continuance/STD plans are meant to provide income replacement for a time-limited period during illness or injury and benefits can last anywhere from 15 to 52 weeks.

What does “salary continuance” mean?

Under a salary continuance plan, your employer continues to pay you if the insurer advises them you meet the test for totally disabled under the policy, this is known as an “administrative services only” policy.

Is there a waiting period?

There may be a short waiting period before benefits start, depending on your policy which can be 1 day or 1 week. Some policies waive the waiting period for hospitalizations or certain illnesses.

How are benefits calculated?

Benefits are based on a percentage of your weekly earnings (can be from 50% to even 100% of weekly earnings) and are usually taxable.

How do I apply?

The application package typically consists of 3 documents; the Employee/Member Statement, the Attending Physician’s Statement and the Employer/Plan Sponsor Statement.

You are responsible for making sure an application is submitted within the required timelines (if possible).

The Employee Statement is the document you are required to complete and is where you can indicate the nature of your illness/injuries and why you are unable to work, in your own words.

The Attending Physician’s Statement should be completed by your primary treatment provider and is where your doctor provides medical evidence of your inability to work and may also include clinical notes and records to support your application.

The Employer Statement is required by the insurance company in order to calculate your benefits.

What if My Claim is Denied?

​A denial of benefits can occur at any stage of the claim, whether at the initial application or while you are on claim. You can appeal the insurer’s decision through their internal process however you do have the right to retain a lawyer to commence a legal action against them.

If your claim for salary continuance benefits or short-term disability benefits has been denied, it is important to seek legal advice so you can be aware of any limitation periods (deadlines to commence a lawsuit) and be informed of your rights.