Short-Term vs. Long-Term Disability: What’s the Difference?

Disability insurance is essential for protecting your financial stability if you are unable to work due to illness or injury. In Ontario, understanding the differences between short-term and long-term disability benefits is crucial for making informed decisions about coverage and knowing what to do if your claim is denied. This blog will explain how each type of disability insurance works, who qualifies, and how a lawyer can help when claims are denied or delayed.

What is Short-Term Disability in Ontario?

Short-term disability benefits offer temporary financial assistance to individuals who cannot work due to a medical condition. Here’s what you need to know:

• Duration: Most short-term disability policies provide for a few weeks up to six months of benefit entitlement, providing income replacement during the recovery period.
• Coverage Amount: These benefits generally cover a portion of your income, often between 50-85%, depending on the specific terms of the insurance policy.
• Qualifying Conditions: To qualify, you need to provide medical documentation that confirms your inability to work. Conditions that commonly qualify include injuries from accidents, surgeries, serious mental health concerns, or short-term illnesses like pneumonia or severe flu.

Short-term disability is often included as part of an employer’s benefits package. If it’s not available through your workplace, you may consider purchasing individual coverage. The Canadian government also provides for “Sickness Benefits” through Service Canada’s Employment Insurance program.

What is Long-Term Disability in Ontario?

Long-term disability benefits come into play when an individual’s health condition prevents them from working for an extended period. Here’s how LTD differs from short-term disability:

• Duration: Long-term disability (LTD) coverage sometimes starts once short-term benefits end and can continue for several years, sometimes up to age 65 or beyond, depending on the policy.
• Coverage Amount: Long-term disability benefits usually replace a smaller percentage of income compared to short-term benefits, typically ranging from 30-70%.
• Qualifying Conditions: While medical documentation is also required, the criteria for long-term benefits can be more stringent, often requiring proof that you are unable to perform any type of work, not just your current occupation.
• Exclusions: Oftentimes an LTD policy will provide for an exclusion for pre-existing conditions. In these cases, the insurance company may be relieved from paying a monthly benefit if the policyholder who is disabled due to a medical condition that existed before insurance was put in place. This exclusion usually does not apply where policyholders have been insured for a certain period of time (usually one year).

Long-term disability insurance can be provided through an employer or purchased as an individual policy. It’s crucial to understand the specific terms, as policies can vary significantly.

Key Differences Between Short-Term and Long-Term Disability

While both short-term and long-term disability insurance aim to provide financial support during periods of illness or injury, their coverage, duration, and eligibility requirements differ. Short-term disability serves as immediate financial relief for illness and/or injury when you are unable to work. Whereas, long-term disability provides financial support to individuals who have been consistently unable to work for a prolonged period of time. Most LTD policies contain a ‘waiting period’ before which no LTD benefits are payable.

Who Qualifies for Disability Benefits in Ontario?

Eligibility for disability benefits in Ontario generally depends on several factors:

1. Medical Documentation: You will need a physician’s report detailing your condition and explaining how it affects your ability to work.
2. Policy Terms: The specific requirements for qualifying are outlined in your insurance policy, which should be reviewed carefully to ensure compliance. Ordinarily, policies require a person provide evidence that they are disabled from performing the essential tasks of their own occupation;
3. Employment Status: Most disability insurance policies require you to be employed at the time of becoming disabled. Some policies may cover those who recently left their jobs under certain conditions.

Understanding the criteria for short-term and long-term disability benefits is crucial, as failing to meet any of the requirements can result in a denied claim.

What Happens if Your Disability Claim is Denied?

Disability insurance claims can be denied or delayed for several reasons, such as insufficient medical evidence, administrative errors, missed deadlines, or disputes over policy terms. If you receive a denial, it’s important to be proactive. A lawyer can help you navigate the process by gathering additional evidence and preparing a strong case to improve your chances of having your benefits approved.. They can also clarify the complex language in insurance policies, ensuring you understand your rights and obligations. If the insurance company  refuses to pay your claim, legal representation may be necessary to escalate the matter so that you obtain the benefits you deserve.

How Can Aaron Waxman and Associates, P.C. Help?

Aaron Waxman and Associates, P.C. recognizes the stress and financial burden that denied disability claims can impose. Our legal team is well-versed in Ontario’s disability laws and can provide support throughout the claims process. We offer a free consultation to assess your case and determine the best approach. If your claim has been denied, we will advance your claim via the issuance of a lawsuit and ensure all necessary documentation is complete and submitted to the insurer in accordance with your policy. In cases where negotiations with the insurance company do not resolve the issue, we are prepared to represent you in court to pursue the benefits you are entitled to. Our commitment is to help you secure the financial support you need during difficult times.

Conclusion

Understanding the differences between short-term and long-term disability benefits in Ontario can help you make informed decisions about your coverage. Whether you are dealing with a short-term disability claim or a long-term disability matter, knowing your rights and options is essential. If your disability claim has been denied or if you need assistance understanding your insurance policy, Aaron Waxman and Associates, P.C. is here to help. Contact us at 416-661-4878 or awaxman@awaxmanlaw.ca for a free consultation.