To receive benefits under the definition of long-term disability, one must meet the criteria. In Canada, there has been significant dispute over what long-term disability means. Numerous court cases have been launched by parties who have been wrongfully denied benefits. There are accusations that they do not meet the criteria for ‘long-term disability.

Here is everything you need to know about how long-term disability is interpreted in Canada.

What is Long-Term Disability?

To put it briefly, long-term disability is defined as a severe and prolonged disability that prevents you from returning to work on a regular or semi-regular basis.

The severity of a disability refers to how the condition impacts one or more areas of functioning. When functioning is reduced, and a person’s performance of basic life activities is limited, severity is noted. Common challenges individuals with severe disabilities face include:

  • cognition
  • communication
  • mobility
  • gross motor skills & fine motor skills
  • self-help
  • impairments in hearing or visually
  • social and emotional skills.

Evidence of Long-Term Disability

A prolonged disability is considered long-term and indefinite or likely to result in death. There is no definition of what ‘prolonged’ means, nor is there a specific amount of time given. It is ultimately open to the interpretation of the parties involved as to whether a disability fits the definition of ‘prolonged’ and ‘long-term.’

What Medical Conditions Qualify

Long-term disability is not just for people who have been injured in a work accident. Many medical conditions can entitle someone to receive disability benefits in Canada. They include but are not limited to bipolar disorder, cancer, chronic fatigue syndrome, Crohn’s disease, degenerative disc disease, fibromyalgia, HIV/AIDS, lupus, multiple sclerosis, and others.

How Long-Term Disability Works

Most long-term disability insurance plans will replace up to 70% of your income. In the first two years, disability benefits are provided under one criterion. The primary component of this criteria is an inability to return to the role you occupied before being disabled.

After twenty-four months, to continue receiving disability benefits, one must provide evidence their disability reduces their ability to work any job at their current employer.

What Does Unable To Work Mean?

To be on long-term disability, one must be unable to work any job you are reasonably suited for. An applicant may be denied benefits because they can do some of their work or work at a desk, for example, if they cannot do more physically-demanding tasks. If you can work in a different job with your disability – assuming you have the training, education, and experience for that role – you will not qualify for long-term disability in most cases.

Long-Term Disability Exclusions

There are exclusions as it relates to long-term disability. Some insurance policies use pre-existing conditions as an exclusion. In other cases, mental and nervous conditions and alcohol and substance abuse-related conditions are exclusions.

Lesser-known exclusions include suicide attempts, normal pregnancies, and intentional acts causing disability. An argument can still be made that one can qualify for long-term disability even in certain contexts with exclusions, assuming there’s evidence of a limited ability to work and that a lawyer agrees.

When to Apply for Long-Term Disability

Long-term disability benefits apply only after your employer’s EI benefits, sick leave benefits, and short-term disability benefits have been collected. When these run out, one can apply for long-term disability.

A long-term disability term varies according to the policy. If needed, based on the individual terms and the type of disability claim filed, a person can be on long-term disability between two and ten years. Fortunately, there are lots of disability financial support systems in addition to insurance that are worth applying for, including provincial disability support and CPP long-term disability support programs.

How to Apply for Long-Term Disability

When you apply for long-term disability, you make a claim that must be supported with medical records, lab tests, and medical and non-medical documentation. It can be a struggle getting approved for long-term disability, at times, due to a lack of documentation, a misclassification of your illness or condition, or an insurer insisting your disability is not as bad as you’ve reported. Fortunately, if your long-term disability is denied, you can speak to a long term disability lawyer.

A long-term disability lawyer has experience in how to appeal a claim. They can obtain the documentation and assessments you need to move forward, and they can provide a lot of support as you navigate what can feel like a complex, high-stress process towards being approved. Suppose you believe you have a case for long-term disability and have been denied on a technicality or feel as if your application was wrongfully dismissed. In that case, a long-term disability lawyer can go over your unique circumstances with you and provide guidance on the next steps are.

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