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In many Canadian group benefits plans, a non evidence maximum (NEM) quietly limits how much disability coverage you actually have, even if the policy advertises a higher percentage of your salary. If your long term disability (LTD) benefit is ever needed, this ceiling can reduce your benefit unless you applied for extra coverage by providing some health information.
You do not need to figure this out on your own—your disability lawyer will review your policy and tell you clearly if the NEM is affecting your case.
What Does “Non Evidence Maximum” Mean?
A non evidence maximum (NEM) is the highest amount of insurance an insurance company will approve for a plan member without asking for any medical evidence of good health. In plain language, it is the amount of LTD or life insurance benefit you get automatically, without filling out a medical questionnaire or going for tests.
The NEM usually appears in group disability insurance and group life insurance as part of a workplace benefits plan. Any coverage above the NEM is called excess coverage and usually requires providing medical evidence, such as a health questionnaire or other underwriting.
If you never apply for that extra amount, your insurance coverage may end up lower than you expected when you make a claim—but this is exactly the kind of issue your lawyer will check for and explain in simple terms. For example, if a salary of 50,000 with 66.67% coverage should pay about 2,777.92 per month, but the non evidence maximum is 2,000, the benefit would be capped at 2,000 unless the member was approved for excess coverage.
How Non-Evidence Maximums Work in Group LTD Plans
In a typical Canadian workplace LTD group benefits plan, you might see wording like: “66.7% of salary to a maximum of 6,000 per month, subject to a non evidence maximum of 2,500.”
For each plan member, this usually means:
Up to the non evidence maximum (for example 2,500/month):
Approved automatically when you join the plan, with no medical evidence needed.Above the NEM, up to the overall policy maximum (for example 6,000/month):
Only available if you submit medical evidence and are approved for excess coverage.
Other helpful details:
The NEM is set by the insurance company based on factors like group size, average salary, and overall risk; larger employers sometimes negotiate a higher NEM.
NEMs can apply to more than one benefit, such as LTD, short‑term disability, and group life insurance.
HR or your benefits booklet may invite you to apply for additional coverage above the NEM within a certain time after you become eligible.
If you feel unsure or worried, your lawyer can walk through these details with you and tell you clearly whether the NEM is actually affecting your benefit, or whether it is just background policy language.
Why Insurance Companies Use Non-Evidence Maximums
From the insurer’s point of view, non evidence maximums are a way to manage risk and cost while still giving basic disability coverage to everyone in the plan.
Common reasons include:
Risk control: The insurer covers everyone automatically up to the NEM, but wants medical evidence for higher benefit levels.
Easier sign‑up: New employees get some coverage automatically, without exams or long forms.
Lower premiums: By limiting automatic coverage, the group benefits plan is usually cheaper for the employer and employees overall.
Because of this, two workplaces can both advertise 60–70% LTD, but have very different NEMs and very different real‑life payouts for higher‑earning employees. Your lawyer can translate your plan’s numbers into a clear picture of what you personally can receive.
How Non-Evidence Maximums Affect Your LTD Claim
When you finally need your LTD benefit, the NEM can have a big impact on how much money actually reaches your bank account.
If you never applied for excess coverage:
Your LTD benefit is capped at the NEM, no matter what percentage of salary the policy advertises.
Other income sources like CPP‑D or WSIB may then reduce that capped LTD amount even further, sometimes leaving very little, or occasionally nothing, from the private disability insurance.
This can particularly affect:
High‑income earners who rely on LTD to cover major expenses.
People who joined the plan late or missed the initial deadline to apply for additional coverage.
If your LTD payment is lower than expected, a disability lawyer will review your approval letter, the calculation, any offsets, and the NEM wording and tell you whether this limit is the reason—and what, if anything, can be done about it.
Non-Evidence Maximum vs. Policy Maximum
Many people confuse the non evidence maximum with the overall policy maximum, but they are not the same thing.
Non evidence maximum (NEM):
The maximum benefit the insurance company will approve automatically, without medical evidence.
Policy maximum:
The highest benefit the plan will ever pay, even if you provide medical evidence and are approved for full excess coverage.
Feature | Non evidence maximum (NEM) | Overall policy maximum |
What it is | Automatic coverage limit without medical evidence | Absolute ceiling on coverage under the plan |
Who sets it | Insurer, based on group risk and plan design | Same insurer, based on product design |
How you qualify | Automatic if you are an eligible plan member | Must apply for extra coverage and be approved |
Typical amount | Lower (for example 2,000–4,000/month) | Higher (for example 5,000–10,000/month or more) |
Role in a claim | Caps LTD benefit if you never apply for more | Caps benefits even if you qualify for excess coverage |
Can it be changed? | Sometimes negotiable at renewal for the whole group | Rarely changed for an individual member |
A helpful way to think about it: the NEM is “the LTD benefit you qualify for without extra questions,” and the policy maximum is “the most you could get if you qualify medically.”
What to Do If Your LTD Benefits Are Capped Because of NEM
If you find out that your LTD benefit is limited by a non evidence maximum, there are practical steps you can take—and you do not have to do everything at once.
Confirm your current LTD benefit (before and after any offsets).
Ask HR for the NEM, the policy maximum, and any optional additional coverage in your group plan.
Check whether you were ever given or completed a medical questionnaire to request excess coverage.
Compare what you are receiving to what 60–70% of your income would be.
Gather emails and onboarding documents that mentioned disability coverage or optional insurance.
Book a free consultation with a disability lawyer to find out whether the NEM cap is simply part of the plan, or whether someone’s mistake reduced your protection.
Speak With a Disability Lawyer
Non evidence maximums are technical, and most people don’t realize how they work until they see a smaller LTD cheque than they expected. A disability lawyer can review your policy, explain how the NEM and any excess coverage affect you in plain language, and identify whether the insurance company or your employer made errors that can be challenged.
Just as importantly, your lawyer can tell you when NEM is not a concern in your situation, so you are not carrying extra worry about your money when you already have enough to manage with your health.
Contact Share Lawyers today and let our experience work for you. Our 40 years of experience can help you win your case against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and other insurance companies. Our legal team offers a free consultation and works on a contingency basis—there are no fees unless you win your case.
