Disability policies in Canada typically do not pay benefits until after the expiration of a waiting period. In the case of short term disability benefits, the waiting period is often 7 days. In the case of long term disability, the waiting period is usually between 3-6 months. Private insurance companies have a submission period and a time frame to turn around the claim form as well, on a case-by-case basis. A policyholder or claimant can easily become discouraged and lose out on benefits simply because they do not understand the details of their policy. And there are mistakes you can make in applying that can hurt your claim or even destroy your chances of receiving benefits.
What you need to understand while you apply for your long term or short term disability benefits
Disability Insurance typically provides benefits equal to 66% of your weekly or monthly base salary (although the amount of the benefits varies significantly from policy to policy). In order to determine the amount you should receive, it is important to read the Benefit Booklet carefully, and also review any enrolment forms that you may have submitted to your employer when you first obtained coverage for disability at work.
It’s in the numbers
In some cases, you may only have qualified for basic or core coverage which can have a relatively low monthly maximum benefit (e.g., Base salary of $50,000 per year would result in an LTD benefit of $2,777.92 at 66.67%, but if your plan has a “non-evidence” maximum of $2,000.00 per month, you can only receive the higher amount if you specifically applied for the additional coverage.)
Claims adjusters or your case or claims handler
In the case of a policy you purchased on your own directly from the insurance company, the amount of the benefit should be stated in the policy that was provided to you when the policy was originally issued. The typical insurance company is made up of many components. When you are submitting a claim for disability an important member of your insurance review team is the claims adjuster. This person may also have a different title, such as “Abilities Manager”, “Claims Handler”, “Adjudicator”, “Claims Analyst”, etc. All of these titles fulfill the same basic role, acting as the gatekeeper on your claim with the insurance company.
Since you have not filed yet, you may not be familiar with the claims adjuster. They are the ones who manage the paperwork on behalf of the insurer and come to an initial conclusion. They are also the representatives who tell you if your claim has been accepted.
Please note that these adjusters are not going to be on your side. They may be nice, polite and may seem accommodating – but you should always take their friendliness with a grain of salt. Their bottom line is to save their company money, so they will poke and prod you with questions until you are sick of it. And they will look for a weakness in your case – or in you.
Please stay calm and keep track of every phone call you are having. Get in touch with a disability insurance law firm, like Share Lawyers who can walk you through how to handle these calls, especially in the case that you are denied after this process.
If you'd like even more information about applying for long term disability benefits, please visit this page on our website and download our Applying for Long Term Disability Guide at the bottom of the page.
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