What to Know About Disability Benefits When Applying, Approved, or Denied

Every day, we talk to people who have applied for long term disability benefits but aren’t sure what is going to happen next.

We understand that things have not been easy for them. Their health has been suffering, they are unable to work, and they’re not sure if their insurance company, who was supposed to be there in their time of need, has decided to pay out disability benefits. These benefits exist to provide people with the financial support needed to focus on their health and rebuild their life, but around 60% of long term disability claims are initially denied by the disability insurance companies.

We’ve written a lot in the past about denied disability benefits, including why legitimate claims are typically denied. But we also speak with people who have applied for LTD benefits, are reading through their documents, and are confused about specific terms or steps along the way. Our disability lawyers hope to make some terms more clear and easier to understand.

How Long Does it Take for a Long Term Disability Claim to be Decided?

Unfortunately, there is not a one-size-fits-all answer to how long it will take for your disability claim to be approved or denied by the insurance company.. Your claim may take anywhere from a few weeks to an entire year for a decision to be made. If it is more than 6 months since you have applied and you do not have a decision contact us to get help now.

Many factors can affect how quickly your insurance company processes your claim. Providing complete and accurate application forms, detailed medical reports from your doctors, and following up regularly with your insurance company can all help speed up the claims process. Keep in mind that insurance companies are known to delay processing so they can avoid paying out on claims. If your insurance company is checking to see if your medical condition is a pre-existing condition, they’ll attempt to gather every bit of medical information they can to see if they can claim your condition is not new.

If they finally respond, and their decision is to deny your disability claim, immediately contact our office to determine what your options are. Remember, just because your short term disability benefits or long term disability benefits have been denied does not mean that your disability claim is not valid. Denying claims is what they do.

What to Expect in a Functional Capacity Evaluation

Functional Capacity Evaluations (FCEs), otherwise known as Functional Abilities Evaluations (FAEs), are conducted by various healthcare providers. They provide objective information about an individual's ability to perform work tasks and activities of daily living. Disability insurance companies frequently use FCEs in the evaluation of long term disability claims.

An FCE may include a wide range of activities to test the limits of the claimant's physical abilities in relation to their occupation. Activities such as lifting, pushing and pulling, repetitive tasks for the upper extremities, precision tasks such as finger dexterity, and postural tolerances such as sitting, standing, and walking are just some of the functions that a claimant may be expected to perform. The duration of an FCE can range from two hours to two days. Once completed, a comprehensive report is produced outlining the claimant's ability to perform the essential duties of their occupation in a safe way on a regular basis. It may include a recommendation of temporary or permanent leave from work. It may also include further rehabilitation or a graduated return to work to their current occupation or another more suitable occupation. The report will also include ergonomic equipment requirements and work modifications that may facilitate a return to work.

Are FCEs a reliable way to measure a claimant's ability to work?

When you consider that there are numerous factors in play that could skew the results of the evaluation, such as the Occupational Therapist's experience, the severity of the claimant's symptoms on that particular day, and most importantly, who is paying the bill for the evaluation (the insurance company), it might be argued that FCEs may not be the most objective way to measure a claimant's ability to perform the essential duties of their occupation on a regular basis, say our disability lawyers. Nevertheless, insurance companies rely upon FCEs as medical evidence when evaluating claims for LTD benefits. As well, so do the disability lawyers who represent the claimants when they have been denied their disability insurance claim. In many cases, disability lawyers will send their clients to FCEs to get a second opinion in response to the insurance company's FCE report.

In this video, Associate Lawyer Alison Gilmour explains what to do if you feel as though your insurance company is trying to force you back to work. If you have been approved your long term disability benefits and your insurance company has asked you to do an FCE but you’re not ready to talk to anyone yet, you can read through the Approved Disability Benefits page on our website.

Can Your Disability Insurance Company Make You Apply for CPP Benefits?

It's no secret that filing a long term disability claim can be time-consuming and confusing. It might seem like your disability insurance company has a never-ending list of questions and demands, or that your case will never be paid. That's why it's always best to consult an experienced disability lawyer during your claim. Share Lawyers will work hard to fight for the benefits you deserve. Learn more about CPP and your LTD insurance benefits below.

Insurance Companies & CCP Disability Benefits

Your disability insurance company may ask you to apply for Canada Pension Plan Disability benefits (CPP) once you've filed a claim with them for LTD benefits.

While this can certainly be confusing for you as the insured, you may actually be obligated to apply for CPP as part of your group insurance policy requirements. You should always check the wording of your policy just to be sure. Most long term disability insurance policies are intended to top up those disability benefits available to you elsewhere. As such, long term disability insurance policies usually have provisions which reduce your monthly payment by benefits payable from:

• any Workers' Compensation plan, including Workplace Safety Insurance payments

• disability benefits received under any other government program, like Canada Pension Plan - Disability, Ontario Disability Support Program, Employment Insurance/ Sickness Benefits

• income from the Criminal Injuries Compensation Act wages or remuneration payable from any employer, including any statutory or common law termination and/or severance pay

CPP Disability Should Not Affect How Much You Get From Your LTD Claim

Keep in mind that the outcome of your application to CPP disability or any other organization should not affect your long term disability claim. If you are denied CPP disability benefits, your insurer must continue to pay your group disability benefits. If you are approved for CPP disability benefits, the monthly benefit amount will be a deduction or offset from your monthly LTD benefit amount. This means that the amount of money you receive each month will not change; you will simply be getting the funds from more than one source.

If you are applying for your disability benefits but you’re not ready to talk to anyone yet, you can read through the Applying for Disability Benefits page on our website.

Denied your long term disability claim?

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