As disability lawyers in eastern Ontario, we regularly work with clients suffering from a serious illness or injury that keeps them from working.
The amount you could receive depends on several factors, including the LTD insurance policy’s terms and any other benefits you may be getting.
Here’s a general guide to help you understand the coverage you might receive.
Accessing Other Benefits First
Employment Insurance
As of December 18, 2022, the Canadian federal government permanently increased the maximum duration for EI sickness benefits from 15 weeks to 26 weeks. This means eligible workers who cannot work due to illness and injury can now receive up to 26 weeks of income support at 55% of their average weekly insurable earnings (up to the maximum set by EI) through the federal government.
For individuals with long-term disability insurance, this change matters because many LTD policies require you first to exhaust all other short-term or government benefits before your LTD payments begin. Understanding how your LTD policy coordinates with these extended EI benefits is essential to avoid surprises in timing or benefit amounts.
Short-Term Disability Benefits
Some policies include Short-Term Disability (STD) benefits that provide income replacement for a limited period—often from a few weeks up to six months—if you are unable to work due to illness or injury. STD benefits are meant to cover you during the initial recovery phase before LTD benefits kick in. Long-Term Disability benefits, by contrast, begin only after the STD benefits (and sometimes Employment Insurance sickness benefits).
Eligibility Criteria
Own Occupation
Before benefits are paid, you must meet the eligibility requirements set out in your LTD policy. Typically, this means you must prove that your medical condition prevents you from performing the duties of your own occupation for a certain period. Often this period lasts for two years.
Any Occupation
Some policies later change the threshold to show that you cannot work in any occupation. Medical evidence, employment records, and sometimes independent medical exams are often required. Failing to meet the policy’s criteria can delay or even prevent payment, so it’s important to understand what your policy requires from the start.
Policy Terms Matter
Every LTD insurance policy is different, so the first place to look is your policy itself.
Most plans replace a percentage of your pre-disability income, typically between 60% and 70%. Some policies have caps on the maximum monthly benefit they will pay. Others may have restrictions on how long benefits are paid or conditions that can limit coverage.
Some policies have shorter benefit periods depending on the nature of an injury. Understanding these details is crucial because they directly impact the total amount you can expect to receive.
Other Income Benefits Can Affect Your Payment
Many LTD policies reduce your monthly benefits if you are receiving income from other sources, such as the Canada Pension Plan Disability benefit (CPP-D). This is called an “offset” provision.
For example, if your LTD policy provides $3,000 per month but you are also receiving $1,000 from CPP-D, then your insurance company may reduce your LTD benefit to $2,000. It’s important to review your policy carefully to see how offsets might apply to your situation.
Getting Legal Guidance
Long-term disability claims can be complicated. Insurance companies may deny or limit claims based on technicalities, leaving you without the financial support you need. An experienced disability lawyer can review your policy, explain your rights, and fight for the full benefits.
If you’re unsure how much you can get for a long-term disability claim—or if your claim has been denied — contact us today. We can help you understand your policy, navigate the claims process, and protect your financial future.
