This comprehensive guide offers valuable insights into securing the benefits you deserve while navigating potential challenges in the process. If you or a loved one has an issue with your short-term disability, contact Matt Lalande, one of Canada’s Top Disability Lawyers today.
As Canada’s leading disability law firm, we understand that when an unexpected illness or injury occurs, the last thing you should be worried about is your financial security—especially if you have a family depending on you. This is precisely why short-term disability benefits exist: to provide a safety net during challenging times.
As experienced disability lawyers, we have witnessed firsthand the critical support these benefits offer to individuals unable to work, even for brief periods. These benefits can make a significant difference, helping you focus on your recovery without the added stress of financial instability.
However, navigating the complex landscape of disability insurance can often feel overwhelming. The various policies, conditions, and legal intricacies can leave you uncertain about your rights and options. In the following sections, we address some common questions to better understand short-term disability benefits and how they can support you during difficult times.
Short-term disability (STD) insurance is designed to provide vital financial support to employees who are unable to work due to an illness, injury, or medical condition. In Ontario and throughout Canada, many employers include short-term disability benefits in their group insurance plans, while some may choose to offer self-funded programs. Regardless of the source, these benefits serve as a financial lifeline during medical hardship, allowing employees to focus on their recovery without the added stress of lost income.
Typically, short-term disability benefits cover a percentage of an employee’s regular income for a specified period. While the duration can vary, most plans offer coverage ranging from a few weeks to several months, with six months being the standard average.
To qualify for these benefits, claimants must meet their insurer’s specific definition of disability and submit adequate medical documentation to support their claim. It’s important to understand that the requirements and limitations of short-term disability policies can differ significantly. Insurers often have strict criteria regarding what constitutes a disability, the type of medical evidence needed, and the duration of the benefit period. Therefore, becoming familiar with the specific terms of your plan is crucial to ensure a successful claim.
If you’ve been cut off from your short-term disability benefits, it can feel like a daunting situation. Seeking legal advice from an experienced disability lawyer can help you navigate the complexities of your policy, appeal a denied claim, and advocate for your rights to the benefits you are entitled to. Our disability lawyer offer free consultations for anyone wishing to learn more about their short-term disability benefits. During these consultations, we can review your policy, clarify it, and advise you of your rights.
The elimination period in Canadian disability insurance is the waiting period between the onset of your disability and the date your long-term disability benefits become payable.
This is a predetermined time, typically ranging from a few days to several weeks, during which you cannot work due to your disability but are not yet eligible for long-term disability benefits.
It is during the “elimination period” or the “waiting period” that short-term disability benefits are paid. However, it is not uncommon for some employers to only offer long-term disability policies and not provide short-term disability coverage. In such cases, employees may need to rely on sick leave, vacation time, or employment insurance benefits to support themselves financially during this initial period.
Generally, short-term disability benefits are paid weekly, and you’ll receive a percentage of your regular earnings for a specified time – which, in many cases, can range anywhere from 120 days to 12 months. Your disability insurer typically pays benefits by way of direct deposit.
The length of time you may be able to get short-term disability benefits will vary by policy. Many policies offer short-term disability benefits of up to six months, though some may be shorter while others may go up to 52 weeks.
Your policy will outline the length of time and all other specifics, but it’s important to remember that these numbers represent the maximum time you can be paid. The amount of time you are paid your benefit will depend on how long it takes you to heal from your illness, injury, or other condition. This can be estimated by your doctor and other medical professionals you consult regarding treatment, tests, etc.
You will also be required to notify your insurance company if your condition changes, for the better or worse. For example, you may reach a point in your recovery where you can return to work but with a temporarily modified schedule and/or accommodations. In this case, your benefits may be reduced but not yet terminated.
Insurers calculate your short-term disability benefits based on a percentage of your regular weekly earnings paid out for a pre-determined time. The rate and timeline are set out in your policy. This is why all plan members must understand their policy and their rights under it.
You must also know your exact weekly earnings to confirm that your benefits are calculated accurately.
While the policy sets out the percentage of earnings paid to you, how it’s paid can differ.
For example, a policy pays for 52 weeks. Within these 52 weeks, you may be paid 100% of your earnings for six weeks, 75% for the following six weeks, and 55% for the remainder of the policy.
There are different variations of this, and each policy may be different.
Whether or not your short-term disability benefits are subject to tax depends on your policy.
If you hold an individual policy and pay the entire premium yourself, the benefit paid to you will be tax-free. However, if your employer offers the coverage through a group plan and pays all or part of the premium on your behalf, the benefit will be subject to income tax once it’s paid to you.
To qualify for short-term disability benefits, you must meet a few criteria.
First, you must be paying into a plan. Many employers offer this to employees. If you’re unsure of your specific benefits, it’s a good idea to look into the coverage you have. Some employers may offer an optional plan, for which you’ll have to manually opt-in.
If you aren’t enrolled in a plan through work, there are private, individual plans you can seek out and enroll yourself in outside of work. These plans vary widely in cost, coverage, and specifics.
If you’ve experienced a sudden injury, illness, or other medical condition and cannot work, you must prove this to the insurer before being paid any benefit. To become eligible for the benefits offered by your plan, you’ll have to meet the insurer’s definition of “total disability.” This means that you must be unable to perform the core duties of your job, even with reasonable accommodations.
Remember, you have the onus to meet the definition of total disability within your insurance policy. To support your claim, you must provide medical evidence, such as clinical notes and records, test results, expert opinions, and doctor’s reports.
Some examples of qualifying conditions for short-term disability include:
Broken bones, injuries, or fractures: These injuries, often sustained in car accidents, motorcycle accidents, pedestrian accidents, or falls, can significantly impact an individual’s ability to work effectively. Although broken bones typically heal with proper treatment, allowing for a full recovery, short-term disability benefits may be necessary during the recovery period.
Post-surgery rehabilitation or recovery: Many surgeries, such as joint replacements, spinal surgeries, or organ transplants, require several weeks or even months for a full recovery. During this time, individuals may be unable to perform their job duties, making them eligible for short-term disability benefits until they regain their strength and mobility.
Chronic pain episodes: Conditions like fibromyalgia, arthritis, or other chronic pain disorders may lead to temporary episodes of severe pain, making it difficult for individuals to carry out their work tasks. Short-term disability benefits can provide financial relief during these flare-ups, helping individuals manage their symptoms and recover before returning to work.
Mental health conditions: Severe depression, anxiety, PTSD, and other mental health conditions can be profoundly debilitating. Individuals dealing with these issues may need to take several weeks or months off to undergo treatment, including therapy, medication, or hospitalization before they can return to their workplace. Short-term disability benefits offer vital support during these periods of recovery.
Autoimmune conditions: Autoimmune disorders such as lupus, multiple sclerosis (MS), and Crohn’s disease can cause unpredictable flare-ups that temporarily incapacitate individuals. During such episodes, short-term disability benefits can help manage the financial burden while individuals focus on treatment and recovery.
Cancer: A cancer diagnosis often requires aggressive treatment, including surgery, chemotherapy, and radiation therapy, which can leave individuals too exhausted or ill to work. While long-term disability benefits may become necessary if the condition persists, short-term disability benefits are essential in the early stages, providing support while individuals navigate their initial treatment and recovery.
Pregnancy and childbirth-related complications: Conditions such as severe morning sickness (hyperemesis gravidarum), pregnancy-induced hypertension, or complications during childbirth can prevent individuals from working for a period. Short-term disability benefits can help cover the time off needed before and after delivery, especially if medical complications arise.
Acute illnesses: Severe, non-chronic illnesses like pneumonia, severe influenza, or kidney stones can incapacitate individuals temporarily, preventing them from fulfilling their job responsibilities. Short-term disability can provide support during the recovery period.
Recovery from severe infections: Individuals suffering from infections like sepsis or meningitis may require hospitalization and extended recovery periods. Short-term disability benefits can help during this time until the individual is well enough to return to work.
Cardiac conditions: Heart attacks, strokes, or other cardiac events may necessitate an extended recovery period, rehabilitation, and lifestyle adjustments. While long-term disability might be necessary for chronic heart conditions, short-term benefits can be crucial immediately after such events.
Orthopedic conditions: Severe back pain, herniated discs, or joint problems such as torn ligaments (e.g., ACL injuries) can temporarily impair mobility and the ability to work, particularly in jobs that require physical activity.
Severe migraines: Chronic, debilitating migraines can significantly affect one’s ability to work, especially if frequent and accompanied by symptoms such as nausea, light sensitivity, and extreme pain. Short-term disability benefits can support individuals while they manage these episodes and explore long-term treatment options.
Burnout and work-related stress: Severe burnout, often due to prolonged work-related stress, can result in physical and mental exhaustion that requires time off for rest and recovery. Some insurers recognize burnout as a valid condition for short-term disability, particularly when it leads to symptoms like chronic fatigue, depression, and anxiety.
Again, regardless of the condition, medical evidence is crucial to support a claim for short-term disability. This can include clinical notes and records, doctor’s reports, medical imaging (e.g., X-rays, MRIs), test results, treatment plans, and expert opinions. Insurers typically require this documentation to verify that the condition meets their definition of disability.
It is crucial to apply for long-term disability (LTD) benefits before your short-term disability (STD) coverage ends. The application process for LTD benefits can be lengthy, often requiring extensive medical documentation and assessment. By starting the application before your STD benefits run out, you ensure there is no gap in financial support.
Many LTD insurers have strict deadlines for filing claims, and missing these deadlines can result in the denial of benefits, leaving you without the income you need to manage your health and daily living expenses. Taking action early also gives you enough time to address any potential issues or requests for additional information from the insurer, reducing the stress and uncertainty during this challenging period.
Navigating the complexities of short-term disability benefits can be daunting and stressful, especially when you’re already dealing with the challenges of an illness or injury. Unfortunately, many claims are denied due to incomplete documentation, missed deadlines, or a misunderstanding of the policy’s requirements. If you find yourself in this situation, it’s essential to seek the guidance of an experienced disability lawyer.
If you’ve been wrongfully denied your disability benefits, we understand the uncertainty and stress this can cause. At Lalande Disability Lawyers, we focus on helping clients navigate the complexities of insurance disputes to recover the benefits they’re entitled to. Since 2003, we’ve been helping claimants whose disability benefits have been stopped or denied. Please don’t hesitate to call us, no matter where you are in Canada, at 1-844-4-Disability or send us a confidential email through our website – and we’ll set up a meeting to explain disability rights and legal options at no cost to you. Remember, our consultations are 100% free, and if we work together, you don’t pay legal fees unless we win your case.
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Short-term disability benefits typically cover illnesses or injuries that temporarily prevent an individual from working, such as surgery recovery or a medical condition.
To apply, you generally need medical documentation supporting your claim and submit it through your employer or insurance provider, following their specific process.
Short-term disability benefits usually cover a period ranging from a few weeks to 12 months, depending on the policy terms.
Yes, claims can be denied if there is insufficient medical evidence, lack of coverage, or if the condition does not meet the policy’s criteria for disability.
Disability lawyers can assist in gathering evidence, appealing denied claims, and navigating the complex process to ensure you receive the benefits you’re entitled to.
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Patricia Williamson
Long-Term Disability
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Long-Term Disability
My experience with Mr. Matt Lalande and his team was exceptional. Matt is a very impressive professional when involved in a long-term disability benefits denial. Matt and Heather responded to all my emails and phone calls in a prompt and efficient manner. Matt is a great and honest lawyer. I highly reco...
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Long-Term Disability
