How to File a Successful Short-Term Disability Claim

So, you’ve been injured or have a medical condition that prevents you from working. If you’re fortunate, your Ontario employer offers short-term disability benefits, or you are part of a private plan with such benefits. If you do, you may receive between 60% and 100% of your income for up to six months or even up to a year with more generous plans.

Before you start getting your benefits, though, you’ll need to file for short-term disability. At Derek Wilson Personal Injury Law, we understand that not everyone knows how to file a successful short-term disability claim, which is why we’ve created this guide. Read on to find out how to build a strong case when filing for short-term disability.

Of course, there are no guarantees. Should you be denied, contact Derek Wilson Personal Injury Law for a free consultation with our founding lawyer, Derek Wilson. During your free consultation, you’ll get a chance to ask questions and find out how you can appeal to get your rightful benefits. 

How to File a Short-Term Disability Claim

Knowing how to file a successful short-term disability claim in Ontario doesn’t require a law degree or advanced education. Fortunately, most employers and their insurers make it easy. Some even have online portals so you can apply online or have easy-to-understand checklists and pamphlets to explain what you need to do.

Before you start filing for short-term disability, though, there is some prep work you’ll want to do beforehand:

• Start documenting. As soon as you’re injured or notice symptoms, start taking notes. Even simple point-form notes or a few photos of your injury can help you remember exactly how often you have symptoms when the symptoms started, and how severe they are. Once you start documenting, keep up the practice so you have all the information you need.
• Visit your doctor. You need your doctor’s buy-in, so it’s valuable to talk to your healthcare provider about your symptoms to find out what your doctor thinks your condition should be. Your doctor needs to agree that you need time off work for you to qualify for short-term disability benefits.
• Get medical treatment. Once your doctor suggests a treatment or makes recommendations, follow the guidance in the letter. Taking your injury or illness seriously shows insurers that you do have a legitimate medical condition.

By taking these steps before you even start filing for short-term disability, you’re setting yourself up for success and making sure you have everything you need when you file.

Steps to Ensure Success

When filing for short-term disability, the key is to follow all directions exactly and to provide plenty of evidence of your injuries or illness to build a strong case. Here are the steps you’ll want to take:

Check Disability Requirements

In general, to be eligible for short-term disability benefits in Ontario, you’ll need to be employed in a workplace that offers short-term disability benefits, and you’ll need to have a medical condition that prevents you from working but isn’t expected to last for longer than six months or a year—however long your employer’s insurer offers short-term disability benefits. If your injury or illness is expected to keep you out of the workplace for longer than this period, you will need to apply for long-term disability benefits instead.

In addition, the insurance company will have its own benefit requirements. For example, the insurer may define short-term disability that prevents you from working due to a mental or cognitive condition, illness, quarantine, injury, or post-surgery recovery. Another insurer may define a disability more narrowly as specific medical conditions or injuries.

Read the paperwork your employer gave you about your benefits package to understand whether you qualify for benefits. If you have questions, reach out to the human resources department or the plan administrator to find out more.

If your workplace doesn’t offer short-term disability benefits, you may be eligible for Employment Insurance (EI) Sickness Benefits. These are offered by the government and pay you 55% of your earnings for up to 26 weeks, with a maximum of $668 a week.

You may qualify for EI Sickness Benefits if you’re injured, ill, or in quarantine and can’t work and aren’t covered by short-term disability benefits. To apply, you’ll need to submit a medical certificate detailing your illness and how it prevents you from working.

Copies of Medical Records

Your medical records are the cornerstone of filing for short-term disability. The insurance company will look very closely at these, so it’s important to get copies of any medical records you can, including:

• Copies of imaging results.
• Documentation of test results.
• Treatment plans.
• Reports from any specialists you’ve seen.

You can ask doctors and specialists who are treating you for copies of these documents for your claim.

Get Medical Evidence from a Doctor

Your doctor is your strongest ally in filing for short-term disability. Since they’re a medical professional, their professional opinion of your condition and your ability to work carries a lot of weight.

This is where documenting your symptoms can help. When you can show your doctor your own records of when you experienced symptoms, how often, and what severity, your doctor can more accurately diagnose you and work to determine how much time you will need to take off work.

You will also need to get a medical certificate from your doctor. This detailed document should contain the diagnosis of your condition, the recommended treatment, a detailed description of your symptoms, and a description of how your condition prevents you from working. It’s important that this document is accurate and detailed to paint a full picture of your injury or condition.

Complete the Forms Needed to File

The insurer will explain what paperwork you will need to fill out, but in general, you will need to fill out an employee claim. Your employer will also need to complete and file an employer statement, and your doctor will need to fill out and file an Attending Physician’s Statement.

The form you’re asked to fill out will ask you for your contact information, personal details, employer and employment information, and information about your medical condition or injury. In addition, you may need to provide a clear copy of government-issued ID or a birth certificate, your SIN number, and banking information so you can get a direct deposit.

It’s important to fill out the paperwork accurately and fully. Consider having a trusted friend or family member check over the forms to make sure everything is clear and accurate. Any mistakes can mean your claim is denied.

Be Honest

It’s always important to be accurate and honest in your claim. The insurer will check your description of your injuries against your doctor’s description. Some insurers even check your social media accounts or hire private investigators to verify you are injured.

Most people intend to be honest, but it’s easy to create the wrong impression. For example, if you’re feeling better one day and decide to go for a walk when you have indicated in your paperwork that you can’t walk because of your injury, that can be misconstrued. Your claim could be wrongfully denied for a simple mistake.

To avoid having these kinds of situations affect your claim, always be honest, detailed, and accurate in your paperwork. You may also want to avoid posting on social media or going on vacation during your recovery.

File on Time

Double-check the deadlines for filing your paperwork and submitting your medical documentation. You will usually have 30 days from the start of your leave from work to file for short-term disability, but this can vary widely depending on your insurer.

When to Reach Out to a Short-Term Disability Lawyer

Even if you try to get everything right and think you have a strong chance of getting your benefits, you could be denied your short-term disability benefits. If this happens or if you do get disability benefits but then get a letter, your payments will stop; you may want to consult with a short-term disability lawyer.

Bring your denial letter to your consultation. A Hamilton short-term disability lawyer knows how insurance companies in the area work and has worked with many clients who were initially denied. They can explain why your claim was denied and can create a plan to secure your rightful benefits.

Contact Us for a Free Consultation

Derek Wilson Personal Injury Law has worked with countless hardworking employees in Hamilton, Brantford, Stoney Creek, Grimsby, Lincoln, Thorold, Niagara Falls, Weiland, Burlington, Oakville, Guelph, St. Catharine’s, Cambridge, Kitchener, Mississauga, Brampton, and Milton who have been initially denied short-term or long-term disability.

Our team has helped these clients build strong cases that, in many situations, have helped them secure the benefits they deserved. Meet with the founder of our law firm, Derek Wilson, for a free consultation to discuss what we can do for you. Contact Derek Wilson Personal Injury Law, today to schedule your free consultation.