How to Transition from Short-Term to Long-Term Disability Benefits

About 27% of Canadians live with a disability that affects their everyday life, according to Statistics Canada. If you are among the more than eight million Canadians living with a disability, you may be counting on your short-term disability benefits (STD) or long-term disability benefits (LTD) to pay your bills while you can’t work.

Unfortunately, employees often find their benefits denied, even when they have a legitimate claim. If this happens to you, you can always contact Derek Wilson Injury and Disability Law for a free consultation. Be sure to bring your denial letter, if you have one, to your free consultation so we can discuss ways we may be able to seek fair benefits for you.

The Differences Between Short-Term and Long-Term Disability

Before we discuss how to transition from short to long-term disability, we need to be clear about the differences between short-term and long-term disability. Both are types of insurance that provide benefits in the form of regular payments if you’re injured and can’t work. Both short-term and long-term disability are offered through your employer, through a group plan, or through individual insurance plans you enroll in, requiring you to pay premiums. If you’re injured and can’t work, you’ll need to apply for benefits.

That’s where the similarities end. As the name implies, short-term disability is for situations where you’re injured or disabled but expect to return to work within weeks or months. Long-term disability benefits are for situations where you can’t work for a longer period of time.

The exact amount of time you can be away from work to receive each type of benefit depends on your insurance policy. For some policies, you can be on short-term disability for up to three months and can transition to long-term disability after that. With other policies, short-term disability may only cover you for six weeks or less. With some generous plans, short-term disability can cover you for up to a year.

Long-term disability, on the other hand, can last until you can return to work or until you reach age 65 or a specific limit on the coverage term. Some LTD policies are fixed term, for 5-10 years, for example, or for another period of time. If you have a fixed-term policy, you will receive your LTD benefits for the fixed term, as long as you qualify, but not for longer.

The two types of coverage also differ in how much they pay. With short-term disability, you can expect to get 50%-100% of your income, depending on your policy. Long-term disability plans can pay 60% to 80% of your gross income, again depending on your policy. It’s important to understand that some policies have caps on the amount they pay per month. If the monthly cap is $2,000, for example, you won’t get more than that even if the policy usually pays out 60% of your income and 60% of your income amounts to significantly more than $2,000.

The schedule of payments can differ, too. LTD is usually paid monthly, but with some short-term policies, benefits are paid weekly or bi-weekly.

Another important difference is the definition of disability. With short-term disability and for the first two years you receive long-term disability, you are disabled if you can’t perform the duties of your “own occupation.” This means you’re disabled if you can’t do your own job — the role you had when you became ill or injured.

If you’re getting LTD, however, the definition changes after two years. At that time, you’re considered disabled only if you can’t perform the duties of “any occupation.” This means the insurance company will look at whether you could perform another role or another job, possibly with some additional training. If it is possible for you to have another job, even if that job pays less than your current job, then you’re no longer considered eligible for LTD.

How to Qualify

The key to qualifying lies in the documentation about your plan. If your disability benefits are an employee benefit, your employer likely gave you information about your benefits during onboarding. This information is also available through human resources or your employee dashboard.

If you signed up for a group plan or individual plan, then you were sent insurance information about your policy by the insurance company or by your broker. You may also have access to an insurance company website, where you can log in to get your policy information.

In either case, it’s important to review your policy and any brochures or information you have about the policy. This is where you’ll find out about eligibility. In general, you qualify for LTD if you’re employed and you’re injured, ill, or disabled to the extent that you cannot work. Your policy will include additional eligibility details about:

• What medical conditions are covered
• What medical conditions and situations are excluded
• How to apply
• What will happen during the application process
• Any other requirements or limits on your policy

Once you understand your policy and believe you qualify for benefits, follow the instructions to apply. You will generally apply for short-term disability benefits first. This is because LTD benefits have what is known as a qualifying period. This is the waiting time between the moment you’re injured or are diagnosed with your disability and the time you can start receiving long-term disability benefits. In Ontario, the qualifying period is usually three months to a year, so policies can vary widely.

During the qualifying period, you can usually apply for short-term disability, though you may not necessarily have this option. Your employer may not offer short-term disability, or you may not have signed up for this coverage when you decided to sign up for LTD coverage. If that’s the case, you may need to rely on sick leave, vacation time, Employment Insurance (EI), or another program until your long-term benefits start paying.

Steps in Making the Transition

Let’s say you do have short-term disability and have been receiving payments, but now the time limit for your benefits is almost up, and you’ll need to transition. Here’s how to transition from short to long-term disability:

• Review your policy. Check to see if your short-term and long-term policies are from the same insurance company. If you’re part of a group plan or employer plan, they may not be. Next, check the policy for your long-term disability coverage. Make note of any deadlines, requirements, and any conditions that may be excluded.
• Continue getting medical treatment. Stay proactive about your health and continue visiting your doctors and specialists for follow-up and continuing treatment. If there are gaps in medical attention, if you’ve cancelled doctors’ appointments, or if there is no evidence you’re getting treatment, your insurer may claim you’ve recovered from your disability and may deny you long-term disability.
• Gather the evidence you need. The medical documentation of your illness, when you applied for short-term disability, may have been from weeks or months ago. Since then, you’ve probably visited specialists or doctors, had additional tests, and had more treatments. Maybe you’ve even had your diagnosis and treatment adjusted. Make sure you work with your doctors to get the most current medical reports and evidence to the insurance company. Treat the application like it’s brand new and send in the most recent medical information available.
• Apply. You will need to apply for long-term disability benefits, just like you applied for short-term disability. You will need to fill out the paperwork the insurance company provides. Make sure you submit to the right insurer if your STD and LTD benefits come from different companies.

If you have a legitimate disability and you’ve been approved for short-term disability, you should also be eligible for long-term disability, provided you are still disabled. However, many employees are denied when they apply for LTD. It is simply a stage of the process where a denial can happen, and while it’s more common when your short-term disability and long-term disability come from different entities, it’s not uncommon for the same insurer to approve a short-term disability application and deny an LTD application from the same employee, for the same medical condition.

You should be prepared for this eventuality and reach out to a disability claims lawyer as soon as it happens. You can contact Derek Wilson Injury and Disability Lawyer to speak to our firm’s founder, Derek Wilson. Derek will look at your denial letter, application, and the facts of your claim at absolutely no cost and discuss the options you have for getting your LTD benefits. 

Possible Issues or Denial Reasons

Even if you receive short-term disability, there is no guarantee that you will get long-term disability. In fact, many hard-working Ontarians are approved for short-term disability quickly and are then surprised to get a denial letter when they apply for LTD.

One thing to keep in mind is that long-term disability benefits cost insurance companies more, which means insurers are more likely to look closely at your application. When insurers can deny claims, they stand to save a lot of money. While most will act in good faith, you need to be aware that insurers benefit financially when they deny a claim.

The most common reasons for denial of LTD benefits are:

• Lack of medical evidence. The most common reason for denials comes down to a lack of medical evidence. You need to work closely with any doctors and specialists who are involved in your care to make sure they document your condition and provide details about how your condition affects your ability to perform critical work tasks.
• Not following requirements. The insurance company will have a long list of requirements for your claim. This includes requiring you to be under a doctor’s care and to continue getting treatment. To apply, you will also be required to submit specific forms and information. If you don’t follow the requirements exactly as outlined by the insurance company, your claim will be denied.
• The company thinks your application is not accurate. If there are any discrepancies in your application or in your medical records, your claim may be denied. In addition, insurers may check out your social media or even hire an investigator. If what the investigator uncovers doesn’t match your application, even if there’s an honest mistake, your claim will be denied.
• Your condition is disqualified. If your condition is listed as among the medical conditions excluded from coverage, you may not be eligible for benefits. In other situations, there may be complicated situations. You may be in the middle of switching jobs, for example, or may have recently been hired or fired. If you’re not sure whether you qualify for benefits and you’ve been denied, consult with a disability lawyer to find out whether you may qualify after all.

Another common issue happens when you already receive LTD benefits. You may be receiving LTD for months a year or even more, but this doesn’t guarantee that you will continue to receive the benefits.

One problem that often arises is that the insurance company will contact you and ask you to submit to an “independent medical assessment.” While the word “independent” is used, you’re effectively being asked to see a medical professional selected by the insurance company.

What often happens in these situations is that the “independent medical assessment” determines that you can return to work — either your own role or another position, sometimes with some workplace accommodations. There have even been cases where the medical professional hired for an independent medical assessment agreed that the employee couldn’t return to work, but the insurance adjuster in charge of the file still decided that the employee should return to their duties.

It doesn’t matter to the insurance company if your own doctor or team of specialists thinks it’s unsafe for you to return to work. Once they determine that you can work, you may be pressured to return to work, and your benefits are in jeopardy.

You may even be facing pressure from your employer to return to work, and some employers are unable or unwilling to provide accommodation for your disability. This can put you in a dangerous position: you may feel you have to choose between disobeying your doctors’ orders to stay away from work and having your benefits cut off.

In this situation, it’s important to consult with a disability lawyer right away. If you act quickly, your lawyer may even be able to attempt to prevent your benefits from being cut off, so you don’t have to try to get by without disability payments. Don’t wait, assuming that you can convince the insurance company to continue your benefits.

Fortunately, there are solutions. Read on to find out what to do if the insurance company is not giving you the benefits you need.

What To Do If You’re Denied LTD Benefits

Whether you are denied benefits when you first transition from short-term to long-term benefits or whether your benefits are cut off after you have been approved and getting LTD for a while, you’ll get a denial letter outlining the denial and the reasons behind it.

The insurance company may give you the option of seeking an internal appeal. The insurer may even recommend that you try the internal appeal process because this process doesn’t involve you being represented by lawyers.

Despite what the insurance company says, the internal appeals process is often not the best option because it’s rarely successful. In an internal appeal, it’s the insurance company reviewing their own decision. They’ve already denied your LTD claim — why would they reverse their decision now? Unless a glaring error was made or you have entirely new information about your medical condition, you’re unlikely to be successful. Even if you do have new evidence or an error was made, the internal appeal can take a long time.

Your second option, if you’ve been denied LTD benefits, is to file a claim against the insurance company. In Ontario, you have two years from the date of denial to file a claim, which is another reason to carefully consider whether an internal appeal is right for you. By the time you have gone through two or three rounds of appeals with the insurance company, that two-year mark may have passed, and you may no longer have the option to seek a claim.

You can work with a disability lawyer to file a claim. A disability claims lawyer will take care of all the paperwork and will know how to build a strong case for you. Your lawyer will also pursue a settlement at the same time, contacting the insurance company and negotiating on your behalf.

If the insurer agrees to a settlement, you won’t have to continue with the claim and present your case before a court. Instead, both you and the insurer can walk away. This can be very beneficial to you since you’ll get the resources you need to pay your bills, and you won’t have to deal with the insurer anymore. You won’t have to follow their requirements and demands. You won’t have to submit to independent medical assessments. You can simply focus on healing and rebuilding your life.

As you consider the internal appeals process, filing a claim, and settlements, how can you know what’s best for you? A consultation with a disability lawyer can help. With Derek Wilson Injury and Disability Law, you can meet with the founder of the firm, Derek Wilson, in a free consultation. It costs you nothing to speak with Derek Wilson, who has 30 years of experience helping employees just like you. You can get answers to your questions, find out what you can expect from working together, and discover what options may be best for you.

It’s important to act fast if you’ve been denied your benefits. Your benefits should be there for you in the event you can’t work. You have paid premiums for them, and you may need these benefits to cover your bills and living costs when you can’t work. Without benefits, you may find yourself dipping into savings, liquidating assets, or even going into debt. You may even struggle to pay for the medical costs not covered by OHIP and your employee plan, which is why it’s so important to consult with a disability lawyer as soon as possible, so you have someone seeking your fair benefits for you.

Contact Derek Wilson for a Free Consultation

Now that you know how to transition from short to long-term disability, you can appreciate that this transition comes with some hazards. Since you need to apply for disability again, there’s a chance your application may be denied. You may even be dealing with a different insurance company with very different requirements. Even if you’re successful in securing LTD benefits, they may be cut off by the insurance company.

It’s common for employees to run into problems when accessing their benefits, but it’s important to keep in mind that you do have options. Derek Wilson founded Derek Wilson Injury and Disability Law to help people just like you. He has specifically chosen to focus on short-term and long-term disability instead of focusing on workers’ compensation and government programs. This focus allows him to put his considerable resources into helping people who have been denied their disability benefits.

Derek Wilson also worked in defense for big insurance firms at the start of his career, so he knows how these companies operate and what makes them accept settlements. When he’s negotiating for you, he can use that to your advantage.

If you’ve been denied your rightful benefits, contact Derek Wilson Injury and Disability Law for a free consultation. Derek will explain whether he can help you and what working together might involve so you know exactly what to expect. It costs you nothing to talk to a disability lawyer with 30 years of experience, so get your free consultation before you make any decisions about what you’ll do next.