I wrote The Ultimate Guide to COVID-19 and Disability Claims for people who need to apply for short-term disability benefits during the COVID-19 pandemic.
While insurance companies and government agencies remain in business as essential services, they’re all dealing with major disruptions to their normal business operations. They are struggling to implement person-to-person distancing requirements in the workplace; they have key employees on sick leave; they have problems with processing paper mail; and in the case of government agencies, they are completely overwhelmed by a spike in new claims.
Because you are reading this article, I know you are doing your research are are on the right track. I can’t overstate the importance of taking time to educate yourself about the disability claim process.
If you have questions about this Guide, or any disability claim issue, call our support team toll free at (888)-732-0470.
Keep on learning and I wish you all the best with your journey,
— David Brannen, Disability Lawyer & Founder, Resolute Legal
Canadian Emergency Response Benefit (CERB)
In response to the COVID-19 crisis, the Federal Government has created the Canadian Emergency Response Benefit (CERB). This is a temporary benefit available to people who are unable to work because of COVID-19-related reasons.
The CERB is unique and covers a broader range of people who have been affected by COVID-19. It covers people who are off work due to being sick with COVID-19, but also people who have been laid off because of COVID-19. There is overlap between the CERB and EI Sickness benefits. You can’t receive both benefits at the same time, so for most people it makes sense to apply for the CERB first, and then apply for EI sickness benefits once your CERB payments run out.
For more information, you can read: Canada Emergency Response Benefit.
COVID-19 and EI Sickness Benefits
EI Sickness pays weekly income replacement benefits to qualified workers who have to take sick leave. The payment is 55% of your weekly income, up to a maximum of $573. This benefit is administered and paid by Service Canada through the Employment Insurance program. To qualify for EI Sickness, you must be unable to work because of illness, injury or quarantine. It covers any illness, not just COVID-19.
EI Sickness won’t cover situations where you are caring for a sick family member or have been laid off from work. It also won’t cover workers who haven’t made sufficient payments into the EI program. Finally, you can’t qualify for EI sickness benefits at the same time you are getting the CERB.
Service Canada administers the EI and CERB programs. It has been completely overwhelmed with the spike in claims for EI sickness, regular EI benefits, and the new CERB. They are driving people to use online applications, but expect delays in processing of claims.
COVID-19 and Short-Term Disability Benefits
Short-term disability benefits are paid through a workplace group benefits plan. To qualify, you must be an employee of a business that has this type of group medical plan for its employees. To qualify for short-term disability benefits, you must be unable to work because of your own illness or injury. If you qualify, benefits are 50-100% of your pre-disability bi-weekly income.
It is critical that you apply for short-term disability benefits while you are still covered under the group benefits plan. If you have been laid off, you may have a short window of time to apply for short-term disability benefits. Group benefits will often continue for a few months for people who have been laid off, but this depends on each employment situation.
New Challenges
There are new challenges with claims for short-term disability benefits during this COVID-19 pandemic. First, when applying for benefits, it is critical to establish that you are unable to work because of an illness or injury. You can still apply for short-term disability benefits even if you have also been laid off — the key is that at the time of your layoff you were already off work because of an illness or sickness, or were in the process of taking a sick leave.
A second challenge is getting necessary medical records and reports from your doctors. Your doctor must fill out a medical report form as part of your application. Also, if your claim is denied, the insurance company may ask for clarifications from your doctor or for a copy of your health or medical records. This has become hard to do since many doctors and health professionals have had to close their offices and work from home. Some doctors won’t communicate with patients during this time or may be unwilling to fill out forms.
Finally, your inability to attend recommended treatment programs (psychology, physiotherapy, occupational therapy) can be a major barrier to your short-term disability claim getting approved. You will need to do your best and inquire with your treatment providers if the treatment can be provided remotely by videoconference or other means.
COVID-19 and Long-Term Disability Benefits
Disability lawyer David Brannen and operations manager Victoria Leger discuss applying and appealing long-term disability benefits during COVID-19.
Long-term disability benefits are paid to eligible workers who are on an extended sick leave from work. These benefits are included in many workplace group benefits plans. You must be continuously unable to work for 17 weeks or more to qualify for long-term disability benefits. If you qualify for benefits, you would receive monthly payments that are usually 50-75% of your pre-disability salary.
What you should expect from insurance companies during the COVID-19 era
For people applying for long-term disability benefits, you should expect delays caused by the disrupted business operations of your employer, the insurance company, your doctor and other health professionals. The insurance company will take longer to process claims. You may have problems with getting your doctor to fill out forms or provide other records. You may be unable to continue treatment programs with other health professionals and they will be unable to provide you with copies of their records to support your disability claim.
For people on approved long-term disability claims, you will face challenges because it’s easier than ever for insurance companies to deny your claim. Insurance policies require you to provide ongoing medical updates to the insurance company. If you can’t get your doctor to fill out forms or can’t get copies of health records requested by the insurance company, then you can expect to have your benefits suspended or terminated.
If you are laid off from employment while on a long-term disability claim, the insurance company may take the position that the only reason you can’t return to work is because there is no job to go back to.
What happens to my claim if my employer goes bankrupt?
Finally, several people have asked us about what happens to a person’s long-term disability benefits if an employer or insurance company goes bankrupt. If your benefits are provided under an insurance policy, your long-term disability benefits will be protected even if the insurance company goes bankrupt. However, if your long-term disability benefits are paid through an employer’s self-funded plan or a non-profit plan, then you could lose your benefits if the employer or organization goes bankrupt. This actually happened in the 1990s when a large company went bankrupt and hundreds of people lost their long-term disability benefits.
COVID-19 and Workers’ Compensation Benefits
Workers’ compensation benefits are paid to people who suffer a work-related illness or injury. Benefits pay up to 85% of your lost income and include payment for related medical expenses and treatment.
Workers’ compensation benefits are administered by provincial agencies. These agencies are deemed essential services and they continue to process and administer claims. You should expect some delays related to disruption of normal business operations within the agency. You may experience delays and problems if you can’t get your doctor to fill out forms or report back to your workers’ compensation claim representative.
Workers’ compensation programs are more aggressive in arranging and paying for treatment (as compared to insurance companies), so you can expect them to find treatment providers who can treat you by distance. It is important that you cooperate with all their efforts to arrange for you to attend treatment.
If you have been laid off while on an approved claim, this can cause issues if the workers’ compensation board takes the view that you are ready to return to work. Even if your doctor says you are not ready to return to work, workers’ compensation may say that the only reason you are not going back to work is because you have no job to go back to.
Frequently asked questions
Can I get CERB if I’m receiving disability benefits?
This really depends on your specific situation.
CERB was introduced to replace the income that is lost as a direct result of COVID-19. This includes sickness, caring for a sick relative, or workplace closures for public safety as a result of the virus.
Since disability benefits are not employment income, in most cases, you will continue receiving them and not be eligible to receive CERB.
Can I still apply for disability benefits?
Yes. As above, you’ll just have to expect some delays.
Since Service Canada offices have largely been closed, as of March 31, 2020, you can apply for CPP disability benefits online.
How can I appeal if courts are closed?
If you’re appealing a decision on your disability benefits, there’s a good chance the hearing will take place virtually, on a teleconference or videoconference.
Read some tips for teleconference hearings: How to Prepare for a Teleconference Hearing [9 Tips].
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