This is your online guide to long term disability in Canada for 2023. If you are looking for a broad overview of Canada long term disability insurance, you have found the right article. In this guide, I cover the basics like what is long term disability in Canada, how it works, and more.
But I also go into depth about the application process as well as what happens after approval. Regardless of what claim stage you are at, this article has something for everyone.
This guide is based on my 17 years of experience as an occupational therapist turned disability lawyer. I cover all the key topics and include links to articles that go into greater detail.
Let’s dive in!
- What is long-term disability insurance?
- What qualifies for long-term disability in Canada?
- How to Buy Canada Long Term Disability Insurance
- How to Apply for Long-Term Disability in Canada
- Lump-sum Settlements for Long-term Disability
- After Approval of Long-term Disability
- Employment Termination and Long-term Disability
- Long-term Disability FAQs
What is long-term disability insurance?
Long-term disability is insurance that pays monthly benefits to eligible people who become unable to work because of a medical condition, injury or disability. The monthly payments are usually 65% of your pre-disability income. If your disability is permanent, payments can last until age 65.
Why is long-term disability insurance important?
Long-term disability insurance gives you financial protection from losing your income. You get monthly income replacement payments that allow you to pay bills and keep a lifestyle similar to what you enjoyed while working.
One in six Canadians will be disabled for three months or more by age 60. A 2019 insurance industry study found that 53,000 Canadians per year get approved for group long-term disability benefits. The reasons for disability included mental illness (Depression, Anxiety), chronic medical conditions (Chronic Pain, Fibromyalgia, ME / CFS, back pain, etc.) and injuries (car accidents, falls).
Without long-term disability insurance, you have limited options for long-term income support. You may qualify for CPP disability benefits, but those payments get capped at $1,457.45 per month.
Provincial disability benefits are another option for long-term financial support. However, you won’t qualify for these payments if you live in a household with another income earner or have savings or other assets.
Finally, if your disability was the result of a workplace injury, you might have disability coverage through a workers’ compensation program. But, these programs are limited to situations where your absence is caused by a workplace injury.
Long-term disability will pay benefits regardless of what caused your disability. There is no financial means test. You can get benefits — regardless of your household income. Therefore, disability insurance is the best way for workers to protect their income.
How does long-term disability insurance work in Canada?
Let’s now review how long-term disability works. To be eligible for long-term disability benefits, you must be a “covered person” under an insurance policy. This policy must be in place before you stop working.
To qualify for payments, you must meet your policy’s definition of “total disability”. The definition of disability is different in each policy. But generally, it will say that you become “unable to perform the essential duties of your own occupation, or any occupation, because of illness or injury.”
The payment amount is 60% to 75% of your regular income. The insurance company pays you monthly.
Long-term disability payments don’t start immediately. Most plans will require you to be continuously disabled for three to six months before you can start getting payments. This time frame is called the waiting period or elimination period. During this time, you can receive short-term disability benefits either through a group insurance plan or from the federal government’s employment insurance (EI) sickness program.
Following is a typical example of how it works:
- You are working and have long-term disability coverage through your employer’s group insurance plan
- You develop a chronic illness that makes it harder for you to work
- After several months of struggling at work, you become unable to perform the usual duties of your “own” occupation
- Your doctor gives you a medical note putting you off work on sick leave
- You go on sick leave and receive short-term disability benefits through your group insurance plan
- After three months, your short-term disability benefits end, and you start getting long-term disability benefits
- After two years, the definition of disability changes to require disability from “any” occupation
- Your doctor confirms that you are also unable to do any occupation
- You continue to get monthly long-term disability payments until you can return to work or reach the age of 65
This guide focuses on long-term disability insurance benefits in Canada. If you are looking for information about long-term disability in your province, check out our provincial guides:
- Guide to Long-term Disability in Ontario
- Guide to Long-term Disability in BC
- Guide to Long-term Disability in Alberta
- Guide to Long-term Disability in Nova Scotia
- Guide to Long-Term Disability in New Brunswick
Total Disability vs Partial Disability
Insurance policies have different definitions of disability. The two most common definitions are ‘”total disability” and “partial disability.”
Total disability means you cannot perform the essential or regular duties of your occupation or any occupation.
Partial disability means you can still work to some extent. Meaning you are able to do some of the important duties of your occupation (but not all), or your income has dropped by more than 20%. Partial disability is usually only available with individual insurance policies. All policies include total disability.
Change of Definition of Disability: Own Occupation vs Any Occupation
There are two types of “total disability.”
First, there is total disability from your ‘own occupation.’ This means you will be considered disabled if you are incapable of doing the essential duties of the job you had when your disability started. With group policies, it is common for this definition to apply for the first two years of disability payments.
Second, there is total disability from ‘any occupation.’ So, being unable to do your own occupation is not enough. To meet this definition of disability, you need to be unable to work in other jobs. However, the definition of “any occupation” is not literal. The other occupations must match your education, work experience and limitations. In most cases, the ’other occupation’ must be capable of paying at least 60% of your pre-disability salary. Therefore, it is possible to do some work and still meet the definition of ‘any occupation if you are not capable of earning 60% or more of your pre-disability income.
For a more detailed explanation, check out our article: ‘Change of Definition’ for Long-term Disability Benefits.
What qualifies for long-term disability in Canada?
So, what is considered long term disability? Almost any illness or injury can qualify for long-term disability. Insurance companies do not approve claims based on a diagnosis. Instead, they focus on whether your medical condition causes functional limitations and impairments.
For example, it’s possible to have the diagnosis of Multiple Sclerosis (MS) but not meet your insurance policy’s definition of disability. Many people with an early diagnosis of MS can still do the essential duties of their occupation. Therefore, they won’t qualify for long-term disability payments. However, they may qualify later on if the MS causes greater functional impairment and limitations.
A 2019 insurance industry study identified the distribution most common diagnosis for disability claims as follows:
- Mental Disorders (30%)
- Musculoskeletal (21%)
- Cancer (13%)
- Circulatory (7%)
- Nervous System (7%)
- Accidents (9%)
- All others (13%)
Do not worry if you do not know where you fit in the above categories. They merely show the breakdown of the approved claim by medical conditions. It doesn’t affect the likelihood of your claim getting approved.
Check out our guides on winning disability benefits for specific medical conditions:
- Back Problems & Conditions
- Bipolar Mood Disorder
- Carpel Tunnel Syndrome
- Chronic Fatigue Syndrome
- Chronic Pain
- Complex Regional Pain Syndrome
- Crohn’s Disease
- Heart Disease
- Headache and Migraine
- Irritable Bowel Syndrome (IBS)
- Knee Disorders
- Long COVID
- Lyme Disease
- Multiple Sclerosis
- Neck and Cervical Disorders
- Psoriatic Arthritis
- Sleep Disorders
- Vestibular Disorders
- Visual Disorders
How long is long term disability paid for?
How long does long term disability last? Long term disability benefits will continue until you no longer meet the definition of disability under your policy or until the specified coverage period ends (typically at age 65). However, coverage periods vary from policy to policy. Check your plan to see how long benefits last under your policy.
How much does long-term disability pay in Canada?
Canada long-term disability benefits are paid in one of two ways. It can be a percentage of your salary — usually from 50% to 85%. Or, it can be a set amount — $2000 a month, for example. Benefits are usually paid on a monthly basis and there is typically a maximum payment, which can be found in your long-term disability policy.
Check your plan or talk to your benefits administrator to see your long-term disability benefit payments in 2023.
Do most employers offer long-term disability?
Most employers offer long-term disability coverage. However, they are not legally required to. Many employers who offer this coverage pay all of their staff’s monthly premiums, while some companies require their employees to contribute to all or part of their coverage. If you aren’t sure if you have LTD coverage check your group benefits booklet or talk to someone in your HR department.
On the other hand, if you are a professional service provider or business owner, you likely have your own coverage through an individual policy. If that’s the case, you would have selected whether you have LTD coverage or not.
Check out our guides on winning disability benefits for specific occupations:
- Dentist Disability Claims
- Veterinarian Disability Claims
- Physician Long-Term Disability Claims
- Long-term Disability Claims for Sales Agents and Representatives
- Chiropractor Long-term Disability Claims
How to Buy Canada Long Term Disability Insurance
In this section, I review what you need to know when buying long-term disability insurance or enrolling in a company plan.
I begin by reviewing the three types of long-term disability insurance. Then I discuss how to apply for disability coverage. I close with a list of questions you should ask when buying insurance or enrolling in a plan.
There are three types of long-term disability insurance:
- Special Purpose
Group disability insurance is the most common. Employers purchase this policy to cover their employees as a group. You cannot buy it directly for yourself. However, when you join your employer’s group medical plan, you apply for it. You then pay premiums for it as part of your payroll deductions. Keep in mind you lose this insurance if you resign from your employment or get fired.
Insurance brokers sell individual disability insurance directly to consumers. This insurance only covers you and is not tied to your employment. You can take it with you if you change jobs. Individual insurance has a more extensive application and medical screening process. Once approved, you pay monthly premiums directly to the insurance company.
Special Purpose Insurance
Special purpose plans cover a wide range of situations when you lose your income because of disability:
- Auto Insurance – pays income loss benefits if you are unable to work after a car accident
- Creditor’s Insurance – covers your visa, loan or mortgage payments if you cannot work because of disability
- Dismemberment coverage – pays a lump sum of money if you lose the use of a limb, hearing or vision
- Critical illness – pays a one-time lump sum if you are diagnosed with a critical illness
- Business overhead – pays a one-time payment or monthly payments to cover business overhead and expenses
- Travel Health Insurance – reimburses medical expenses incurred while travelling
Disability Insurance Coverage: How Do You Enrol?
Applying for insurance coverage is how you enrol in a plan or policy. Without coverage, you cannot file a claim should the need arise. How you apply for coverage will depend on the type of disability policy:
Applying for Group Insurance Coverage
You apply for group insurance coverage through your employer, union or association. You are eligible to enrol because of your status as a full-time employee or member of a union or professional association.
The application involves filling out a form. If the group covered by the insurance is small, you may also have to fill out a medical questionnaire. Or undergo medical tests. With large organizations, there are no barriers to enrolment other than your status as a member of the group. Once enrolled in the plan, you are considered a covered person under the plan. If you later become unable to work, you can file a long-term disability claim under the insurance policy.
Applying for Individual Insurance Coverage
Applying for individual insurance is more complicated than group insurance. You will have to provide detailed information about your medical history and undergo a medical assessment and bloodwork.
The insurance company then reviews your medical information to determine if they will agree to offer you a long-term disability insurance plan.
If you have pre-existing medical conditions, it is possible those will be excluded under the policy. For example, you were treated for depression in the past but are currently not having problems. In this instance, an excluded medical condition means you would not be able to file a disability claim for depression. But could be for any other new medical conditions or injuries.
For more information, check out our article: Pre-Existing Conditions and Long-Term Disability.
Questions to ask when buying or enrolling in a long-term disability plan
The questions you should as are different depending on whether you are enrolling in a group or individual plan. I cover both below:
Questions for Group Insurance Plan
- What percentage of pre-disability income will be paid? 65%, 75% or 85%?
- How long is the waiting period for benefits to start? 3 months? 6 months? 12 months?
- Does the plan pay short-term disability benefits during the waiting period?
- How long do benefits last? To age 65?
- How does the plan define “total disability”?
- Does the plan include “own occupation,” “any occupation,” or both?
- Are the monthly benefits taxable as income?
- what types of other income does the plan offset?
- How long is the pre-existing conditions exclusion period?
- Are any medical conditions excluded?
- Are any benefits limited by medical conditions?
- Is there a waiver of premium for group insurance benefits while you are on an approved long-term disability claim?
Questions for Individual Insurance Plans
- What is the benefit payment amount? Is it a fixed amount per month or based on a % of pre-disability income?
- How long can benefits be paid? To age 65? Longer?
- How is disability defined in the policy?
- Is this an own occupation policy? Or does it go from ‘own occupation’ to ‘any occupation’ over time?
- If it is an own-occupation-only policy, will I still get payments if I am able to work in another occupation?
- Is there a partial disability clause? How long can one get partial disability?
- Are there any pre-existing condition exclusions?
- Are there any benefit limitations based on medical conditions?
How to Apply for Long-Term Disability in Canada
Do you need to apply for long-term disability benefits? Are you looking for a simple step-by-step guide? If so, you are in the right place. Follow our 7-step process to complete your application for long-term disability.
1. Determine when the waiting period ends
All long-term disability plans have something called a “waiting period.” You can only qualify for long-term disability benefits if you are off work for an extended time. The waiting period is simply the length of time you must be off work for your disability to be considered “long-term.” This is in contrast to a short-term or temporary disability.
There is no standard length for a waiting period. It can vary from plan to plan and may range from 12 to 52 weeks. However, the vast majority of long-term disability plans fall in the 17- to the 22-week range. Your insurance policy or group benefits booklet sets out your waiting period.
You can start your application before the waiting period ends. You want to apply early so your benefits can be approved and start immediately once the waiting period ends. The benefits administrator needs time to process your application. This can take four weeks or more. If you wait until the waiting period ends, then there could be a delay until your payments actually start. The delay may be a month or more. So, we recommend starting your application at least four weeks before the waiting period is over.
2. Make sure your doctor supports you in applying for long-term disability
Before starting the application process, you need to know that your doctor will support you. You will never be approved for long-term disability if your doctor disagrees. Some doctors will recommend short-term disability but may hesitate to recommend long-term disability. They may believe that trying to go back to work after a short break is the best thing for you.
It is absolutely vital have a clear and frank conversation with your doctor. You need to know for certain if they will recommend that you stay off work after the waiting period expires. If your doctor supports you, then you are good to go. You can start your application. However, if your doctor doesn’t support you, or recommends you try and return to work, you will have to delay your application until you get their support or figure out an alternative.
3. Tell the insurance company you want to apply for long-term disability
Once you have your doctor’s support, the next step is to tell the insurance company that you want to apply for long-term disability. Exactly how to apply for long-term disability will vary from plan to plan. So, you need to ask your insurance company what you need to do.
There are two possibilities:
First, you may not have to do anything more. If the insurance company is already paying your short-term disability, then they may consider your long-term disability automatically. Or, they may only need an updated medical report from your doctor.
Second, the insurance company may ask you to fill out an application package. This is common when the insurance company has not managed your short-term disability claim. They will send you the application package, which usually includes an application form, a medical form, and an employer form.
4. Fill out the forms in the application package
The application package will usually include three forms:
- Application form (you fill out)
- Medical form (your doctor fills out)
- Employers form (your employer fills out)
You are responsible for filling out the application form. Many of the questions may seem straightforward but take your time. As questions about your work, medical conditions, symptoms, and limitations will require special care. If you run out of space on the form, it’s perfectly fine to write in the margins. You can even attach a separate sheet of information — but make sure you indicate that you have done this.
It is crucial to get the application submitted as soon as possible. All insurance plans have a deadline. It is usually 3 to 6 months after the end of your waiting period. We recommend you get your application in before your waiting period ends. However, if you have missed the deadline to apply, reach out to us or another law firm to learn what you should do.
The doctor’s form is the most important part of your application for long-term disability. The insurance company cares most about how your doctor describes your medical condition, limitations, and treatment plan. You can give this information to the insurance company yourself. However, they will not take it seriously unless it comes from your doctor.
It is your responsibility to get the doctor to fill out this form. We recommend you make an appointment with your doctor where you exlusively deal with this form. That way, the doctor knows it is coming. Do not try to fit it in during another appointment. Do not drop it off for the doctor to fill out in their spare time. It is best to have the entire appointment time devoted to the form so the doctor can ask you questions while filling out the form.
You have to arrange for your employer to fill out the employer’s form. This form asks them to confirm your job title, salary, hours of work, job duties, and responsibilities. Ideally, you will want to review this form before it gets sent to the insurance company. You want to do this to ensure the information on it is accurate. Some employers will provide incorrect information either by mistake or on purpose.
If you notice incorrect information on the employer’s form, do not write on it or edit it in anyway. It is critical that the employer’s form only has your employer’s writing. Otherwise, it may look like you are tampering with the form. If you see incorrect information, start by bringing this up with the employer. It may have been an oversight. They can correct it on a new form. However, if the employer refuses to correct the information, you can address this in a separate letter attached to your application. Do not write anything on the form.
5. Send the application and supporting documents to the insurer
Ideally, you want to send your application in one package with all supporting documents. This package should include the following:
- Your application form, completed and signed
- Sheet attached to the application form with any additional information that would not fit on the form
- Medical form completed and signed
- Employers form, completed and signed
- Cover letter
You might not be able to send everything at once. For example, some doctors and employers will insist on sending their forms directly to the insurance company. Or, if someone takes a long time to do the form, you should get your application and supporting documents in as soon as possible. That way, you will at least start the process so the insurance company can assign a claim representative to your long-term disability claim. Sometimes, the claim representatives can help you get the doctor or employer to get their form in.
6. Cooperate with reasonable requests from the insurer when applying for long-term disability
A cooperative mindset will go a long way when applying for long-term disability. You should act in good faith with any reasonable requests from the insurance company. The following are some common requests:
- Speak with them by phone to answer questions
- Provide copies of your medical records
- Ask your doctor to give more information
By reasonable requests, I don’t mean what you personally feel is reasonable, or what your doctor thinks is reasonable. Rather, I am referring to what a court would determine is reasonable in the circumstances. You need to follow this standard when deciding whether to deny a request from the insurance company.
Some people have the instinct to provide the insurance company with as little information as possible or to object requests for information or documents. We have seen people make excessive or unfounded complaints about privacy violations and other petty problems.
Please resist the urge to do this. When you act unreasonably with the insurance company, it hurts your credibility. Credibility is the key issue in most long-term disability claims. If people see you as credible, your claim will have a much greater chance of being approved. If you are not credible, there is a much smaller chance you will get approved — even if you are legitimately disabled and should qualify.
A denied claim will ultimately end up in court. You want the judge to conclude that you went above and beyond to be helpful and acted reasonably at all times. If the judge sees that you were unreasonable or petty and sees the insurance company acting reasonably, then you are sure to lose your claim.
7. Wait for the insurance company’s decision
The final step in applying for long-term disability is to wait for the insurance company’s decision. The representative may tell you over the phone, but usually, you will get an email or letter. It usually takes 30 to 60 days to get a decision. However, it can take longer if the employer or medical form gets delayed or if you get delayed in filling the insurance company’s other requests for information.
If the insurance company approves your application, make sure to read the letter carefully. Sometimes, it may only be a temporary approval. Sometimes, approvals are conditional. You might need to get them other outstanding information by a deadline.
If the insurance company denies your application, you have the right to ask them to reconsider, which is called an appeal. I strongly recommend you consult with us at Resolute Legal or another disability law firm before going ahead with your appeal. Each appeal needs to be done strategically in order to maximize your chances of success. The right approach for you will be different from what others should do. This is because no two situations are the same.
Appealing a denial of long-term disability
You have the right to an internal appeal if your claim gets denied. An appeal means you ask the insurance company to reconsider its decision to deny your benefits. A long-term disability internal appeal means that the appeal is handled by employees of the insurance company. Each insurance company has its own process. You need to make this request in writing.
Finally, if the insurance company denies your internal appeals, you have the right to do an external appeal. External means that the appeal is handled by someone who is independent of the insurance company. In most cases, this will be a judge in your province. However, some plans have different procedures. So, it could be an arbitrator.
When you do an external appeal, it can involve filing a lawsuit against the insurance company. However, this is still an external appeal. So, the insurance company can decide to approve your claim before it gets to court.
The insurance company could also negotiate a one-time settlement with you. This is called a lump-sum settlement. I will discuss that in the next section below.
For more information on how to appeal, check out our article LTD claim denied.
While you’re at it, take a look at our article: ‘Will I Have to Pay My LTD Insurer’s Legal Fees if I Lose My Case?‘ where we discuss what happens if you win or lose your legal appeal and long-term disability lawyer fees.
Lump-sum Settlements for Long-term Disability
Insurance companies sometimes pay settlements. In other words, you would get a one-time payment for past and future benefits instead of monthly payments. Settlements are most common during lawsuits or legal appeals. The insurance company will offer to settle rather than go to trial. They provide you with a one-time payment for past and future benefits instead of monthly payments. The settlement will not be the full value of your future payments. So there is a tradeoff. The amount administered in the lump sum settlement can vary widely from case to case.
Lump-sum settlements are less common for people receiving benefits. If you are on an approved claim, you shouldn’t try to get a settlement. That typically doesn’t work because insurance companies will only make the offer if they want to. And because they only do this when it makes financial sense for them. You can read our article on long-term disability lump-sum buyouts to learn more. You can also check out our homepage to learn more about how our LTD lawyers can help you.
After Approval of Long-term Disability
You still have to deal with the insurance company after they approve you for long-term disability. They will continue to monitor your condition and treatment. They may ask you to see a doctor. Or, they might enrol you in a treatment program. Ultimately, it’s your responsibility to follow the rules laid out by your provider.
So, to keep your benefits, you must carefully manage your relationship with the insurance company. You will need to do what they ask, even if you disagree with it. The following are common issues that happen after claim approval.
Continuing medical review
You have to keep proving your disability even after you get approved. This is called a continuing medical review.
Typically, the insurance company asks your doctor for updates. They might ask every month or every six months. It might only be once per year. Whatever the case, the insurance company has a right to these updates. Therefore, you have to cooperate with them. Otherwise, they can stop your payments.
- Long-term Disability ‘Update Forms’: 3 Traps to Avoid
- What to Do When Your Doctor Refuses to Send Medical Records to Your LTD Insurer
Treatment and rehabilitation programs
Insurance companies can force you to attend treatment and rehabilitation programs. For example, they
might send you for psychological treatment. Or, they can enroll you in physiotherapy programs. Not every policy has the right to do this, but most do. So, make sure to check yours. They can’t force you to go, but they can stop payments if you don’t.
Further reading: Long-Term Disability and Pharmacogenomic Testing
Independent medical examinations
Insurance companies can send you to a doctor of their choice. This type of exam is also known as an independent medical examination or IME.
The purpose of an IME is for the doctor to give an opinion. This doctor doesn’t treat you, however. So, they don’t replace your doctor or specialist.
After your visit, the doctor sends a report to the insurance company. In the report, they answer questions for the insurance company. The report also includes the doctor’s opinions about your conditions, treatments, and disability.
You might not want to see these doctors. Some common objections are that it’s too far to travel. Maybe the doctor’s specialty doesn’t match your condition. Another is that the doctor will say bad things about you. Perhaps they have terrible reviews online.
These concerns are certainly valid. But you still need to attend the exam. This is because the insurance company has the legal right to send you to their doctor. If you refuse to go, then they can stop your payments.
Go to the medical examination in good faith, even if the doctor has terrible reviews. You may be pleasantly surprised by the results! Sometimes the doctors will give opinions that support you.
Holistic and Alternative treatments
It is very common for people who are on long-term disability to want to participate in every possible treatment to get better. And sometimes, that will lead them to try holistic or alternative treatments. However, depending on your policy and whether the treatment is approved by your doctor, you may run into problems with your insurance company.
For more information on this, check out our article: Can Long-Term Disability Insurers Reject Alternative or Holistic Treatments?
Offsets and integration of benefits
It’s common for insurance companies to reduce your disability benefit if you get other payments. In other words, they offset their payment — usually dollar-for-dollar. For example, let’s say you get a CPP disability payment of $900 per month. In this case, your insurance company reduces their payment by $900 per month.
Other offsets include money you get from workers’ compensation, personal injury settlements, or severance payments, to name a few.
For more information, check out:
- 6 Reasons to Apply for CPP Disability, Even Though Your Insurance Company Gets All the Money
- LTD Overpayment because of CPP Disability Retroactive Payment: What are my options?
- Irrevocable Consent to Deduct and Pay an Insurer: What You Need to Know
Can the insurance company force me to apply for CPP disability?
Yes, an insurer can force you to apply for CPP disability. Again, the policy gives them this right. Most policies do this, but not all. Technically, you can refuse to apply for it. If you do, then they will guess what CPP would pay you. Then, they can deduct it from their payment.
They can also force you to apply for other benefits, including:
- Worker’s compensation
- Medical pensions
- Other disability insurance policies
Insurance companies hire private investigators all the time. They do video and online surveillance. They try to get you on video doing things you said you could not do. Or, they find things online that make you look bad.
But you won’t always be under surveillance. It happens more if you’re young or if you have high payments. It also happens more if you have been getting benefits for over two years. Basically, they want to keep their money.
I have seen a lot of surveillance videos of my clients, and they rarely prove a person to be a liar. But they can show inconsistencies and insurance companies will make a mountain out of a molehill. For example, you might take five steps when you say you can’t walk. If they record you doing this, then it can hurt your credibility. Unfortunately, that is their goal: to make you look like a liar.
So, is it legal? Yes, as long as investigators stay in a public space. This gets a little weird. For instance, they can record you on your property if they are standing on a public sidewalk.
Online surveillance happens too, but it’s limited to the investigator viewing what’s publicly available online. Check out our article, Long-term Disability Surveillance: Online Guide 2023, for more information.
Long-term disability after 2 years in Canada
If you have been on long-term disability for more than two years, you will likely receive benefits based on an “any occupation” definition of disability. This means that the insurance company will pay benefits as long as it believes you are incapable of doing any type of work.
Not exactly “any” type of work, but any work that you can do and from which you could earn 60% or more of your pre-disability income.
Being approved beyond two years is not a guarantee that benefits will continue to age 65. The insurance company will continue to monitor your claim. It will ask for updates. You need to continue treatment when appropriate.
Return to work programs
At some point throughout your claim, the insurance company may ask you to take part in a return-to-work program. This program usually involves a gradual return to the workplace, which could include working at reduced hours or with modified duties while you get settled back into your former position.
The insurance company cannot force you to return to work. However, they can threaten to cut off your benefits. If you and your doctor agree that you aren’t healthy enough to return to work, you shouldn’t give in to their demands.
Now let’s suppose you and your doctor feel like you are ready to try to go back to work. In this case, we highly recommend doing so. Even if the return to work is unsuccessful, you can usually get your benefits reinstated. This is because most LTD policies have a recurrence clause that allows you to get back on benefits if the return to work fails as a result of the same disability. This clause also allows you to get your benefits reinstated without having to undergo another waiting period. However, it’s important to keep in mind that you can usually only claim recurrent disability within a certain time frame. It’s usually between six to 12 months.
You should always speak with a disability lawyer before attempting a return to work. They can look over your policy and make sure it has a recurrent disability clause and help with any other issues that may come up.
For more information, check out:
- Returning to Work While on Long-Term Disability
- Can you Attend School While on Long-Term Disability?
Long-term disability after age 65 in Canada
Most long-term disability policies only last for a specific period of time or until the policyholder reaches a certain age. The most common expiration date is when the claimant turns age 65. However, the expiry date will differ depending on what type of policy you have. For instance some benefits only last for two years while others will last a lifetime. Never assume. Always check your policy to see how long your benefits will last.
Employment Termination and Long-term Disability
“Can I be fired while I am on long-term disability?” We get this question all the time.
Unfortunately, the short answer is yes. Generally speaking, employers can fire employees at any time. They can’t just fire you because of your disability — that would be a human rights violation. Legally, they have to provide termination or severance pay.
So, in some cases, you may have a legal claim against your employer. For instance, if you are terminated without severance pay. You would also have a case if you believe it was because of your medical condition or disability. In these cases, you can win compensation in court.
Most employers won’t terminate you if you’re on long-term disability because they know it looks bad. They want to avoid lawsuits and human rights claims. Therefore, cautious employers will allow you to be on sick leave for up to two years.
But, after two years, your employer may have the option to terminate you for cause. This means they would only have to pay the minimum severance allowed under provincial laws. This type of termination is based on the frustration of employment. This is a complicated area of law. If this is your situation, I urge you to get specific legal advice.
To read more about this, check out our articles:
- Long-Term Disability and Termination of Employment
- Severance Packages and Long-Term Disability: 3 Things to Watch Out For
- Can I Quit My Job While on Long-Term Disability?
Disability Insurance Companies
Disability insurance companies are a private source of long-term disability benefits. They are all members of the Canadian Life and Health Insurance Association (CLHIA). You must be a member of an insurance policy to receive benefits. The following are all the disability insurance companies in Canada.
- ACA Insurance
- Assumption Life Financial Services
- Canada Life long-term disability
- Blue Cross Life Insurance Company
- Canadian Tire Life Insurance
- New York Life long-term disability (CIGNA)
- Co-operators Life Insurance Company
- Desjardins long-term disability
- Empire Life Insurance Company
- Fenchurch General Insurance Company
- Industrial Alliance long-term disability (iA Financial Group)
- La Capitale Life Insurance
- Manulife long-term disability
- Primerica Life Insurance Company
- RBC Life Insurance Company
- Sun Life long-term disability
- Standard Life Insurance Company
- SSQ long-term disability
- ScotiaLife Financial
- UL Mutual Company
- Wawanesa Life Insurance Company
Public Sector Long-term Disability Plans
The following is a partial list of non-profit long-term disability plans in Canada:
- OHA Disability Income Plan (HOODIP 1992)
- Ontario Teachers Insurance Plan (OTIP)
- Nova Scotia Public Service Long-term Disability Plan (Manulife)
- NSAHO LTD Plan (Manulife)
- Nova Scotia Teacher’s Union LTD Plan (Manulife)
- PEI Public Sector Group Insurance Plan (Great-West Life)
- New Brunswick LTD Plan (Blue Cross)
- New Brunswick Teachers Union LTD Plan (Manulife)
- Newfoundland and Labrador Public Sector LTD Plan (Great-West Life)
- PSAC LTD Plan (Sunlife)
- SISIP LTD Plan (Manulife)
Complaints Against Long-term Disability Insurance Companies in Canada
Each province has a government agency that regulates insurance companies. If you need to file a complaint against an insurance company, you need to send it to the right agency for your province.
- Nova Scotia
- New Brunswick
- Newfoundland and Labrador
- Prince Edward Island
- British Columbia
- Northwest Territories
Long-term Disability FAQs
Let’s conclude with some frequently asked questions. The following are answers to the most common questions people ask us about long-term disability benefits:
Who is eligible for long-term disability benefits?
Most people aren’t eligible. You have to be a worker with group benefits. And, those benefits must include long-term disability. Otherwise, you are only eligible if you purchased an individual policy. This is common with self-employed professionals — doctors, dentists, chiropractors, and vets, for example.
Who pays for my medical plan while I’m on long-term disability?
Typically, you have to pay your medical benefits while on long-term disability. Normally, this comes out of your paycheque. But, the insurance company doesn’t take it from your monthly benefits. You have to pay for it yourself. Sometimes the long-term disability policy pays your premiums. But this is very rare. You should assume you have to pay. Speak to your employer about it.
When does long-term disability start?
Every plan has a waiting period or an elimination period. Long-term disability benefits start after you have been continuously disabled for a certain length of time. It is usually three to six months. You can get other benefits like short-term disability or EI during the waiting period.
Do I have a right to a copy of the report from the Independent Medical Examination?
You do not have a right to the IME report. You have a right to medical records from regular doctor visits. IMEs are not regular visits. They are a private consultation for the insurance company. You may have a right to the report during a lawsuit. Consult a lawyer.
Does my employer have a right to know WHY I am on long-term disability?
You have a right to privacy. Therefore, your employer can’t ask for details about your medical condition. But, your employer has a right to know about any permanent work restrictions. Otherwise, they can’t figure out if they can accommodate you. Your doctor must give enough information so the employer knows what help you need.
When does long term disability end?
Long-term disability benefits will persist either until you no longer meet the disability criteria outlined in your policy or until the specified coverage period concludes, which is typically at age 65. Nevertheless, these coverage periods can differ among policies, so it’s essential to review your specific plan to determine the duration of benefits provided under your policy.
What happens when long term disability ends?
In most cases, your long term disability insurer will give you some notice that your benefits are going to end. However, sometimes a denial can come out of nowhere. Either way, your benefits ending will have the same result: you will have to return to work or appeal the denial.
If your benefits ended merely because your coverage period ended, you will have to apply for other benefits, retire or return to work.
What happens after long-term disability runs out?
LTD can end for two reasons. One, you or the insurer believe you were well enough to return to work. Two, your coverage period has terminated (i.e., you turned 65). Regardless of your scenario, your options are to return to work, appeal the decision, rely on other benefits or retire.