You went off work on your doctor’s advice. Your employer approved your sick leave. You used your sick pay and vacation days. But when you applied for short-term disability payments, the insurance company denied your claim. In this article, we review your options after the insurance company denies your short-term disability claim.
There are several options open to you. You need to take stock of your situation to figure out what option makes the most sense. Below are six options that are open to you.
This article is part of our Ultimate Guide to Short-term Disability.
1. Go Back to Work
This may not be an option, but it’s possible your disability claim was denied because you are well enough to work. Be honest with yourself on this. If you know you can’t work. Or that if you return to work, you will be off work again in a few weeks, then skip this option.
2. Appeal the Denial
Your second option is to appeal the denial. You want to follow the usual best practices for appealing a disability claim denial. You need to get the insurance company to put the reasons for the denial in writing. In your appeal, you need to address the reasons given for the denial. You do this by giving the insurance company the information or medical evidence needed to approve your appeal. If the insurance company denies your appeal, then move on to the next option.
3. Apply for EI Sickness Benefits
If your short-term disability appeal is denied, but you are not well enough to return to work, then your next best option is to apply for Employment Insurance (EI) sickness benefits. EI Sickness benefits are a Federal Government Program paid by Service Canada. They will pay you 55% of your pre-disability weekly income for up to a maximum of 15 weeks. You will need to fill out an application online or at a Service Canada office. You will need to get a Record of Employment from your employer that shows you are on a medical / sick leave from work. You will need your doctor to certify that you are unable to work due to illness. EI sickness benefits will give you 15 weeks of payments.
4. Apply for Long-term Disability Benefits
If you are still not able to work after the 15 weeks, then you need to apply for long-term disability benefits. You should apply for long-term disability benefits even though your short-term disability claim was denied. While it is almost certain the insurance company will also deny your long-term disability claim, you need the application and denial to happen so you have more options.
5. Appeal the Long-term Disability Denial
You have the option to ask the insurance company to review its decision to deny your long-term disability claim; but, this really has a very low chance of success unless you have some new information or medical information that was not already given to them. If you don’t have new information, then you should just skip this step.
6. File a Lawsuit Against the Insurance Company
If the insurance company denies your long-term disability claim, and you are still not able to work, then your next step is to file a lawsuit against the insurance company. Speak with a disability lawyer to learn about your options. You may be concerned about not having money to hire a lawyer, but there are disability lawyers across Canada who could represent you on a no-win, no-fee basis.