I Have Been Approved for Short Term Disability Benefits. What Happens Next?

Short term disability benefits are just that. Short term. Usually 12 weeks/3 months. Step one is to check your policy to see how long benefits will be paid for this interim period.

If you have a benefit/policy booklet, in addition to how long the benefit will be payable you will find information about the amount of the benefit usually represented as a percentage of pre-disability salary. 80% is excellent but most range from 50 – 70% of salary. This is not a negotiable rate as it was set the day the policy was purchased.

Once you know more about the wage loss benefits you are receiving, you need to read on to learn about how to continue to receive wage replacement benefits until you are fully recovered. Generally short-term benefits can be turned into long term disability benefits with little trouble other than a comprehensive medical report from your physician. Test results and specialist consultations reports should be included.

Physical illness or injuries are much easier to document than emotional disturbance and therefore less likely to be challenged. When you are suffering from disease that others cannot see, chronic pain syndrome or PTSD being examples, you may appear outwardly well enough to work raising doubts that your eligibility for benefits exists (or continues to exist).

The percentage amount payable for short term disability benefits is often mirrored by the rate paid later for long term disability benefits and this is where the negotiating power of your union, your organization or your personal pocket comes to light. In general, the policy premiums are lower when benefit payment percentages are lower and those numbers are determined when the policy is initiated.

During the first two years of disability from your job the “disability test” relates to your ability to perform YOUR occupation as in the job you were hired to do. Plumber, Teacher, studio musician for example. Are you able to perform all, some or none of the duties associated with your particular job? The inability to work can be so varied that summarizing policy interpretation is impossible. A spinal cord injury causing paralysis is a far different situation than a mental health crisis.

If your employer is able to offer you modified work or part-time hours that information will be considered by the adjuster handling your claim. If there is any wiggle room in the medical reports that suggest a return to work may happen after a certain date, time period or treatment is possible, that information will be delved into. The goal of any insurance company is to get you back to work and off their books as soon as possible so don’t expect sympathy.

The bigger argument with disability claims arises at the time of the two year test, often enumerated as “104 weeks” in policy booklets. At two (2) years the test shifts from your ability to perform your OWN occupation to ANY occupation. Your occupation may require specific skills and training. None of that matters. Any occupation is just that. Can you do anything for which someone will pay you. You don’t have to be able to last a 40-hour work week or even an eight-hour day.

Alternate employment could be as a staff member in the plumbing department at a box store deemed a compatible occupation as you were a plumber pre-illness; a tutor at a children’s help center because you taught high school English; a shoe saleswoman in an athletic department deemed appropriate as you were a high school track athlete. The process where the insurance company seeks alternate occupations for you is demeaning and distressing. You may not decline involvement in the process, or your benefits will be discontinued for “non-compliance”.

Some policies contain a requirement that your earnings match the salary expectations of your pre-disability work. If you have one of those it will be much harder for the insurance company to cut off your benefits.

At any stage of the long-term disability process your insurance adjuster may request that you apply for Canada Pension Plan disability benefits. Your agreement to do so is set out in the policy that covers your coverage, so this is a legitimate request for the insurance company to make. Your compliance is required.

If you do not have a copy of the policy, or at least a benefit booklet describing your entitlement, request it. You are entitled to this information and any lawyer that you consult will need it to answer your questions.

All disability situations and insurance policies are different and should be considered individually. It is not possible to cover all variables. If your benefits are discontinued before you feel ready to return to work, you need to speak to a lawyer before the appeal period expires.

This is not a process without pitfalls. Brown Law Office is experienced in handling disability claims regardless of the reason for your disability be it illness or accident injury. Please contact us to request an initial consultation if you feel your insurance company is requesting medical records or assessments without basis or made a decision you feel is wrong. Our contact page can be accessed here.