Long-term disability (LTD) insurance is important for anyone in the workforce regardless of whether you work in a physically intensive job or in an office environment.
When we think about assets, our minds generally go towards a house, a car, a portfolio of securities in your registered retirement savings plan (RRSP), etc.
However, your ability to continually generate income is perhaps your greatest asset. Regular income is what makes mortgage or loan payments possible, as well as allows you to top up your investment account every once in a while.
However, a disability can create major problems when it comes to personal finances.
While your expenses and obligations remain largely the same (or even more if you are seeking medical treatment for your disability), your inability to work impacts your salary.
For such instances, long-term disability insurance is the solution to prevent you from eroding your assets or taking on excess debt.
- What is long-term disability insurance?
- What can I do during the waiting period?
- Long-term disability benefit timeline
- Own occupation vs. any occupation
- Your own occupation is not the same as your job
- What is covered under long-term disability insurance?
- Difference between critical illness insurance and long-term disability benefits insurance
- Key differences between the insurances
- Differences between life insurance and long-term disability benefits insurance
- Tips to increase your chances of a successful LTD claim
- Frequently asked questions about long-term disability insurance
What is long-term disability insurance?
Long-term disability insurance is a type of insurance coverage that replaces a fixed percentage of your lost income (approximately 65%), in the event that you are unable to work due to a disability that is verified by a licensed physician.
Once you receive the diagnosis from your physician, you have to go through a pre-defined waiting period. This waiting period is the amount of time that the insured person must wait before insurance coverage kicks in.
After the the waiting period, the insurance company sends out monthly payments according to your insurance policy.
What can I do during the waiting period?
Waiting periods generally range from three to six months. If you are dealing with a disability that prevents you from living your normal life, this waiting period can seem endless.
However, during the waiting period, you can apply for and receive short-term disability benefits from a group insurance plan provided by your employer. Another option is the government of Canada’s employment insurance sickness benefits program.
These benefits are available to you in the interim waiting period and go away once your long-term disability benefits take effect.
Long-term disability benefit timeline
Enroll in your employer’s benefits plan
If you are a full-time employee receiving employer benefits, you might have long-term disability coverage as part of your group insurance plan. As long as you are enrolled in this plan, you should be able to use long-term disability insurance if and when you need it at a later date.
When you are diagnosed with a critical illness by a physician and are unable, or substantially less able, to work, you can go on sick leave if you have a medical note from the physician.
Short-term disability benefits
During the waiting period, you can apply for short-term disability benefits either through your group insurance plan or from the federal government’s employment insurance sickness benefits program. These short-term disability benefits are paid out on a monthly basis.
Long-term disability benefits
Once the waiting period has elapsed (usually between three and six months), your long-term disability benefits will replace the short-term disability benefits program you were using.
A key change that occurs during the course of your long-term disability benefits coverage is that the definition of ‘disability’ now refers to a disability that prevents you from performing any occupation (not just your own previous occupation).
This change usually occurs at the two-year mark of the onset of your disability. However, policies can vary. It is important to carefully read your policy to understand the terms and conditions applicable to you. It is also important to note that a physician must confirm the same.
Long-term disability benefits expiration
In many cases, the long-term disability benefits remain in effect until the insured person can return to work or when the insured person turns 65. Once again, policies may vary.
Some insurance plans only provide LTD benefits for a period of 5, 10, 15 years, etc. It is in your best interest to understand what your specific plan includes.
Own occupation vs. any occupation
Long-term disability insurance can often include terminology that may be confusing to a first-time reader. One of the main considerations to look out for when reviewing an LTD policy is the ‘test’ of disability. This test stipulates that the insured person must be unable to perform the duties of his or her ‘own’ occupation or ‘any’ occupation.
If your policy is an ‘own’ occupation policy, you get long-term disability insurance payments if you are unable to complete the requirements of your current job. Even if you can go into work, if you cannot complete the precise set of tasks for your job, you are eligible to qualify for LTD payments.
Your own occupation is not the same as your job
Note that your ‘occupation’ is not the same as your ‘job’. To qualify for long-term disability payments, the insured person must be unable to complete a similar standard and class of job with a different employer within the same occupation field. Usually, the ‘own’ occupation test is applied for a period of two years (although the precise time may vary depending on the policy).
If your policy is an ‘any’ occupation policy, it doesn’t mean that you will only qualify for LTD payments if you are physically unable to perform any job. These policies take into account your education and professional credentials. Using these factors, the ‘any’ occupation threshold means an occupation that you are reasonably well-qualified for that constitutes ‘gainful’ employment.
In this context, gainful employment is one that provides you with at least 60% of your earnings prior to the disability. After two years (or the corresponding amount of time for your ‘own’ occupation policy), you will likely be subject to the ‘any’ occupation test to determine whether LTD payments should continue to be paid.
What is covered under long-term disability insurance?
Long-term disability insurance policies can vary significantly from one to another. Each insurance company has a different definition for ‘disability’. However, the below list details the most critical illnesses and policies that the majority of LTD policies will cover.
Musculoskeletal issues, such as arthritis, are the cause of over a third of total long-term disability claims in North America. These conditions can cause pain, stiffness, and loss of dexterity or mobility in key joints throughout the body.
Beyond the physical impacts, musculoskeletal issues can also cause significant mental health detriments. Some common musculoskeletal conditions include:
- arthritis and osteoarthritis
- spinal stenosis
- carpal tunnel syndrome
- degenerative disc
- neck and cervical disorders.
Over six million Canadians reportedly suffer from chronic pain. Chronic pain is pain that remains with the patient for a long period of time and can occur on a single body part or throughout several parts of the body.
It is also believed that chronic pain patients have some of the lowest quality of life experiences among major long-term disability conditions. Such patients regularly experience physical pain, fatigue, lower energy levels, etc., which can subsequently lead to mental health issues including depression and anxiety. Some common chronic pain conditions include:
- chronic nerve, back, and neck pain
- psychogenic pain
- injuries incurred due to accidents or falls.
Personal injuries can include those caused by fractures, loss of a body organ, dismemberment, scarring, disfigurement, and other serious ailments such as a herniated disc. If you experience any of these, you are likely eligible to receive LTD payments that would cover your medical costs, lost wages, physical and emotional pain, and disability accommodations for your home or car.
Mental health and psychological issues
Over the last few years, mental health has become an increasingly common issue in Canada, affecting hundreds of thousands of people across the country. A study by the Canadian Mental Health Association reported that 1 in 2 Canadians will suffer from some sort of mental illness by the time they reach the age of 40.
Patients suffering from mental health are often unable or significantly less able to perform daily living and working activities. Some of the most common mental health conditions covered by LTD include:
- intellectual disabilities
- bipolar disorder
- post traumatic stress disorder (PTSD)
- alcohol or drug addictions
Cardiovascular conditions impact the heart. They are caused by fat deposits, inflammatory cells, or the buildup of plaque in the arteries.
These then cause blockages in the bloodstream, preventing the delivery of oxygen to the heart. In Canada, nearly 30% of deaths are from cardiovascular diseases.
Some of the most common cardiovascular conditions covered by LTD benefits include:
- chronic congestive heart disease
- congenital heart disease
- chronic venous insufficiency
- peripheral arterial disease.
Respiratory conditions are diseases that affect the lungs or other parts of the respiratory system. These diseases can be caused by smoking, air pollution, asbestos, or radon, among other causes.
When filing an LTD claim for respiratory conditions, long-term disability insurers will often require detailed documentation of medical evidence like pulmonary function tests that justify the severity of your illness and its detrimental impact on your day-to-day living.
Common respiratory conditions include:
- cystic fibrosis
- chronic obstructive pulmonary disease (COPD)
- asthma or chronic asthmatic bronchitis
- restrictive lung disease
Neurological disorders impact a patient’s brain and central nervous system, including the spinal cord. There are currently over 600 known neurological disorders, and symptoms can be mild or severe depending on the patient and illness.
Some disorders are more episodic, wherein symptoms are only experienced at intervals (such as seizures) while others tend to cause more serious, continuous, and adverse changes to a person’s quality of life.
The type of neurological disorder diagnosis is important as a patient can only receive LTD benefits if their disorder causes them to be totally disabled. Some common neurological disorders that are likely eligible for LTD claims include:
- Alzheimer’s disease
- Huntington’s disease
- multiple sclerosis
- Parkinson’s disease
- cerebral palsy
- brain tumours
- traumatic brain injuries
- spinal cord injuries.
Cancer is a life-threatening disease caused by the development of abnormal cells in the body that start to multiply in uncontrollable numbers, and infiltrate and compromise body tissue across the body. It is the second cause of death globally.
The four main types of cancer include:
- carcinomas (the most common type of cancer that includes prostate cancer, breast cancer, lung cancer, and colorectal cancer)
- sarcomas (cancer that develops in fat, muscles, nerves, tendons, joints, blood vessels, lymph vessels, and cartilage before spreading across other parts of the body
- leukemia (cancer of the blood)
- lymphoma (cancer beginning in the lymphatic system).
Difference between critical illness insurance and long-term disability benefits insurance
Another component of most employers’ benefits packages is critical illness insurance. While both critical illness insurance and long-term disability benefits insurance protect your financial future, there are some fundamental differences between the two.
Critical illness insurance is a one-time, lump-sum payment provided to the patient, in which the patient has complete discretion over how they want to use the funds.
Critical illness insurance covers medical treatment costs. On the other hand, long-term disability benefits insurance replaces your salary when you are unable to work. In general, LTD insurance replaces 60% to 65% (and up to 75% in some cases) of lost salary.
Key differences between the insurances
Utilization of funds
Disability insurance is used to help you maintain a certain standard and quality of life on an ongoing basis even if you are not able to work anymore. On the other hand, critical illness insurance can be used to cover the costs of treatments, medications, private hospital rooms or nurses, etc.
The waiting period for disability insurance varies from a month to up to six months depending on the policy. Most policies have a 90-day waiting period.
On the other hand, the waiting period for critical illness insurance is much shorter. Funds are usually disbursed at approximately the 30-day mark.
Eligibility for application
Only people that are employed can apply for long-term disability insurance, as the insurance is intended to offer benefits contingent upon a specific salary. In contrast, anyone can apply for critical illness insurance as long as they are listed as a covered individual under the policyholder’s plan.
Differences between life insurance and long-term disability benefits insurance
Life insurance is a policy in which the life insurance company pays out a benefit to your listed beneficiaries in the event of your death. This is a lump-sum benefit paid out on a tax-free basis to your family, as long as your insurance policy is valid and the death met the terms of the policy.
Long-term disability benefits insurance provides a steady stream of income to replace your lost salary. It is paid to you on an ongoing basis until you turn 65, or until you are able to return to work.
Tips to increase your chances of a successful LTD claim
There are certain steps you can take to improve your likelihood of a successful long-term disability (LTD) claim.
Keep detailed records and documentation of all your medical history
Whenever you visit a physician or other treatment provider, make sure you keep a copy of the interaction for future records. File these in chronological order if possible. Keep them easily accessible in case you need to present evidence of an underlying condition or disability that prevents you from doing your own or any occupation.
Understand your policy
One of the main ways that people get in trouble with long-term disability insurance policies is by not reading the policy document. This document contains all necessary information, including covered conditions, the specified waiting period, and other terms and conditions regarding your eligibility. By carefully reviewing this information, you can ensure that you are best prepared to submit your LTD claim.
Stick to your treatment plan
Your physician or clinical service provider will outline a treatment plan for you at the inception of your condition or disability. It is important that you adhere to this treatment plan, as your insurance provider will review this to ensure that you used all available options to make a full recovery. Any deviations from your treatment plan can cause the insurance company to reject your claim.
Track your symptoms
Even if you are on a treatment plan, it is important to keep track of your symptoms over time. Keep a journal handy so you can easily pull up the precise dates of symptoms and treatments and explain how you felt or what you experienced.
In general, honesty is the best policy when it comes to filing long-term disability claims. When you are visiting a doctor or clinical service provider, be upfront about your symptoms.
Don’t understate anything, but don’t exaggerate your symptoms. Insurance companies sometimes hire private investigators to verify that your stated condition or disability is legitimate. This is entirely legal, as long as the private investigator respects laws, including those of trespassing on your property.
Submit information quickly
Whether you are using a lawyer or filing a claim yourself, submit your documents quickly. The faster you can send documents when needed, the easier it will be for the insurance company to process your claim and help you.
Frequently asked questions about long-term disability insurance
While policies may differ, long-term disability insurance generally lasts until the age of 65 for people who are employed or until the insured person is able to return to work. That said, it is best to check your individual policy statement, as some LTD policies may clearly stipulate that benefits will only last for a specific period.
While there is no comprehensive list of diseases or conditions that definitively qualify for all long-term disability insurance policies in Canada, there are certain critical illnesses that are generally covered under LTD policies. These conditions are encompassed under several categories, including (i) musculoskeletal issues, (ii) chronic pain, (iii) personal injury, (iv) mental health and psychological issues, (v) cardiovascular conditions, (vi) respiratory conditions, (vii) neurological disorders, and (viii) cancer.
There are dozens of illnesses or conditions under these categories that are covered by most long-term disability insurance policies. However, it is best to check your individual policy statement for your coverage details.
‘Own’ occupation policies generally tend to be more flexible than ‘any’ occupation policies. Under an ‘own’ occupation policy, you can do part-time or even full-time work provided that the work you are doing is entirely different from the work that you were doing when you were diagnosed with the long-term illness.
Pursuing work under an ‘any’ occupation policy may result in a reduction or termination of disability benefits depending on the wages you earn at the new job.
Usually, short-term disability coverage only lasts for a period of three to six months. This short-term coverage is intended to provide you with income in the near term while the waiting period for your long-term disability benefits elapses. Once the waiting period on the LTD benefits is completed, the short-term coverage goes away and is replaced by LTD coverage.
In Canada, there is generally a fixed set of steps to take when applying for long-term disability insurance.
1. Determine when your waiting period ends. Look at your policy statement to find out this number and start preparing your application at least six weeks in advance.
2. Visit your doctor and have an honest conversation. If the doctor is in agreement that you are unable to work even after the waiting period ends, then you can continue with the application. The doctor’s agreement is perhaps the most important and critical step in this entire process.
3. Inform the insurance company that you intend to apply for long-term disability benefits. At this point, the insurance company may choose to move forward with your application, or ask you to put together an application package. Each company is different, so it is vital to ensure that you ask exactly what the insurance company will require to process your claim.
4. Send the application package to the insurer. This application package should include your application form, medical form, employer’s form, and other supporting documentation including medical records as defined by the insurer.
5. Watch out for any additional requests for information from the insurer. If an insurer comes back with further requests, it is best to oblige on a timely basis. Any delays on your part could hurt your chances of a successful claim, as LTD applications hinge on your credibility as a claimant.
6. Wait for the insurance provider’s decision. This normally takes anywhere between one and two months. If your claim is approved, make sure that you read the letter carefully to determine whether there are any conditional stipulations embedded. If you are rejected, then you have the right to pursue an appeal.