Denied or Cut Off Long Term Disability Benefits or CPP Disability? Unable to Work?
Step 1 Do not quit your job!
If you are too sick to work due to injury or sickness, do not quit your job.
Step 2 Provide medical note to employer
Instead, get a medical note and consider what benefits may be available to support you while you recover.
Step 3 Obtain Short Term Disability application from HR or broker, or apply to Medical EI if no short term benefits
If you are an employee and part of a group benefit plan, ask your Employer or HR Manager for an application form for Short-Term Disability benefits.
If none, apply for Medical Employment Insurance benefits through Service Canada.
If you are injured at work, apply to WorkSafe BC. If injured in a motor vehicle accident, apply to ICBC for wage loss benefits.
If you are a professional or self-employed, ask your broker to help make application for income replacement benefits under an individual policy.
Step 4 Review employment contract, workplace policies, or collective agreement for medical leave of absence terms
Determine if your employment contract or workplace has any written policies concerning a leave of absence for medical reasons. This will allow you to plan according to such terms or policies.
If you are a member of the union, set up an appointment with your union representative to discuss all steps required to make a claim or take an appeal under the terms of the collective agreement.
Step 5 Obtain complete policy wordings for all benefits
Most employees are provided a booklet. On the first page inside of the booklet it will reference that the booklet is not the policy. You need the complete policy wording to read what benefits you have in place.
Your Employer or Union must provide this as the policyholder.
If you have a professional or income replacement plan, your broker will be able to provide you the policy wordings and help you with the application process.
Step 6 Apply for Long Term Disability Benefits
Whether you are approved for Short Term Disability or Medical EI or not, if you remain off work past the elimination period for LTD benefits in the policy, you must obtain the LTD application form from your Employer or HR Manager or broker.
Most LTD plans start after 4 months from onset of disability.
If union plan, it may be 1 year of STD benefits before any LTD is available, or you may have no LTD benefits. It depends on your particular plan wording.
Step 7 Follow treatment recommendations and provide ongoing proof of disability as required
Most policies will require you to remain under the regular care of a physician and receive customary treatment for your disability.
Some policies also provide rehabilitation benefits or requirements to participate in a return to work program where appropriate.
If you do not have a proper medical diagnosis for your disability, keep pushing to get one. A working diagnosis is typically required by the insurer before they will approve benefits.
Step 8 Be proactive!
Do not expect the disability insurer to look out for your interests.
You must be proactive and an advocate for yourself, making sure you gather and submit all relevant medical evidence and opinion needed to prove your claim at your cost.
It is not the insurer’s job to prove the claim. If your application or medical support is incomplete or vague, you may be denied benefits.
If your disability is severe and prolonged, apply for CPP Disability benefits from Service Canada whether or not you have received the other benefits.
Step 9 Beware the appeal process
If your benefits are denied or cut off by an insurer, you may be offered an appeal from the insurer to give the appearance of a fair, objective process.
If you have new medical evidences or opinion to offer on the appeal, it may make a difference to the insurer and could change their opinion.
If you have the same evidence to submit and repeat, it will unlikely make any difference and you will continue to be denied.
If you are denied CPP Disability benefits, an appeal will be offered by a set deadline, and you are encouraged to make that appeal before the deadline as the next hearing may be successful.
Step 10 If denied or cut off benefits, seek legal advice
There are time limits for filing an action in court against the insurer.
In general, it is two years from the date you were last paid, or ought to have been paid, or the date of the denial, whichever is earlier.
Some policies may extend this date beyond the two years, but most do not.
If union, there may be time limits to appeal to labor relations or pursue a claims review committee or medical review panel hearing.
If CPP Disability is denied, it is usually 90 days to make an appeal.