Long Term Disability Law in Ontario

Under Long Term Disability Law in Canada, individuals who are unable to work for an extended period of time due to an illness or an injury may be entitled to certain financial benefits so they are still bring in an income even though they are no longer able to work.

There is no clear definition of what constitutes a ‘disability’ under Long Term Disability Law as the definition varies based on insurance companies and plans (even within the same company!). Depending on the situation and illness, Long Term Disability Benefits can be paid for anywhere from two years until retirement, again this is largely dependent on the insurance company and your policy and coverage.

While disability can mean any number of issues, some conditions and illnesses which may qualify an individual for long term disability can include but are not limited to:

  • HIV/AIDS
  • Cancer
  • Mental Illness such as Bipolar Disorder or Depression
  • Cancer
  • Serious pregnancy complications / conditions

If you’re wondering whether your illness or injury would qualify as a disability, the best thing to do would be to contact your insurance provider or a disability benefits lawyer.

While the general law is similar across Canada, the types of benefits do vary from province to province. Before being approved or applying for long term disability, the individual first needs to exhaust shorter term benefits either through their employer, for example using up accumulated sick days and sick leave benefits or apply for sickness benefits through Employment Insurance (EI).

Sickness Benefits through EI is designed for individuals who are temporarily unable to work, for instance as a result of pregnancy complications or sickness. In order to be eligible for benefits through EI, the individual has to have accumulated 420 to 700 hours of employment, have paid EI premiums and have their weekly income reduced by more than 40%. The exact number of employment hours will vary depending on your place of residence. EI Sick leave will cover a maximum of fifteen weeks and is capped at a yearly amount of $53,100 in Ontario.

Once you have exhausted your short term disability options, what’s next? In Ontario, there are several different types of programs an individual may be eligible for under Long Term Disability Law such as:

  • Canada Pension Plan Disability:

This program is open to individuals (under 65 years of age) who can no longer work because of their disability, and who have contributed to the Canada Pension Plan. Because the contribution is taken at the source through payroll, most people will typically meet this requirement.

  • Benefits under Worker’s Comp:

This program is only applicable if the injury or illness you sustained is work related or if you are unable to work as a result of the work you do. Under regulations outlined and administered by the Workplace Safety and Insurance Board, you may be entitled to receive financial assistance to replace your salary as well as medical benefits. Many employers are notorious for not wanting to provide this benefit to their employees in the event something goes wrong, so it’s always a good idea to get some legal advice or a lawyer so you are aware and versed on your rights.

  • Ontario Disability Support Program (ODSP):

Certain criterion must be met in order to be eligible for ODSP. This program is a social assistance program, which falls under the Disability Adjudication Unit of the Ministry of Community and Social Services and provides individuals facing financial difficulties as a result of their disability with basic necessities like food and shelter.

  • Long-Term Disability Insurance:

This program is designed to provide a replacement income to individuals who are unable to go back to work or earn a living as a result of their disability. This is not like Worker’s Compensation, meaning your injury or illness does not have to be work related. Eligibility criteria includes having long term disability (LTD) coverage either through your employer’s or union’s group benefits plan or LTD provisions through your own, personal insurance plans. If the illness or injury is serious to the point where you will never return to work again, the Long Term Insurance Benefits will be paid out till retirement – the age of 65 in Ontario. It’s important to note, an individual cannot receive both Long Term Disability Insurance and Worker’s Compensation.

Keep in mind no matter the situation or what the disability is, you will need to provide medical documentation and records to prove your illness and the severity of your disability. In order to minimize fraud cases, insurance companies will likely scrutinize every aspect of your life (professional, social, personal) to determine whether you are in fact disabled and unable to work so it’s important to attend every doctor’s appointment, keep meticulous records and notes in the event you need to appeal a decision. Also keep in mind there are deadlines in place, which need to be adhered to in order to apply for LTD, reading the fine print on your policy is extremely important!

If all this sounds very complicated and you are unsure of where to start or what to do, the best way to truly have a better understanding of your situation and what steps you should follow next is to contact a lawyer. They can help look into your disability concerns and answer questions like, what are you entitled to? How much are you entitled to? For how long? What can you do if your claim is rejected? What are you rights? Etc. Many Disability Lawyers in Ontario will provide a free initial consultation to discuss your case, so it cannot hurt to have a conversation with a specialist so you are fully prepared.