During your application process for your Long Term Disability (LTD), certain terms will show up in your policy. Understanding the terms in your policy is important and it ensures you, that you have chosen the best policy for your needs. Our Long Term disability lawyers in Richmond Hill has had years of practice and knowledge of LTD’s. With their expertise, we have sourced a comprehensive list of important terms you will face in your policy.

Definition of Disability

There are two different types of disability that are covered in your policy:

  1. Regular or Own Occupation: A person is disabled and not able to perform their regular duties at their occupation.
  2. Any Occupation: A person is disabled and not able to perform regular duties of any occupation for which they are suited for, based on their education, training, and experience.

Certain policies will start you off with the “regular or own occupation” for the first 24 months then it will be switched to “any occupation”. Revise your policy to see which definition of disability, you are covered on.

Pre-Existing Conditions

In many LTD policies, there might be clauses excluding or restricting pre-existing conditions. This is a result of protecting the policy from a high claim payout due to a person’s pre-existing condition.

Exclusions and Limitations 

Exclusions and limitations do not stop at pre-existing conditions. LTD benefits will not be paid under theses conditions:

  • In prison
  • Receiving income from an occupation that is not approved by the insurer
  • Not under a care of a medical practitioner
  • Refusal to participate in medical treatments
  • Living outside of the country permanently or for a temporary time
  • Entitled to maternity or parental leave

If any of these exclusions or limitations affects you, check your policy and if you have been denied your LTD benefits due to other exclusions or limitations contact any of our long term disability lawyers in Richmond Hill.

Qualifying Period

A qualifying period also known as a waiting or elimination period is the period the insurance company takes to clarify your policy. It can range up to 52 weeks. Some insurance companies intervene earlier which is called an early intervention. This is when your insurance company gets involved in your claim in the first few days of your absence.

Recurrent Disability

The goal of LTD is to help you recover and get you back to work. If you do try to return to work within the qualifying period and you are unable to perform your task; you will be placed on recurrent disability and will be considered totally disabled.

Partial and Residual Benefits

What is the difference between partial and residual benefits and which one are on your policy?

Partial Benefit is a person that is able to work in a reduced capacity. The benefits are payable if the income is reduced between 15% to 20%.

Residual Benefit is a person that is unable to perform their task at work and their income has been reduced to 20%.

Benefit Maximum

There is a certain amount your insurance company is willing to insure a person. There are two terms within benefit maximum: non-evidence and overall maximum.

Non-Evidence Maximum

Non-evidence maximum is the amount of benefit your insurance company will provide you without submitting medical evidence during the time of enrollment. If you are entitled more than the non-evidence maximum, than medical evidence will be required to be reviewed by the medical underwriters.

Overall Maximum

This is the maximum amount your insurance company can insure you.

Direct and Indirect Offsets

Other sources of income can reduce your LTD benefits. They can be direct or indirect offsets that effect your LTD.

Direct Offsets:

  • Any amount received by the government
  • Payable benefits from auto insurance
  • CPP (Canada Pension Plan)/QPP (Quebec Pension Plan) or Worker’s Compensation

Indirect Offsets

  • Retirement benefits
  • CPP (Canada Pension Plan)/QPP (Quebec Pension Plan) payable by a dependant
  • Income from an occupation that was not approved
  • Benefits payable under an association

To learn more about direct and indirect offsets, visit our main site to get more details. (LINK)

Continuation of Benefits

If your group insurance is terminated by your employer; the LTD benefits will continue. The insurance company is obligated to continue your benefits as long as you are in accordance with the terms of your insurance policy.

Long Term Disability has many terms you should be aware of. Understanding your policy and choosing a policy that is best suited for your needs and families peace of mind. Our long term disability lawyers in Richmond Hill can help you through your policy if you have been denied or your policy has been terminated.