Understanding Long Term Disability Policies In Ontario

Once employed people who are now unable to work due to a disability may qualify for long term disability insurance. This insurance is meant to provide income to those who are no longer able to work due to a significant injury or disability.
Long term disability can be purchased by an individual privately for peace of mind and financial coverage should the individual become disabled. Some large corporations include long term disability as part of their employee benefit package. Small business owners usually buy this type of insurance especially if they are the primary financial provider for their family and have family (or employees) dependent on the business owner for their livelihood. There are even special long term disability policies that provide coverage if a person becomes disabled due to a specific job. These are more often bought by entertainers and specialized medical care professionals.
Long term disability policies can vary widely since there is no regulatory body for them. While most may seem similar at a quick read, there can be significant differences between exact words and definitions. These can provide loop holes that allow an insurer to deny coverage to their client.
If you’ve been denied coverage, you may be able to appeal the decision. It’s important to make sure you consult an experienced long term disability lawyer. Often, it’s a good idea to consult this type of specialized personal injury lawyer in Sudbury before making the request to increase the chance of receiving maximum benefits from your long term disability policy.

Long Term Disability Wording and Clauses

Many people report experiencing confusion reading some of the warning and clauses in their long term insurance policies. Here’s a look at a few of the words and clauses that cause the most confusion.

Own Occupation

The average policy specifies a period of ‘Own Occupation’ coverage which means the client needs to be totally disabled from the job they were doing at the time the disability occurred in order to qualify for long term disability.Some policies stipulate total disability as a pre-requisite for benefits.
Interpreting “total disability” can also vary, depending on the policy. It’s generally understood to mean that the client’s ability to do the job properly without further personal injury or damage has been affected due to the disability.
When insurance companies fight against a claim, they generally focus on the work the disabled person is able to do and use these capabilities as a way to deny benefits. Totally disabled, as defined for the purpose of the Own Occupation clause, doesn’t need to mean the person must be completely helpless in all areas. Past disability case has shown that in order to meet the “totally disabled” requirement, the client is unable to do the all necessary duties required within the context of the person’s occupation. The client may be able to do some of those duties.Many insurance policies have a two-year limit on total disability after which the client is asked to consider almost any job, including ones the client could be trained for in the future.