The disability system in British Columbia offers financial assistance to employees that experience an illness, injury, or chronic medical condition that prevents them from working. Disability plans are provided by employers as part of your terms of employment and benefits are administered by insurance companies who decide whether you qualify for benefits. The two primary types of disability benefits offered by employment-based plans are short-term disability (STD) and long-term disability (LTD).
Understanding the difference between long- vs short-term disability eligibility, benefits, applications, and the denial appeals process for each is essential to pursuing the benefits you deserve.
Disability Basics
Disability benefits are designed for those experiencing what’s called a “non-occupational disability.” This means their illness or injury was not brought on by their work environment or job responsibilities.
Start by contacting your company’s HR representative or a member of your employer’s management team to learn about any disability plans offered by your company. Once you’ve confirmed that you have coverage, contact a compassionate and experienced disability lawyer for a free consultation.
How Long Can You Collect Short- vs Long-Term Disability Benefits?
The primary difference between short- and long-term disability is the length of time you receive benefits after you’ve been approved.
Short-term disability plans differ but typically provide benefits for up to six months. Short-term disability benefits are one of several “safety nets” employees in BC may have access to in the event of a temporary illness or medical condition keeping them from working.
Long-term disability plans provide benefits for up to two years before re-evaluation. After two years, you may be eligible to receive disability benefits for years afterward, perhaps indefinitely, depending on the details of your plan. Long-term plans are designed to replace income in the event of a prolonged inability to work.
Benefits Provided by Short- vs Long-Term Disability
STD plans in British Columbia are required to provide what’s called “own occupation” disability insurance. “Own occupation” means that to receive benefits, your disability must prevent you from working your current job. Short-term benefits typically pay a minimum of 55% of regular weekly earnings. You can receive short-term disability benefits for up to six months.
LTD benefits typically range from 60% to 70% of regular income. Eligibility is based on plan details and can include benefits for “own occupation” disability or “any occupation” disability. “Any occupation” disability plans only cover individuals whose condition is serious enough to prevent them from working any available job. Unlike “own occupation” benefits, “any occupation” plans won’t cover you if the insurance company decides that you’re not sick or injured enough to keep you from working a different job.
LTD benefits can last for up to two years or longer. After two years, you must be re-evaluated by a doctor. Your eligibility will likely be based on the “any occupation” standard after that point. Unfortunately, it is possible for your benefits to end, even if your health status remains unchanged.
Qualifying For Disability
- You are employed full-time or part-time and your employer offers benefits. All legal workers in BC with an employer-sponsored plan can receive benefits.
- You’ve cleared the minimum waiting period. This is also called an elimination period. BC insurance companies are required to make disability benefits available no later than three months after starting work.
- You have exhausted your paid sick leave. Not all employers provide sick leave but if they do, employees are required to use it before they receive disability benefits.
- You’ve completed your application. There are several steps to completing your short-term or long-term disability applications covered in the sections below. Many applicants seek help from a lawyer to file their disability claims.
- STD claims will include an “Attending Physician’s Statement” provided by a doctor verifying that disability prevents you from working for at least six months.
- LTD coverage does not start immediately. During this time, you can use paid time off (PTO), apply for short-term disability payments, and/or apply for government EI Sickness Benefits.
Steps to Applying for Disability
The section below contains the steps involved in applying for short- or long-term disability. These steps are not intended to serve as legal advice but rather, can help applicants understand the process of preparing and submitting an application.
Steps to Applying for Short-Term Disability
- Alert your employer.
- See your doctor.
- Have your doctor complete the Attending Physician’s Statement.
- Request and receive an Employee Statement.
- Fill out the Employee Statement.
- Submit your application.
Steps to Applying for Long-Term Disability
- Alert your employer.
- Contact a lawyer (optional).
- See your doctor.
- Talk to your doctor about LTD benefits.
- Ask about seeing a medical specialist.
- Submit a notice of claim form to the insurance company.
- Acquire medical documentation including medical records, diagnostic tests, and a doctor’s written evaluation.
- Complete the application.
- Have you or your lawyer craft a cover letter (optional).
- Submit your application.
- Attend the interview, if requested, with your claims representative.
- If your application is denied: Submit an appeal with a lawyer’s help (optional).
When filing for long-term disability, experts recommend detailing your disability symptoms, and all the ways they affect you, in a health journal. A health journal can help your doctor, and possibly your lawyer, better understand your condition. Even if you aren’t sure if you’ll apply, consider talking to your doctor and starting your health journal now.
Differences Between STD and LTD
Whether you are awarded disability benefits is a decision based on whether or not the insurance company representative finds the information contained in your application convincing and credible.
There are significant differences between the STD and LTD applications. Each requires different forms of documentation and is subject to different evidentiary standards. LTD applications are reviewed with a high level of scrutiny and require clear and compelling evidence. Evidence can be supported with personal details that highlight the devastating effect your disability has had on your life.
It is generally accepted that the standard for receiving LTD benefits is higher than for STD. LTD requires a thorough medical evaluation, often by a doctor who specializes in your condition. STD plans only require a doctor to affirm your qualifying illness or injury with an Attending Physician’s Statement and supporting documentation.
It is possible to have the full support of your doctor and still have your LTD claim denied by the insurance company. It is your legal right to appeal. Expert LTD lawyers can combine your medical specialist’s evaluation, your job’s requirements, witness testimony, and any relevant personal details in a way that builds a compelling case for why you are unable to work and are owed benefits.
What to Do If You’re Denied Disability
There are many reasons why you could receive a denial letter. It’s not uncommon to be denied. Don’t lose hope; every day, disabled individuals successfully overcome denials with their appeals.
Reasons for short-term disability application denial include:
- Your symptoms are not serious enough to qualify.
- Your diagnosis is not serious enough to qualify.
- You have not sought or accepted treatment.
- Treatment does not reflect a serious illness or injury.
Reasons for long-term disability application denial include:
- Lack of medical documentation.
- Lack of medical evidence.
- You’re not “totally disabled.”
- Your condition doesn’t qualify.
- The insurance company has evidence that disputes your claim.
Although it’s not an official reason for denial, claims based on “invisible illnesses” such as chronic pain, cognitive disorders, or mental health conditions are often rejected, even if they are legitimate. A lawyer can act on your behalf to make sure the insurance company sees all the ways your disability affects your functioning.
Appealing a Disability Claim Denial
It’s your right to appeal denied LTD benefits as many times as you see fit. But it is important to act fast to meet important deadlines. Get help from the experienced lawyers at Stephens & Holman to better understand how to build a successful application or appeal. We deal with insurance companies so that you can focus on your recovery.