How to Make a Short-Term Disability Claim in Ontario
Short-term disability (STD) is a type of insurance benefit that provides compensation or income replacement for injuries or illnesses that render you unable to work. Coverage typically provides benefits for up to 6 months, though it is dependent on your employer’s disability plan. For details on your plan, speak with your employer’s human resources staff, as they may be able to provide you with information, including any sick or vacation time polices that may apply. If you or your employer do not have short term disability coverage, you may be eligible for Employment Insurance (EI) sickness benefits.
If you do have short term disability coverage, you must go through a claims submissions process in order to receive benefits. It is recommended that you submit your claim as soon as possible, as most contracts have a set time frame for eligibility. The submission is a package usually comprised of three forms, which will be outlined below.
Plan Sponsor’s Statement
The plan’s sponsor statement is to be filled out and faxed by your employer, which includes administrative information about your benefit plan and coverage. Your employer will also provide information about the history of your employment and salaries, as well as previously claimed benefit policies, such as sick pay, vacation pay and workers compensation.
Plan Member’s Statement
You will receive a plan member’s statement form to fill out from your employer. Once it is completed you will be required to fax or mail it to the insurance company providing coverage. The plan member’s statement will require information about your condition, how and when it occurred, general medical history and expected source of income while you are on leave. You will also be required to provide authorization that allows the insurance company to exchange information with your physician and health care professionals providing care.
Attending Physician’s Statement
You will receive an attending physician’s statement from your employer, which you take to your doctor. The form can be filled out by any medical professional that is a doctor of medicine (family doctor, walk-in clinic or specialist), who has been treating your condition. Your doctor will complete the form and fax it to the insurance company. The statement will provide the insurance company with specific medical information about your condition, as well as your expected recovery time. If you have seen a specialist for your condition, make sure your doctor forwards all consultations and clinical notes with the statement. It is important to note that your doctor may charge a fee to complete the statement.
Once the disability insurance company receives these three forms, they will be sent to a case manager, who will then start processing your short term disability claim. The case manager will assess the information about your medical history, ability to function with daily living activities, occupational demands, and how your condition would affect your ability to perform occupational duties. If the case manager requires more information, they will contact you or your doctor by phone to ask further questions. The claims assessment process is relatively quick, where decisions are can made within 5 business days. If your claim is denied or approved, the case manager will notify you and your employer in writing.
My Short-Term Disability Claim Was Denied
If your claim for short term disability benefits is terminated or denied you should retain a lawyer as soon as possible. You should avoid the unnecessary and biased insurance company internal appeal process. Your lawyer should obtain medical evidence from your treating doctors such as your family physician, specialists and therapists to support your claim. Your lawyer may send you to a specialist for a medical/legal opinion to demonstrate that you meet the test of short term disability as set out in your policy.
At Kotak Law we represent people who have been denied short term disability and long term disability benefits. We are strong and compassionate advocates who have successfully sued insurance companies including: Manulife, Sun Life, Desjardins, Blue Cross, Great West Life, AIG, SSQ, Industrial Alliance, RBC, Canada Life, Equitable Life and more.
If you have been denied short term disability benefits you are no doubt feeling frustrated by the process. We are committed to helping people access the short term disability benefits they have been denied and we understand your frustration with your insurance company.
We offer free consultations and don’t charge until your case is resolved. We represent people throughout Ontario and for those who cannot meet us at one of our offices we offer consultation at your home, a local coffee shop, courthouse, by telephone, Skype, Zoom or WhatsApp.
Kotak Personal Injury Law/disability Lawyers Can Help You
We understand that being denied disability benefits can be frustrating and devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling a long term disability lawyer. We have successfully sued numerous disability insurance companies including: Manulife, Sunlife, Desjardins, Great West Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance and more.
Call your trusted long term disability lawyers at 1-888-GOKOTAK or (416) 816-1500. Our consultation is free and we don’t get paid until you do. We can meet you at our offices, at a coffee shop, your home or a local court house. We represent disabled people throughout Ontario including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharine’s, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor. Markham, Pickering, Oshawa, Peterborough, Keswick, Kingston Ottawa and other locations.
Kotak Personal Injury Law
Main offices in Toronto, Brampton, Mississauga
Serving all of Southern Ontario – we come to you!
Phone: (416) 816-1500
Toll Free: 1‑888‑GO‑KOTAK
Fax: (905) 755-8901