LONG-TERM DISABILITY CLAIMS IN ALBERTA: YOUR COMPREHENSIVE GUIDE (2024)

Having a long-term disability (LTD) is disruptive to say the least — it takes away your ability to work and earn a living. If you’re one of the thousands each year who are forced to engage this painful process, it’s paramount that every worker understand their rights and know just how long-term disability claims typically work. Below is a complete guide that will walk you at length of all the required information on LTD claims in Alberta.

WHAT IS LONG-TERM DISABILITY IN ALBERTA?

Long-term disability usually relates to severe illness or injury that keeps you from working for an extended period. “long-term” means you are usually off work for 17 weeks or more. The definition distinguishes this form of disability from short-term, which covers no more than 17 weeks.
These benefits offer financial assistance when you cannot work due to an injury or illness. They can be arranged through an insurance company or work-based plans. Either way, the policy compensates for your daily needs, securing financial stability.
Such benefits mainly aim to give you a portion of your income. At the same time, you cannot perform your duties due to a disabling condition. In such a way, you can focus on your recovery without the additional pressure of making ends meet.

TYPES OF LONG-TERM DISABILITY COVERAGE IN ALBERTA

There are Many Forms of Long-Term Disability Coverage in Alberta

1. Long-Term Disability Insurance — This coverage is usually for a specific dollar amount per month, and it may be made part of your employee benefits package as an employer group plan or purchased separately from an insurance company. It usually replaces a percentage of the income you earned before becoming disabled.
2. CPP Disability Benefits (Canada Pension Plan): A federal program that offers monthly payments to CPP contributors who cannot work in regular employment because of a severe and prolonged disability.
3. AISH (Assured Income for the Severely Handicapped) is a provincial program run by the Government of Alberta that provides ability-to-work benefits for Albertans with permanent disabilities and laminated family income.
4. Workers’ Compensation Board (WCB) in Alberta: if you become disabled due to an injury or illness at work, the WCB might be able to assist through its program. This pays for medical bills and provides income replacement.
5. Disability Tax Credit: This is not a direct payment program, yet it provides substantial tax relief for those who qualify; charitable family members may also claim.

Each type of coverage has its own eligibility requirements, benefit amounts, and claim processes. It’s important to understand which type(s) of coverage you have or may be eligible for when considering a long-term disability claim.

QUALIFYING FOR LONG-TERM DISABILITY IN ALBERTA

In order to be eligible for long-term disability insurance in Alberta, your condition must meet the following criteria:

• Under a disability insurance: This may be through your employer’s group benefits plan or via an individual policy you have acquired.
• Satisfy the definition of disability: The policy will say what it means to be disabled for purposes. This usually means that you cannot engage in substantial gainful activity from your primary occupation for the initial two years.
• Satisfy the elimination period: The LTD benefits will not kick in until after you have been disabled for a certain amount of time, typically 3-6 months. Short-term disability or sick leave usually covers this.
• Extensive medical proof: These consist of compiled documentation from your doctors, records stating the medicines and any kind of examinations carried out to provide an in-depth understanding
• Be under the regular care of a licensed physician and follow recommended treatments: Compliance with your treatment plan is crucial for maintaining eligibility.

Any medical condition has the potential to be eligible for long-term disability as there exists a definition of disability within the program. Hence, you will never be approved for a claim just based on your condition but how it affects the way of working. Common conditions that may qualify include:

• • Mental health conditions: Depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD)
  • Chronic pain conditions: Fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome (CRPS)
  • Musculoskeletal disorders: Back problems, arthritis, repetitive strain injuries
  • Neurological disorders: Multiple sclerosis, Parkinson’s disease, epilepsy
  • Cardiovascular conditions: Heart disease, stroke
  • Respiratory disorders: Chronic obstructive pulmonary disease (COPD), severe asthma
  • Cancers: Various types and stages
  • Autoimmune diseases: Lupus, rheumatoid arthritis, multiple sclerosis
  • Severe injuries from accidents: Traumatic brain injuries, spinal cord injuries
  • Chronic illnesses: Diabetes with complications, Crohn’s disease, ulcerative colitis

The key factor is not the specific diagnosis, but how the condition impacts your ability to work. Your medical evidence should clearly demonstrate how your condition prevents you from performing your job duties.

HOW MUCH DOES LTD PAY IN ALBERTA

How much long-term disability benefits you receive in Alberta will depend on the specific policy of insurance that covers your economic loss:

1. 1. Group LTD Insurance: Normally pays 60% to 70% of your pre-disability gross salary. Specific policies include a monthly benefit limit.
   2. Private LTD Insurance: Often provides a pre-set monthly benefit governed by the policy. For example, this could be $5,000 per month for your first couple of months.
   3. CPP Disability: The base rate is $583.32 starting in 2024, though the final payout depends on how much you paid into CPP while employed. The average monthly payment was $1,127.30 (as of October 2023), with a maximum monthly fee of $1,606.78 in 2024.
   4. WCB: Repays 90% of your net salary (by the way, for example, account bonus = $104,600 in 2024)
   5. AISH: Provides a maximum standard living allowance of $1,863 per month in 2024.

Note that there can also be some deductions within long-term disability payments. Other payments you receive — from sources like CPP disability, WCB (Workers’ Compensation Board) or severance pay- may reduce your LTD benefits. These discounts, also known as “offsets,” can differ significantly for each plan you have.

Tax ramifications of LTD benefits are based on who is the payer of premiums:

1. Suppose your employer makes any or all of the payments on LTD insurance premiums. In that case, benefits received under such a policy are taxable as income.
2. Your LTD benefits will be tax-free if you pay all the premiums.
   You must be aware of this aspect when considering a budget and finances active period during your disability.

THE CLAIMS PROCESS

WHAT TO DO AFTER BECOMING DISABLED

1. Determine Your Coverage
   • Check if you have group benefits through your employer.
   • Review all individual disability insurance policies.
   • Consider whether you are eligible for government programs like CPP disability or AISH.
   • If your disability is work-related, find out if the WCB covers you.
2.  Get Support from Your Doctor
   • Book an appointment to discuss your condition and LTD claim with your doctor.
   • Make sure your doctor will support your claim and explain how your condition affects your ability to work.
   • Ask your doctor to provide the insurance company with detailed medical reports.
3. Gather Medical Evidence
   • Start collecting all available Documentation from your healthcare providers.
   • Please include information on your condition, symptoms, treatment and how it affects your ability to work.
   • Ensure you have copies of all the test results, imaging examinations and specialist consultations.
   • Begin keeping a diary to document your symptoms and how they limit your daily activities.
4. Obtain the Correct Application Forms
   • Request forms from your insurance company employer, or find them online
   • Ensure you have all necessary forms, including those for your doctor and employer to complete
5. Complete the Application Forms
   • Fill out your form completely and correctly.
   • Describe the accident and give a detailed explanation of the injuries or illness that resulted.
   • The duties of your job; be particular.
   • Double-check all forms for completeness and accuracy before submission.
6. Submit Your Application
   • write a short cover letter with the accompanying documents.
   • Ensure all paperwork is completed and submitted in the designated periods
   • Keep a copy of everything that you file with them
   • Send your application through registered mail for future proof of being delivered.
   • Take the interview with your Claims Representative
   • Prepare for this essential call
   • Inform yourself well in advance of what you should report accurately, and have evidence on hand
7. Follow up and wait for the decision
   • Supply any requested additional information promptly
   • Be patient during the waiting period
   • Document all communication with the insurance company
   • Keep in the course of your treatment & attend all your medical appointments.

During this process, you are going to want very detailed records of all communications with your workplace and your doctor appointments, as well as how having a disability can affect your everyday ability to work. This Documentation can be invaluable if you need to appeal a decision or provide additional information.

COMMON CHALLENGES IN LONG-TERM DISABILITY CLAIMS

Many claimants face significant challenges when filing for LTD benefits:

• Claims denied for lack of medical evidence or disagreement on the definition of disability
• Long processing times leading to financial hardship
• Surveillance by insurers to confirm the extent of your disabilities
• Stressful independent medical exams requested by the insurer
• Policy limitations on certain types of disabilities, such as mental health conditions
• Complications with partial disability and attempts to return to work attempts
• Difficulty obtaining necessary medical documentation due to healthcare system delays
• Misunderstanding of policy terms and conditions
• Challenges in proving “invisible” disabilities like chronic pain or mental health conditions

Understanding these potential obstacles can help you prepare a more substantial claim and navigate the process more effectively.

WHAT TO DO IF YOUR LTD CLAIM IS DENIED

If your long-term disability claim is denied in Alberta, don’t lose hope. A denial is not the end of the road. Take these steps:

1. Review the Denial Letter
   • Carefully read the reasons for denial
   • Note any deadlines for appealing
   • Look for specific information the insurer says is missing or inadequate
2. Seek Professional Advice
   • Contact a disability lawyer for a free consultation before appealing
   • Get an expert review of your situation and options
   • Discuss the strength of your case and potential strategies for appeal
3. Gather Additional Evidence
   • Collect new or additional medical evidence supporting your claim
   • Consider obtaining specialized assessments or second opinions
   • Gather statements from colleagues, friends, or family about your limitations
4. Consider Legal Representation
   • A lawyer can strengthen your appeal and navigate the complex process
   • They can help interpret policy language and challenge insurer decisions
   • Legal representation often leads to more favorable outcomes in appeals
5. Prepare a Strong Appeal
   • Address each reason for denial with specific evidence
   • Include any new medical information or expert opinions
   • Clearly explain how your condition meets the policy’s definition of disability
6. Submit Your Appeal on Time
   • Adhere strictly to the appeal deadline specified in the denial letter
   • If you need more time, request an extension in writing before the deadline
7. Consider All Options
   • If the internal appeal is unsuccessful, discuss further options with your lawyer
   • This may include filing a complaint with the Ombud Service for Life & Health Insurance or pursuing legal action

Remember, the appeals process is time-sensitive. Missing deadlines or failing to provide sufficient evidence can hurt your chances of a successful appeal. Many initially denied claims are approved on appeal, especially with proper representation and thorough documentation.

HOW ALB FIRM CAN HELP

At Affinity Law , we specialize in helping Albertans navigate complex long-term disability claims. Our comprehensive services start with a free initial consultation, during which we review your case at no cost. We then conduct a thorough case evaluation, examining your policy, medical records, and claim details to develop a personalized claim strategy tailored to your unique situation. Our experienced lawyers are skilled in expert negotiation with insurance companies, advocating effectively for your rights. If needed, we provide guidance through appeals and litigation, prepared to take your case as far as necessary to secure your benefits. We offer continuous support throughout the process, keeping you informed and involved at every stage. Don’t let a long-term disability claim overwhelm you. Contact Affinity Law today for expert guidance and support. Our dedicated team is committed to fighting for your rights and ensuring you receive the benefits you deserve.