Navigating the complexities of financial assistance when you have a disability can be overwhelming. Here are some resources that you can explore to determine potential sources of support:
Is your injury/illness work related?
In Ontario, if you are employed by an employer who has business activities covered under Schedule 1, Part I and Schedule 2 of Ontario Regulation 175/98 and you suffer a work-related injury or illness, you may be eligible for benefits under the Workplace Safety and Insurance Board (“WSIB”). Your injury or illness must be workplace related but the system is no fault, meaning that you can make a claim even if there is no wrongdoing on the part of the employer. There are some limitations as to which claims can be covered and these can usually be found in the WSIB Operational Policy Manual.
Filing a claim under WSIB may result in an entitlement to income replacement benefits (known as Loss of Earnings or “LOE”) if you are unable to work; non-economic loss (“NEL”), a payment based on the degree of work-related permanent impairment, health care benefits for required therapy, treatment, assistive devices, equipment and prescription drugs and return to work assistance.
If you are employed with a WSIB covered employer, chances are you may not be able to pursue a tort claim for negligence or wrongdoing where the employer is at fault for your injury or illness. WSIB entitlements are generally considered to be in lieu of rights of action.
In order to submit a claim for WSIB, a Form 6 must be completed by the employee and submitted within six months from the date of injury or from the date of the disease diagnosis. A Form 7 should generally be completed by the employer and submitted within 3 days of the injury.
Short and Long Term Disability Benefits Coverage
Disability benefits are monthly benefits available to individuals eligible to receive them under an insurance policy or plan. Short term disability benefits are usually available for shorter periods of absence and are designed to cover short term illness or injuries with a shorter recovery period. Long term disability benefits are usually designed to cover longer term absences.
An employee may be eligible to receive disability benefits as part of a group benefits package. Many individuals are aware that they have coverage for medical and dental benefits, but they may not be aware that they also have coverage for disability benefits.
If you are unable to work due to medical issues, the first step is to determine whether you have coverage for disability benefits. If you are employed, check your benefits booklet. You probably received a benefits booklet when you first became employed. If you did not, you can always contact Human Resources personnel at your employer to determine whether they have coverage for long term disability benefits.
Group coverage may also be available to members of an Association or a Union. Many professional associations such as Chambers of Commerce, Boards of Trade or even university alumni groups offer disability insurance coverage to members. Professionals or self-employed business people may have purchased individual insurance directly from an insurance company, perhaps through a broker or financial advisor. This is known as individual or private insurance.
For group disability insurance claims, the disability application package usually consists of at least three forms:
- A Claimant/Employee or Plan Member’s Statement – completed by the person making the claim;
- An Employer/Plan Sponsor’s Statement – completed by the employer; and
- An Attending Physician’s Statement – completed by an appropriate healthcare professional.
In order to be entitled to receive benefits, claimants have to meet certain tests for disability specified in the insurance policy or plan a copy of which can be requested from the insurance company.
Application packages can be found online, sometimes through portals established by employers/insurers or by requesting them directly from insurers or Human Resources.
Canada Pension Plan Disability Benefits
Many people are familiar with Canada Pension Plan retirement benefits but are not always familiar with the fact that Canada Pension Plan also has a disability component known as Canada Pension Disability Benefits or CPPD Benefits.
The CPPD benefit is a benefit that is paid monthly by the government. The benefit is administered by Service Canada. To be eligible for this benefit, you must be under age 65, you must have paid into and made sufficient contributions to the Canada Pension Plan and you must have a severe and prolonged physical or mental impairment that prevents you from working at any job.
An pplication kit for Canada Pension Plan Disability Benefits consists of various forms:
- Application for Canada Pension Plan Disability Benefits (Form ISP-1151) – to be completed by the person applying for benefits;
- Medical Report (Form ISP-2519) – to be completed by a doctor or nurse practitioner;
Canada Pension Plan Disability Benefits can be received even if you have assets, it is not based on financial criteria. Eligibility is based on contributions and whether you meet the specified disability criteria set out in the legislation.
Ontario Disability Support Program
The Ontario Disability Support Program (“ODSP”) is a means-tested income support system funded by the government. To qualify financially, your income and assets cannot be more than a certain amount specified in the applicable legislation.
In order to qualify you must also meet the ODSP definition of a “person with a disability” which requires you to have a physical or mental health problem that is expected to last a year or more and that limits your ability to work, look after yourself, or do daily activities at home or in the community in a substantial way.
ODSP provides money to disabled individuals to help them with living expenses, including food and rent, health benefits, including prescription drugs and vision care and employment support to assist with preparing for and finding a job.
A very useful guide for ODSP applications can be found here.
Employment Insurance Sickness Benefits
Employment insurance sickness benefits can provide up to 26 weeks of financial assistance if you are unable to work due to medical reasons. In order to qualify your regular weekly earnings need to have decreased by more than 40% for at least 1 week due to medical issues and you need to have accumulated 600 insured hours of work.
You will need to submit an application for these benefits. In addition to completing documentation with personal information and details you will need to obtain a medical certificate signed by your doctor or health practitioner and a Record of Employment (“ROE”) from your employer. If you are unable to secure an ROE, you can request assistance in that regard from Service Canada.
Disability Tax Credit
The disability tax credit (“DTC”) is a tax credit available to people with a severe and prolonged physical or mental impairment resulting in marked restriction. Eligibility is not based on a specific diagnosis but considers functional impairment.
The DTC is designed to reduce tax payable. It can be used in the year of application and can also be backdated up to 10 years. The person submitting an application may claim the DTC on their income tax return once the Canada Revenue Agency has approved their application.
To apply for the DTC you will need to submit the Form T2201, Disability Tax Credit Certificate. Part A is completed by you and part B by a medical doctor or other health practitioner.
Conclusion:
As long term disability lawyers we most often deal with litigating the denial or termination of short and long term disability benefits claims. We understand that dealing with disabling medical conditions and an inability to work can be overwhelming and incredibly stressful and the need to secure alternate financial resources to ameliorate some of the financial burden is critical.
If you have a short or long term disability benefits claim that has been denied, please contact us online to submit a request for a free 1 hour consultation to review the nature of your long term disability benefits claim denial.
This blog was written by Leanne Goldstein of Leanne Goldstein Law, P.C.. Leanne is an insurance and disability lawyer. Her practice is focused on long term disability benefits, critical illness, and life insurance claims. Leanne also deals with workplace related disability issues. Leanne is a Lexpert ranked lawyer. This Blog is not intended to be legal advice, it is made available for educational purposes. By viewing this blog, you understand that there is no solicitor-client relationship between you and the blog publisher.