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Employment & Labour

Navigating disability benefit claims a ‘whack-a-mole’ game

For people who can’t work due to injury or illness, navigating the disability insurance process can be draining — sometimes to the point where application fatigue sets in and employees abandon their claims prematurely, says Ottawa employment lawyer Ella Forbes-Chilibeck.

But Forbes-Chilibeck, the founder of Forbes-Chilibeck Employment Law, has created a checklist to help those who are ill or injured to access income replacement through short- and long-term disability benefits.

Recent amendments to the Employment Standards Act means workers now have annual access to 10 personal emergency leave days, two of which are paid.

If you are going to be off work longer than that, she suggests finding out what benefit coverage you have available through your work.

Most employers offer long-term disability coverage, but they have a qualifying period requiring the individual to be off work for 15 to 26 weeks before they can collect those benefits. Some employers also provide short-term coverage, which bridges them to the long-term program.

For those who don’t have short-term disability coverage through an employer, Employment Insurance (EI) provides 15 weeks of sickness benefits, which is typically when long-term disability coverage kicks in. But it’s one or the other. Forbes-Chilibeck says there’s no double-dipping into both the EI and work insurance wells.

Completing all the necessary paperwork can be a job in itself, she tells

“It can be a challenge and like a whack-a-mole game, new problems keep popping up,” she says. “When you should be focusing on health and recovery, this process can be very devastating.”

“If people aren’t computer savvy or they’re feeling their best, it can be challenging to fill out these forms because it’s overwhelming,” Forbes-Chilibeck says, adding that it’s better to indicate that a certain section doesn’t apply rather than leaving it blank.

Where people often go off the rails in the application process is not involving medical professionals early enough. She suggests maintaining a relationship with your doctor. If there is a determination that the illness or condition is interfering with your ability to work, the physician is already familiar with your situation and can provide that objective evidence.

The application, Forbes-Chilibeck adds, should be made as early as possible. A disability claim requires medical support and filling out the necessary forms within a prescribed timeline.

She also suggests that just because an application has initially been denied doesn’t mean it can’t be appealed. It’s in the insurance company’s interest to deny or delay coverage and to carefully scrutinize claims, so persistence pays off.

“If the denial was as a result of missing a deadline that resulted from the illness, a letter from the doctor providing a medical reason for the delay may well rectify the issue,” she says.

It’s often after the appeal process has been exhausted that Forbes-Chilibeck will be called in to help the applicant, but the key is getting that proper advice as soon as possible.

“I think it’s a really good idea to consult a lawyer early in the process,” she says. “I have a higher rate of success if I’m involved earlier.”

An insurer might require that the applicant undergoes an independent medical examination, Forbes-Chilibeck says.

“Its important to ensure that they are provided with the medical information they need to support your claim.”

She acknowledges that the process is frustrating, and sometimes people simply give up and try to get better with no salary replacement, which means they may end up returning to work before they are ready.

But Forbes-Chilibeck points out that workers pay insurance premiums so that in the event they cannot work for health reasons they can have the peace of mind that their financial security will still be protected.

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