Many employers provide group benefits packages to their employees, including long-term disability (LTD) benefits. In addition, some employers also have an additional LTD policy to cover workplace injuries and illnesses caused at/by the workplace, called an occupational long-term disability policy. Some Ontario industries (eg. construction) are required by law to participate in a provincial workers’ compensation plan, such as WSIB. Some other companies have an occupational long-term policy in place to cover workplace illnesses and injuries that would be covered under the provincial workers’ compensation plan, if they had one. Mental and physical illnesses and injuries that are specifically related to the workplace are covered by occupational policies.
There are many differences between a group LTD policy and an occupational policy. For example, the definition of disability under an occupational policy differs from a group LTD policy. Under an occupational policy, you must be unable to work due to an illness or injury arising out of and because of your employment. Under some occupational policies, you must be unable to do any occupation within the company you work for, that you are or may be qualified for that would be at a minimum of the same pay-rate as your pre-disability income. With group LTD policies, however, you may be unable to work due to an illness or injury sustained outside of the workplace.
To be eligible for benefits under a group policy, you are required to provide evidence that you became totally disabled due to an occupational illness or injury while covered under the group policy, You must show that your disability continued past the waiting period stated in the group policy and you have sought appropriate treatment.
The payout under an occupational policy is generally a higher percentage of your monthly income than through a group policy. To be eligible for benefits under this policy, you must prove that you became totally disabled due to an occupational illness while covered under the group policy. As with a group policy, you have to show that your disability continued past the waiting period and you are seeking appropriate treatment.
Although the two types of policies have differences, they also share some similarities. Both types of policies require that you be an active employee when your disability started. You must meet specific criteria as stated in both types of policies in order to qualify for disability benefits. As well, both policies usually have two different definitions of disability one involving your ability to continue working in your own occupation and the other being your ability to work in any occupation, even if you were to be provided education or training in another occupation. With both types of policies, other types of benefits – such as Canada Pension Plan Disability Benefits – can be used to reduce your LTD benefit amounts. LTD policies have a waiting period before benefits are paid out, and benefits can end for a variety of reasons, such as not following the recommended treatments, returning to work and are therefore gainfully employed, or turning 65.
If you were injured at work or developed an illness, such as anxiety or depression, and you decide to submit a claim, you will need to show when the illness/injury began or happened and how it relates to your workplace. It is best to include as much detail as possible, and attach an incident report (if there is one) and any other written evidence, doctor’s notes or reports regarding your illness or injury and treatments, prognosis and progression. The more information you provide, the better able your insurer will be able to assess what benefits you are entitled to.
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