(Photo credit: Mattox/SXC)
What happens when an illness or injury stops you from working?
Most likely, you will want to collect benefits which are designed to be your replacement income during the time when you are unable to work. The amount you will be awarded and the duration in which you will receive these benefits will depend on the severity of your injury. One of the first things considered will be whether your injury has left you disabled for a long or short term.
The details vary depending on your employer’s insurance, but often times to qualify for long-term disability, you will have to be “totally disabled”. What this actually means is that your injuries have disabled you in a way that you logically should not be partaking in certain activities, even if you are not entirely disabled from doing so.
But if you are going to be collecting money from an insurance company for your disability, there are some rules you have to play by. Typically, if you qualify for long-term disability, you can collect automatically for two years. At that point, your condition will be revaluated and if the insurance company is going to continue doling out the cash, they are going to need proof that you still can’t work. They will often be very meticulous and will try to uncover reasons why you are able to go back to work so that they can stop sending you your disability cheques. If you think you can exaggerate a story to collect disability, you would be very wrong.
Insurer’s Medical Examinations (IMEs) will get medical information that will either prove or disprove your case. These reports can result in termination of your benefits. It doesn’t stop there either. They will even have you on surveillance where they hire investigators to keep an eye on you. This might mean that they show up to watch and follow you likely even photographing or filming you. They have also been known to interview your neighbours or former coworkers. This might sound incredibly intimidating or even an invasion of privacy. The reality though is that this is usually accepted and so long as your story is perfectly honest, this process shouldn’t hurt you.
For short-term disability, the benefits must be paid to you no later than the fifteenth day after your disability started. You can also opt to collect EI from the government and get paid either cumulatively or weekly. You should be aware that there are limitations on who can collect EI. If your injury has been self-inflicted, happened while you were on a paid vacations or leave of absence, or occurred as a result of partaking in a riot or public disturbance, you will not be eligible to collect from your insurance company no matter how severe or debilitating your injuries are. The benefits paid by your insurance company though must be equal to what would have been paid through EI. (This is 55 per cent of the average insurable earning.)
There are cases where you may make a claim for a reasonable disability and yet the insurance company denies your request. In these cases, you can always consider filing a lawsuit. The personal injury and accident lawyers at Neinstein Personal Injury Lawyers have been handling all types of injury cases for clients throughout Ontario for over 45 years. We understand the impacts injuries can have on your life and know how to help you. Call us at 416-920-4242. Set up a free consultation and come talk with us.
Greg Neinstein
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