It’s Your Responsibility To Know The Details
You may have many questions regarding employee benefits. Finding the answers is your responsibility. Ask your Human Resources Manager for an Employee Benefits Handbook if you lost the one originally provided to you.
During your employment, your health plan options may change. If your health plan does change:
- How will you and your family be affected?
- Is your healthcare provider still on the list of providers?
- Has your co-pay changed?
- Are there deductibles and limits to the coverage?
What To Do Before Deciding To Return To Work
If youre considering working while on long-term disability, be careful to review your policy with an experienced attorney. Your attorney should help you fully understand whether it is an own occ or any occ policy, and the implications of both. This will help you benefit from both continued disability checks and participation in meaningful work.
What Happens To Long
The answer depends on the specific disability insurance policy. Suppose an insurance company pays for your disability benefits. In that case, your employment status most likely wont impact your long-term disability benefits. However, if your employer pays them, then your disability payments may stop.
Whether employer-paid disability benefits will continue after termination is dependent on the terms of the applicable disability plan.
Disability benefit administrators must take into account the claimants medical status at the time their employer lets them go, even if an employee is fired for cause. An administrator cant legally deny a disability claim just because the employer terminated the claimants employment. The only way they can is if the disability plan includes explicit terms to the contrary.
Keep in mind that there are also other instances when the insurance company can legally stop your benefits. When this happens, its typically because you dont meet the definition of disabled any longer. The insurance company can also cancel your benefits if you dont cooperate with their requests for information.
How The Americans With Disabilities Act Can Protect Your Job
Although most employees in the United States work on an “at-will” basis, which means they can be terminated for virtually any reason, the Americans with Disabilities Act makes it illegal to fire an employee due to disability. This law protects those who meet the ADA’s definition of disability, which includes many individuals on disability leave and some who have previously received benefits and returned to work.
Under the ADA, disability is defined as “a physical or mental impairment that substantially limits a major life activity.” Employers covered by the ADA must offer to make reasonable accommodations of your disability as long as it will not cause them “undue hardship.” The burden is, however, on the employee to inform their boss of their disability so that accommodations can be provided.
Accommodations can include restructuring a person’s job duties or schedule, installing Braille signage, modifying desks, making the workplace more wheelchair accessible, and many others. Even granting additional unpaid leave can be a reasonable accommodation. Whether any of these accommodations constitute a hardship for the employer depends on many factors, including the size of the company and the cost of the changes. If there aren’t any reasonable accommodations an employer can make that will allow a disabled employee to perform all the essential functions of the position, the worker may be legally terminated.
Can You Be Fired While On Long
Generally, LTD benefits are an insurance policy that protects an employee from loss of income in the event he/she is unable to work due to illness, injury, or accident for a long period of time. Typically, LTD benefits work in conjunction with short-term disability benefits, in the fact that they begin to assist the employee when STD benefits end, and they typically pay an employee a predetermined percentage of their salary. Thus, LTD benefits are an important component of a comprehensive employee benefits package. In fact, according to experts, long-term disability insurance coverage is as important to an employee as life insurance. Accordingly, each employee should understand the nuances of his/her LTD insurance policy.
Every LTD insurance policy has different conditions for payout, what constitutes a disability, or any pre-existing conditions that may be excluded, as well as various other conditions. For example, some policies will pay disability benefits if the employee is unable to work in his or her current profession, while others require the employee to take any job he/she is capable of doing.
LTD and Termination
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How To Buy Long
In this section, I review what you need to know when buying long-term disability insurance or enrolling in a company plan.
I begin by reviewing the three types of long-term disability insurance. Then I discuss how to apply for disability coverage. I close with a list of questions you should ask when buying insurance or enrolling in a plan.
Do Disability Benefits Continue Upon Termination
Rarely, a long-term disability policy will expressly state that employees arent eligible for disability payments if the employer terminated their employment with good reason. Whether or not your disability policy contains this language will dictate if a for-cause termination causes the employee to stop getting long-term disability benefits.
Its also worth noting that your termination will also impact your health insurance coverage. Employer-sponsored healthcare benefits usually cease on the last day of the month in which the employee was let go unless the employee elects to continue coverage via COBRA. This might cause problems with your long-term disability claim since employees need continued proof of their disability to keep receiving their disability benefits.
Therefore, if financially possible, keep getting medical treatment even if you dont have employer-sponsored healthcare benefits anymore. You might also qualify for discounted health coverage via in addition to COBRA.
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Appealing A Denial Of Long
You have the right to an internal appeal if your claim gets denied. An appeal means you ask the insurance company to reconsider its decision to deny your benefits. A long-term disability internal appeal means that the appeal is handled by employees of the insurance company. Each insurance company has its own process. You need to make this request in writing.
Finally, if the insurance company denies your internal appeals, you have the right to do an external appeal. External means that the appeal is handled by someone who is independent of the insurance company. In most cases, this will be a judge in your province. However, some plans have different procedures. So, it could be an arbitrator.
When you do an external appeal, it can involve filing a lawsuit against the insurance company. However, this is still an external appeal. So, the insurance company can decide to approve your claim before it gets to court.
The insurance company could also negotiate a one-time settlement with you. This is called a lump-sum settlement. I will discuss that in the next section below.
While youre at it, take a look at our article: Will I Have to Pay My LTD Insurers Legal fees if I Lose My Case? where we discuss what happens if you win or lose your legal appeal.
Americans With Disabilities Act
Under this act, employers with 15 or more workers have to provide reasonable accommodations to their disabled employees.
Reasonable accommodations are sometimes referred to as productivity enhancers. These are the adjustments or changes to the workplace so disabled workers can successfully perform their tasks to the same extent as people without disabilities. Provided that such adjustments will not cause the company undue hardship.
For example, the employer can install ramps or modify the layout of the workplace. They can also provide assistive technologies such as screen readers and videophones. If necessary, the employer can also offer a more flexible schedule or change the employees job requirements.
Only after your employer has provided reasonable accommodations and you still cant do your job properly, can they legally dismiss you. The same also applies if no reasonable accommodations exist that can cater to your disability.
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What Happens To Health Insurance If You Go On Disability
People often overlook what happens to their health insurance coverage when they go on disability leave from work.
The Family Medical Leave Act and several state-level laws govern the issue. However, these rules apply to only about half of the working population, and the legal protections expire after twelve weeks in most cases.
First, you may want to know whether your employer can cancel your coverage when you are unable to work. The answer is often yes so finding options that cover needed medical care becomes critical.
Second, you might be curious about who pays the premiums. At a minimum, the after-tax cost of your usual obligation will rise. Once again, you may want to explore more affordable options.
What Qualifies For Long
The qualifications for long-term disability are usually more stringent than those for short-term disability. With short-term disability, benefits can be awarded if the employee is unable to do their job. With long-term disability, benefits will typically only be awarded if the employee is unable to do any job. What constitutes a qualifying event will be specified in the policy, so it is important to understand when benefits may apply before accepting a long-term disability policy.
Qualifying events may include chronic pain, cancer treatments, or debilitating illness or injury lasting more than 26 weeks. If an employee could qualify for another form of income replacement, such as Social Security Disability Insurance, the long-term disability policy will no longer provide benefits.
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What Happens To Long Term Disability When Terminated
It depends on your disability insurance policy. If your disability benefits are paid by an insurance company, then your employment status wont affect your benefits. But if its paid by your employer, then your disability payments may cease.
Although, there are instances when your insurance company can legally terminate your benefits. Most of the time, its because you no longer meet the definition of disabled. Or sometimes because you refuse to cooperate with the insurance companys requests for information.
Pregnancy And Maternity Leave
If you are pregnant, you are eligible for disability benefits for four weeks before your due date and six weeks after giving birth .
You may be entitled to further disability benefits up to the maximum 26 weeks with documentation from your medical care provider.
Either way, you will need to submit a medical report completed by a doctor or certified nurse midwife stating your disability is due to or related to pregnancy or recovery from delivery. Physical and mental health conditions due to or related to your pregnancy or post-partum recovery may be eligible for disability benefits.
Note: Benefits are not payable for any period you are unable to work due to elective surgery .
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Disability Insurance Coverage: How Do You Enrol
Applying for insurance coverage is how you enrol in a plan or policy. Without coverage, you cannot file a claim should the need arise. How you apply for coverage will depend on the type of disability policy:
Applying for Group Insurance Coverage
You apply for group insurance coverage through your employer, union or association. You are eligible to enrol because of your status as a full-time employee or member of a union or professional association.
The application involves filling out a form. If the group covered by the insurance is small, you may also have to fill out a medical questionnaire. Or undergo medical tests. With large organizations, there are no barriers to enrolment other than your status as a member of the group. Once enrolled in the plan, you are considered a covered person under the plan. If you later become unable to work, you can file a long-term disability claim under the insurance policy.
Applying for Individual Insurance Coverage
Applying for individual insurance is more complicated than group insurance. You will have to provide detailed information about your medical history and undergo a medical assessment and bloodwork.
The insurance company then reviews your medical information to determine if they will agree to offer you a long-term disability insurance plan.
Ensuring Your Coverage Continues
If you are going on disability and want to make sure that your life insurance coverage continues, there are a few things you can do.
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Can Cobra Help You
COBRA continuation coverage gives employees and their dependents who leave an employer’s group health plan the opportunity to purchase and maintain the same group health coverage for a period of time under certain conditions. COBRA can help bridge the gap. Under HIPAA rules, COBRA is counted as previous health coverage, as long as there was not a break-in coverage of 63 days or more.
Employer Canceling Health Insurance While On Disability
The first thing that might happen to your health insurance when you go on disability is that your employer might cancel the coverage when they terminate your employment.
The Family Medical Leave Act requires employers to maintain group health coverage as if disabled employees are still working. But it covers only about half of all workers and lasts only twelve weeks. However, do not worry, as you have three options to address the issue.
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Working While On Long Term Disability Under Any Occupation Policies
Can you work while on disability under an any occupation policy? As its name suggests, you should not be able to work in any job if you hold an any occupation policy. A lot of own occ policies transition to any occ after 24 months.
Under an any occ policy, you qualify for disability benefits because you are unable to perform any occupation. However, an any occ policy will allow you to work on a limited basis.
Under an any occ policy, your disability is likely to be reduced or eliminated the more you earn from your new job. If your new job pays 80% or more of what you earned before you became disabled, your benefits could be terminated. If you earn less than 20% of your pre-disability income, your disability is likely to remain the same.
Most any occ policies allow you to receive residual or partial disability for part-time work. Your benefits will be reduced in proportion to your new income if its 20-80% of your pre-disability earnings.
A lot of any occ policies also offer rehabilitation incentives. They can motivate you to get back to work by offering an extra 5-10% of monthly benefits. To receive the incentive, you will have to participate in an approved rehabilitation or job-training program.
Severance Of Employment For Employees On Long
In Canada, employers often continue to employ individuals on staff for at least two years after they receive a medical diagnosis or sustain an injury that prevents them from returning to work. However, your company may decide to terminate your employment before this two-year period ends based on the doctrine of frustration. If you lose your job, your employer usually has to provide you with notice of termination or provide you with severance pay or both.
Companies have the right to terminate a staff members employment for a number of reasons. Despite this, employers are not usually allowed to fire anyone simply because they have a disabling medical condition.
If you believe your employment was terminated solely because of your disability, you may decide to seek legal assistance.
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What Are The Elimination Periods For Long
The most common elimination period for long-term disability is 90 days, but the exact terms of the elimination period will be specified in the policy. If short-term disability coverage is available, the effective waiting period before receiving benefits will be relatively short. When a short-term policy is not available, however, employees may have to wait several months with no income before qualifying for long-term benefits. Due to the longer elimination periods, many employees opt for a combination of short-term and long-term disability coverage.
Can You Get Ltd Benefits If You Were Fired
Even if your employer fired you and terminated your LTD coverage, you may still be able to receive benefits. The question of whether you are eligible depends on when your disability first started not when you applied for benefits. In other words, as long as you were covered by the policy when you first became disabled, you may still qualify for benefits.
This concept may be confusing, but if you compare it to other types of insurance, it may make more sense. Consider this situation: you have renters insurance for your apartment, but cancel the policy as of March 31 because you have bought a house and will be covered under a new homeowners insurance policy. If your apartment is robbed on March 31, you can still file a claim under your renters insurance because the covered incident the robbery happened while the policy was still in effect.
In the same way, if you became disabled while your LTD policy was in effect, you may be eligible for benefits. The key here is to examine your policy to determine if you are considered disabled under its terms. While each policy is different, if you were unable to work due to your disability, you may be approved for benefits.
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