Disability Determination Process
When To Apply
You should apply as soon as you become disabled.
- Social Security Disability Insurance (SSDI) benefits have a five month waiting period, which means that benefit payments will not begin before the sixth full month of disability. The SSDI waiting period begins the first full month after the date we decide your disability began.
- There is no waiting period if your disability results from amyotrophic lateral sclerosis (ALS) and you are approved for SSDI benefits on or after July 23, 2020.
- We pay Supplemental Security Income (SSI) disability benefits for the first full month after the date you filed your claim, or, if later, the date you become eligible for SSI.
How To Apply
You can apply for Disability benefits online, or if you are unable to complete the application online, you can apply by calling our toll-free number, , between 8:00 a.m. and 7:00 p.m. Our representatives can make an appointment for you to apply.
People who are deaf or hard of hearing may call our toll-free “TTY” number, , between 8:00 a.m. and 7:00 p.m. on Monday through Friday.
Some publications that will give you more information on disability benefits.
The Disability Starter Kit will help you get ready for your disability interview or online application. Kits are available for adults and for children under age 18.
The starter kits provide information about the specific documents and the information that we will request from you.
The kits also provide general information about the disability programs and our decision-making process .
Here are some additional resources with information on disability benefits:
Find information about health care coverage including Medicare and Medicaid. Also, learn about workplace disability insurance, compensation benefits for disabled veterans and Social Security benefits for people with disabilities.
On This Page
- Short-Term and Long-Term Disability Insurance
- Social Security Benefits for People with Disabilities
- Health Insurance and Health Resources for People with Disabilities
- VA Disability Compensation Benefits
Short-Term and Long-Term Disability Insurance
If you can’t work because you get sick or injured, disability insurance will pay part of your income. You may be able to get insurance through your employer. You can also buy your own policy.
Types of Disability Policies
There are two types of disability policies.
Short-term policies may pay for up to two years. Most last for a few months to a year.
Long-term policies may pay benefits for a few years or until the disability ends.
Employers who offer coverage may provide short-term coverage, long-term coverage, or both.
If you plan to buy your own policy, shop around and ask:
How is disability defined?
When do benefits begin?
How long do benefits last?
How much money will the policy pay?
Federal Disability Programs
Two Social Security Administration programs pay benefits to people with disabilities. Learn about Social Security Disability Insurance (SSDI) and Supplemental Security Insurance (SSI).
Social Security Benefits for People with Disabilities
If you have a disability, two programs from the Social Security Administration (SSA) may be able to help. To find out if you’re eligible for either one, use the Benefit Eligibility Screening Tool.
Definition of Disability
To qualify for either program, you must meet SSA’s definition of disability:
Your disability is expected to last for at least one year or result in death
Your impairment is on Social Security’s list of disabling medical conditions
Understand Social Security Benefit Programs for People with Disabilities
Social Security Disability Insurance (SSDI) is for people who have become disabled after earning enough Social Security work credits within a certain time.
Supplemental Security Income (SSI) is for people with disabilities or who are 65 or older with little to no income and resources. SSI is not Social Security. Although the names sound similar and the Social Security Administration runs the program, it does not fund SSI.
How to Apply for Social Security Disability Insurance (SSDI)
If your application is approved, you’ll have a five-month waiting period for benefits to start.
If your application is denied, you can appeal the decision.
How to Apply for Supplemental Security Income (SSI)
Adults can apply for SSI by phone, in person at a local Social Security office, or in some cases online. To apply for SSI for a child, you can start the process online but will need to complete it either in person or by phone.
Explore a listing of SSI topics to learn more detailed information.
Going to Work
Whether you receive SSDI or SSI, you can work without it impacting your benefit if you earn less than a certain amount. You can find all the details in the booklet Working While Disabled: How We Can Help.
Health Insurance and Health Resources for People with Disabilities
Find information about health insurance and resources for people with disabilities.
Health Coverage for People With Disabilities
If you have a disability, you have three options for health coverage through the government.
Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.
Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Learn about eligibility, how to apply and coverage.
Affordable Care Act Marketplace offers options to people who have a disability, don’t qualify for disability benefits, and need health coverage. Learn about the Marketplace, how to enroll, and use your coverage.
Health Resources for People With Disabilities
Federal, state, and local government agencies and programs can help with your health needs if you have a disability.
Explore the Disability and Health section of CDC.gov for articles, programs, tips for healthy living and more.
Learn more about assistance and benefits for people with disabilities from the Social Security Administration.
Contact your local city or county government to find out what medical and health services are available locally for people with disabilities.
Your state social service agency can help you locate medical and health programs.
Visit USA.gov’s Government Benefits page to learn more about government programs and services that can help you and your family.
VA Disability Compensation Benefits
Veterans who have a service-related injury or illness may be entitled to VA disability compensation. It’s a tax-free monthly benefit.
Visit VA.gov to learn:
Which conditions qualify you for benefits
How the claims process works
Where to file your claim
How to appeal a decision you disagree with. The process changed in February 2019.
Survivors of veterans may receive compensation benefits in certain situations.
Do you have a question?
Ask a real person any government-related question for free. They’ll get you the answer or let you know where to find it.
Last Updated: March 30, 2021
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Apply Online for Disability Benefits
Social Security offers an online disability application you can complete at your convenience. Apply from the comfort of your home or any location at a time most convenient for you. You do not need to drive to your local Social Security office or wait for an appointment with a Social Security representative.
You can use the online application to apply for disability benefits if you:
- Are age 18 or older;
- Are not currently receiving benefits on your own Social Security record;
- Are unable to work because of a medical condition that is expected to last at least 12 months or result in death: and
- Have not been denied disability benefits in the last 60 days. If your application was recently denied for medical reasons, the Internet Appeal is a starting point to request a review of the medical determination we made.
Here is what you need to do to apply for benefits online:
It will help you gather the information you need to complete the application.
Complete the Medical Release Form
We suggest that you have the following information at hand. It will make completing the application much easier.
Information About You
- Your date and place of birth and Social Security number
- The name, Social Security number and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death (if appropriate)
- Names and dates of birth of your minor children
- Your bank or other financial institution’s Routing Transit Number [more info] and the account number, if you want the benefits electronically deposited
Information About Your Medical Condition
- Name, address and phone number of someone we can contact who knows about your medical conditions and can help with your application
- Detailed information about your medical illnesses, injuries or conditions:
- Names, addresses, phone numbers, patient ID numbers and dates of treatment for all doctors, hospitals and clinics;
- Names of medicines you are taking and who prescribed them; and
- Names and dates of medical tests you have had and who sent you for them.
Information About Your Work
- The amount of money earned last year and this year
- The name and address of your employer(s) for this year and last year
- A copy of your Social Security Statement
- The beginning and ending dates of any active U.S. military service you had before 1968
- A list of the jobs (up to 5) that you had in the 15 years before you became unable to work and the dates you worked at those jobs
- Information about any workers’ compensation, black lung, and/or similar benefits you filed, or intend to file for. These benefits can:
- Be temporary or permanent in nature;
- Include annuities and lump sum payments that you received in the past;
- Be paid by your employer or your employer’s insurance carrier, private agencies, or Federal, State or other government or public agencies; and
- Be referred to as:
- Workers’ Compensation;
- Black Lung Benefits;
- Longshore and Harbor Workers’ Compensation;
- Civil Service (Disability) Retirement;
- Federal Employees’ Retirement;
- Federal Employees’ Compensation;
- State or local government disability insurance benefits; or
- Disability benefits from the military (This includes military retirement pensions based on disability but not Veterans’ Administration (VA) benefits.)
We may ask you to provide documents to show that you are eligible, such as:
- Birth certificate or other proof of birth;
- Proof of U.S. citizenship or lawful alien status if you were not born in the United States [more Info];
- U.S. military discharge paper(s) if you had military service before 1968;
- W-2 forms(s) and/or self-employment tax returns for last year;
- Medical evidence already in your possession [more info]. This includes medical records, doctors’ reports, and recent test results; and
- Award letters, pay stubs, settlement agreements or other proof of any temporary or permanent workers’ compensation-type benefits you received [more info].
We accept photocopies of W-2 forms, self-employment tax returns or medical documents, but we must see the original of most other documents, such as your birth certificate. (We will return them to you.)
Do not delay applying for benefits because you do not have all the documents. We will help you get them.
Mailing Your Documents
If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents.
If you do not want to mail these documents, you may bring them to a Social Security office. Do not mail foreign birth records or any documents from the Department of Homeland Security (DHS), formerly the Immigration and Naturalization Service (INS), especially those you are required to keep with you at all times. These documents are extremely difficult, time-consuming and expensive to replace if lost. Some cannot be replaced. Instead, bring them to a Social Security office where we will examine them and return them to you.
Our online disability application process offers several advantages. You can:
- Start your disability claim immediately. There is no need to wait for an appointment.
- Apply from the convenience of your own home or on any computer.
- Stop and return to your saved application before submission.
- Avoid trips to a Social Security office.
- Complete the process online even if you live outside the United States.
After we receive your online application, we will:
- Provide confirmation of your application- either electronically or by mail.
- Review the application.
- Contact you if we need more information or documentation.
- Inform you if other family members may be able to receive benefits on your record, or if you may be able to receive benefits on another person’s record, such as your spouse or your parent.
- Process your application.
- Mail our decision to you.
You can also apply:
- By phone – Call us at 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. If you are deaf or hard of hearing, you can call us at TTY 1-800-325-0778.
- In person – Visit your local Social Security office. (Call first to make an appointment.)
If you do not live in the U.S. or one of its territories, you can also contact your nearest Federal Benefits Unit that provides service to your country of residence.
- Apply Online for Disability Benefits
- Disability Benefits
- Fact Sheet – Exclusion of Certain Medical Sources’ Evidence
- Disability Planner
- Information for Representatives
- What You Need to Know About The Online Disability Application
- Helping Someone Apply Online
- Information on Excluding Certain Medical Sources’ Evidence
What about SSI?
Supplemental Security Income (SSI) pays benefits to disabled adults and children with limited income and resources.
Employee benefits encompass a wide variety of compensation and insurance policies. Along with health, life, dental, and vision insurance coverage, disability insurance is often offered to full-time employees. This includes both short term disability and long term disability benefits.
When an employee becomes disabled and stops working, they must carefully review their disability insurance options. Depending on the terms of the policy, short term disability benefits are usually available for a time period of 30 to 180 days. If an employee remains disabled after the maximum duration of the short term disability benefits, they should immediately apply for long term disability benefits. Some employees make the mistake of assuming that their short term disability benefits will automatically roll into long term disability benefits; however, in most circumstances a separate application for long term disability benefits (LTD) is required.
Here Are 5 Steps to Apply for LTD Benefits:
1. Request an Application from Your Employer
Someone at your employer’s Human Resources Department should be able to provide you with an application and all instructions to complete your LTD application. However, sometimes there are situations where your employer fails to provide you with the materials necessary to apply for LTD benefits. If so, you can probably find an application from the insurance company or claim administrator online. For example, if CIGNA (also known as Life Insurance Company of North America) is your insurer, try a Google search for “CIGNA long term disability application” or “CIGNA long term disability claim form”. There is a good chance that the forms necessary to apply for LTD benefits will be available on the insurance company or claim administrator’s website.
2. Complete and Submit the Employee’s Statement
This is the section of the LTD application that you are responsible for completing and it is sometimes called the Employee’s Statement. The requirements of the Employee’s Statement vary depending on the insurance company, but generally you must disclose information such as:
- Your name
- Social Security number
- Date of birth
- Address and phone number
- Family members
- Name of your employer and your occupation
- Your work history and education information
- Date of your injury or sickness
- Last date worked
- Your reason for disability
- All medical providers and their contact information
- Prescribed medications
- And any other forms of income that you may be eligible to receive
You will want to complete this form in detail. You may notice that the form does not allow much space to write or type your responses, so you may want to provide additional pages in order to fully respond to these questions. Further, you will have to submit a signed authorization that allows the insurance company or administrator to request your medical records.
3. Acquire Your Employer’s Statement
Your employer is also responsible for completing a portion of the LTD application. In this section, the employer will generally have to provide information such as your date hired, effective date of insurance coverage, earnings, last date worked and whether you returned to work, other insurance benefits or income you are eligible to receive, title of your occupation, and the physical and mental requirements of your occupation.
4. Get a Statement from Your Attending Doctor
In addition to statements from yourself and your employer, the insurance company or claim administrator will require your doctor to complete a statement. The insurer will usually request that your doctor provide information about diagnoses, signs and symptoms, objective findings, whether your injury or sickness is work related, dates of treatment, types of treatment (such as hospitalizations, surgeries, and medications), referrals, an estimate of your physical limitations and/or mental impairments, an estimate of when you may return to work, and additional remarks. I recommend taking this form directly to your treating physician and asking them to complete this statement in-person. That way, this form will not be misplaced and you can remind your doctor to complete this form in detail.
5. Submit Anything Else in Your Possession that Supports your Disability Claim
Do not assume that the insurance company or claim administrator will gather all medical records and other evidence for your disability claim. If you have test results, doctors’ records, or anything else you believe supports your disability claim, submit this documentation with your long term disability application. Doing so could potentially shorten the time you have to wait for a claim determination and strengthen your chances of being approved.
For reference, see the following examples of long term disability claim forms taken directly from insurance companies’ or claim administrators’ websites:
Contact Keller & Keller for a Free Consultation
If your claim for short term disability or long term disability benefits has been denied, contact an experienced disability attorney at Keller & Keller today. We can provide a free consultation about your short term disability and long term disability claims. Please be advised that a denial of disability insurance benefits must be timely appealed. If you fail to submit a written appeal to the insurance company or administrator, then you may forfeit your claim for short term or long term disability benefits.
You May Also Qualify for Social Security Disability Benefits
In addition, if your disability will last 12 months or longer, then you should consider applying for Social Security disability benefits. Keller & Keller can assist you with your Social Security disability application. Call 1-800-253-5537 today to learn more.
Long Term Disability (LTD) and Short Term Disability (STD) are disability insurance policies offered through your employer.
If your employer doesn’t offer this insurance, skip this article and go have a nice snack.
If your employer offers disability insurance, you are very lucky. Private insurance decisions are sometimes much quicker than Social Security disability. Some people are able to start collecting disability right away, instead of having to wait months or years.
On the other hand, you are also a bit unlucky, because you are going to have to wade into the stormy, thorny and unpredictable waters of private disability insurance companies. If you learn a bit about how these insurance plans work, the next few years of your life may be a lot easier and a lot better.
If you are still working or still employed now, here’s a few very important things you need to know: How to Avoid Getting Screwed Over if Your Employer Offers Disability Insurance
Please Read Your Policy
As you read the rest of this page, you will come across several million reasons why reading your policy is a good idea. Some people wait and do not read their policy until months or years after they apply, and then discover some very unhappy surprises. It will be a great help to you if you can get a copy now to read.
Asking for Your Policy
You can ask the person or department who handles Human Resources at your job for a copy of your Long Term Disability policy and Short Term Disability policy. Or you may be able to get a copy through your disability insurance company. Sometimes people feel afraid, shy or embarrassed to ask for their policy. As an employee, you have a right to see your policy and to know what it says. You do not need to offer an explanation why you are requesting this. You have the right to be informed about your benefits.
Avoid Getting Capped
After you read your policy, you will discover that many policy will cap certain conditions and try to automatically cut you off after two years. Obviously, you would rather avoid this. How to Avoid Getting Capped
If you are appealing your case, it is a good idea to hire a lawyer. Most disability lawyers do not handle Long Term Disability claims. You will need to find someone who specializes in Long Term Disability (also called “erisa” claims). Learn more about Where to Find a Lawyer for LTD
Chronic Pain and Chronic Fatigue Syndrome
If you have Fibro, Chronic Fatigue Syndrome, or a related condition, there are a few important things you need to know about Applying for Long Term Disability for Chronic Pain and Chronic Fatigue
Social Security Disability
It’s important to also apply for Social Security disability. Very important. It’s better not to wait. Here’s some Tips for Applying for Both Social Security and Long Term Disability
Some of our readers on Long Term Disability report that having a supportive doctor is critical. For many insurance companies, there is quite a bit of paperwork for the doctor to fill out, and a supportive doctor can make a big difference. How to Find a Doctor to Help With Disability Documentation
Sometimes the insurance company will send a doctor and important form and only give ten days to respond. It’s a good idea to stay in touch about forms. Some readers report that they had success by getting copies of all forms themselves, bringing them to the doctor, sitting with the doctor while they get filled out, and then mailing them to the insurance company by certified mail.
Proving You Cannot Work
Many LTD policies start by asking you to prove that you can no longer work at your current job. Then at some point they switch to asking you to prove you cannot work any job. This is called “own occupation” and “any occupation.” If you are trying to prove own occupation, you may find it helpful to read some of Peony’s tips on How to Prove You Cannot return to your current job
Common regrets reported by our readers:
Being Too Friendly – Those nice people from the from the insurance company that call you on the phone or want to drop by your house and check on you, those are not your friends. They may send people to videotape or photograph you outside your home. They may follow you on social media and use your photos or writing as evidence against you. They will also read your medical records and any statements you have ever made about your employer or job or your personal life may be considered.
Talking Too Much – The LTD company may also call you and record what you say and use it against you. When in doubt, many questions can be answered by saying, “I am following my doctor’s medical recommendation on this matter.” (as long as you actually are following your doctor’s medical recommendation on this matter). You can also refer them to your medical records for more answers.
Making Bad Decisions at The Doctor’s Office – The decisions you make, and the things you say, and the things you do right now may turn out to have a big impact on you later. How to Go to the Doctor Without Regret
Videos – This law office has created an interesting collection of videos and stories about each different Long Term Disability Company. In the comments, people tell you what they really think about each one!
Articles – Attorney Scott Davis has written this excellent series of articles with tips for improving your chances of winning Long Term Disability claims. He practices in Arizona and Nevada.
The Whistleblower – Linda Nee has an excellent blog that some of our readers have found helpful. She used to work for a Long Term Disability company.
Tips from Readers:
“Keep copies of all office visits, tests, procedures etc. I have FOUR large binders. My insurance company conveniently states they aren’t getting records from my doctors. So I personally mail everything requiring a signature even when I’m confident they already received and sitting on someone’s desk.”
“Always request and collect full records with treatment notes – not online records or visit summaries. To get treatment notes, you have to sign forms and pay money.”
Updated January 2019. Please comment below with stories, questions, input or ideas. Please let us know if any links on this page stop working. If you found this page helpful, please use one of these magic buttons to share this post on Facebook or Twitter:
When you sustain a disability that prevents you from working for three to six months or longer, long-term disability insurance can be a lifesaver. It provides you with a percentage of your income when you are unable to earn a living due to long-term illness or injury. Below, we provide a basic rundown of how long-term disability works, when you can use it, and how other disability awards might affect your benefits.
For help filing a long-term disability (LTD) claim and to explore all of the disability benefits you might be entitled to, call Gallon, Takacs & Boissoneault and request a free consultation with our disability attorney: 419-843-6663.
When can I use LTD benefits?
If you have coverage through employer-sponsored or privately purchased LTD insurance, the first thing you will need to do after you sustain a serious disability is to review your policy. The summary plan description will include a distinct definition of “disability,” and information about how long you must wait before you can file a claim. LTD policies vary from provider to provider, and you will need to understand exactly what your policy entails and what the limitations are.
For most policies, your benefits become available when your short-term disability (STD) runs out, which is typically three to six months. LTD is essentially STD’s predecessor. Its requirements and guidelines are similar to STD, only it kicks in once your STD ends/once your elimination period is over. As with all types of disability claims, you will need to prove that you meet the insurer’s definition of disabled to obtain your benefits.
Some LTD policies pay only for total disabilities, while others pay for both total and partial disabilities. Many stipulate that you cannot file for LTD if you are still on your employer’s payroll.
If you are unsure of what your LTD policy entails or exactly what the requirements are, speak to your HR manager or insurance agent, or call our office at 419-843-6663. We would be happy to review your policy and explain the fine print.
How do I prove I am disabled?
Your treating doctor’s medical opinion of your condition and your medical records are your key pieces of evidence for proving to the insurer that you are disabled. Your records should include not only your doctor’s subjective findings and observations, but also objective tests that demonstrate your condition, such as x-rays, blood work, and surgical reports.
Some conditions are easier to prove than others. Cancer and heart failure may be much easier to prove with medical tests than soft tissue musculoskeletal injuries or an anxiety disorder, for instance. To ensure you have adequate supportive evidence for your LTD claim, have one of our attorneys at Gallon, Takacs & Boissoneault Co., L.P.A assess your file prior to submitting your claim.
How much will my LTD monthly benefit be?
Most LTD policies will pay claimants 50 to 70 percent of their pre-disability wages each month for total disabilities, up to a certain cap, e.g., $8,000/month.
For partial disability claimants, the insurer will calculate the monthly benefit at a certain percentage of the difference between their pre-disability and current wages. For instance, if you made $4,000/month prior to your disability and now only make $1,000/month due to your condition, your insurer will calculate your monthly benefit at a percentage (50 to 70 percent) of the $3,000 difference.
Benefits can continue as long as you are eligible to receive them, as per your plan rules. Some plans only provide LTD benefits for a certain length of time, e.g. five or ten years, while others may pay LTD until you reach retirement age.
Note, you may also qualify for Social Security disability (SSD) benefits if your condition has lasted or is expected to last a year or longer. In fact, your LTD insurer will probably encourage you to apply for SSD once you become eligible. This is because SSD benefits or any other disability benefit like Veterans Disability Compensation will offset your LTD benefits. So naturally, your LTD provider will want you to receive as many other benefits as possible to reduce the amount it has to pay you.
It is important to note that your insurer might take your SSD check for the months your SSD award should have been offsetting your LTD benefits.
What types of disabilities does long-term disability not cover?
LTD policies cover most injuries and impairments, but there are exceptions. Most policies exclude self-inflicted injuries, work-related injuries, preexisting conditions, injuries sustained while committing a felony, and injuries caused by acts of war. There may be a waiting period for conditions caused by drug abuse, alcoholism, or certain mental conditions.
You also must continue to receive treatment for your condition to remain eligible. For more information, check the exclusion and limitation clauses of your policy.
Our disability lawyers can help you get the disability benefits you need.
An estimated one-fourth of today’s 20-year-olds will become disabled before they retire, reports the Social Security Administration. And a disability can impair your ability to earn a living for a substantial amount of time. In fact, the average long-term disability recipient receives benefits for an average of 35 months, according to the 2011 U.S. Group Disability Rate & Risk Management Survey. LTD helps people stay afloat in the interim.
Our disability lawyers at Gallon, Takacs & Boissoneault can make sure you take advantage of all the benefits that are available to you. Our attorneys can assist with all types of LTD disability claims at any stage of the process, from initial filing to appeals.
After reviewing your case, we can also explain whether there are other avenues of compensation that you may qualify for, such as workers’ compensation, a third-party liability claim, or SSD, and help you coordinate your claims for maximum recovery.
Contact us today at 419-843-6663 for a free consultation and learn how we may be of service to you.
Our areas of practice include personal injury, social security disability, workers’ compensation, probate, real estate and bankruptcy. With more than 300 years of accumulated experience, we are prepared to fight for your right to compensation.
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Long Term Disability (LTD) can be used following Short Term Disability (STD) plans or alone.
Long Term Disability coverage provides wage replacement that is between 50-70% percent of your earnings before a non-work related injury impacted your ability to work.
If a LTD plan is offered through your employer, it is very important to sign up during the initial enrollment period, when you cannot be denied coverage for a pre-existing condition. Read the plan summary for definitions detailing what is covered as well as specific details required by your plan.
Most LTD plans include a waiting period that lasts from 3-26 weeks, which coincides with the length of time you can be paid for STD benefits, before you are eligible to begin receiving LTD benefits.
In order to continue to qualify for benefits detailed medical information must be provided to the LTD carrier initially and then throughout the life of the claim as requested. Failure to do so will result in termination of your benefit. If you are considered disabled longer than 90 days, most policies do not require you to continue paying premiums.
Most LTD policies have two definitions of disability: “Own Occupation” and “Any Occupation”.
- During the Own Occupation period, benefits are payable if the employee is unable to perform his or her regular job or a similar job. This period can last up to two years.
- After that, benefits are payable only if the employee is unable to perform Any Occupation for which he or she is or becomes reasonably qualified by education, training or experience.
Most LTD companies require you to apply for Social Security Disability (SSDI) benefits, and may provide assistance in the application process. Your LTD policy provides for what is known as an offset, or any benefit you receive from SSDI will reduce the benefit paid by the LTD policy.
If you are approved for SSDI and receive a retroactive payment check, you are normally required to pay the amount back received by the LTD company during the time which SSDI pays you.
In addition to STD and LTD, two additional federal disability programs you may be eligible for include Social Security Disability Insurance and Supplemental Security Income (SSI).
In order to be deemed disabled, you must have a medical condition that meets the Social Security Act (SSA) definition of disability, which is “having an illness or injury that is expected to last at least 12 months or if your condition may be considered terminal.”
What are CPP Disability Benefits?
Canada Pension Plan (“CPP”) disability is a Federal program administered by Service Canada. If you have paid into CPP, then you may qualify for CPP disability benefits in the event you become unable to work due to an injury, illness or medical condition. If you are approved, you will receive monthly disability benefit payments to replace your income.
Who can Apply for CPP Disability Benefits?
Do you suffer from a disability and you find yourself unable to work? You may be eligible for CPP disability benefits. Below are the qualifying criteria:
1. Minimum Qualifying Period
You need to have worked 4 out of the last 6 years before you can go on disability.
2. Doctor’s Support
You need to have your doctor support your absence from work. Your doctor will need to fill out a medical report form as a part of your application for CPP Disability, therefore his or her support is crucial.
How to Apply for CPP Disability Benefits
To apply, you need to meet with your family doctor or treating physician, complete the appropriate forms and send them to your Service Canada processing centre.
If your application is approved, you will receive a retroactive payment for all benefits owing to a maximum of twelve (12) months prior to the receipt of your application. You will also be eligible to receive a payment each month until you reach the age of 65, or until you are no longer disabled.
If your application is denied, then you will be able to appeal the denial within Service Canada.
What are LTD Insurance Benefits?
Many companies provide Long Term Disability (LTD) insurance benefits coverage to their employees. That was if you become too disabled to work due to injury or illness for a sustained period of time, you would have some income to support yourself and your family.
Under these plans either your company will cover the cost of these monthly premium payments, or they will be deducted from your paycheque. If you pay the premiums any benefits you receive will be non-taxable income.
In order to reduce the monthly payments, two common clauses in LTD insurance policies are the requirement to apply for CPP Disability benefits and the allowance of a deduction for any CPP disability benefits received.
However, if you are in the position where you want to use your LTD insurance benefits and apply for CPP disability, how does this work?
Let’s assume you are receiving $2,500 per month in disability benefits and you are approved for CPP disability benefits of $500 per month.
You will still receive $500 per month from CPP disability, but your monthly insurance benefit is reduced to $2,000 per month. You will receive two cheques and your total monthly income is unchanged, meaning, you will still receive a total of $2,500.
Why You Should Always Apply for CPP Disability Benefits if you are receiving, or might receive, LTD Insurance Payments
1. Additional Support for Your LTD Insurance Benefits Claim
CPP Disability benefits require a severe and prolonged disability, which is usually a higher standard than the requirement of a disability found in most LTD plans.
If you are found totally disabled by the CPP disability program, this is further evidence in support of your claim, which will make it more challenging for your insurer to prove you are able to return to your own or any occupation.
In addition, when you receive CPP disability, this reduces the insurance company’s financial obligation to you, but allows you to receive the same amount of compensation.
2. CPP Disability Will Be Your Safety Net
It may be difficult to get approved for CPP disability benefits, however, once you are approved you are likely to keep receiving payments as long as you are too disabled to work. This is even the case in the event your insurance company stops paying you benefits.
By obtained support from two sources, you are better protected.
3. LTD Policies Require You To Apply
Nearly all LTD insurance policies require you to apply for CPP Disability benefits. Failure to comply with this policy requirement may result in a deduction or suspension of benefits.
You should always make good faith efforts to apply for CPP Disability benefits.
4. Approval for CPP Disability May Equal Higher CPP Retirement Pension
Winning CPP disability payments can actually result in you getting a higher CPP Retirement pension when you turn 65. While you receive CPP disability, you are not penalized for not contributing to the CPP program.
However, if you do not apply for CPP disability, you will be assessed as providing a zero contribution each year going forward, resulting in a lower retirement CPP payment.
5. CPP Inflation Increases Not Subject to Clawback
Each year, your CPP disability payments increase according to inflation. However, most disability insurance policies will continue to deduct just your original CPP payment amount. These increases are not clawed back from the insurance company.
Monkhouse Law Can Help You
At Monkhouse Law, we encourage all of our LTD clients to apply for CPP disability benefits. Even though it may seem like your insurance company gets all of the benefits, in reality, getting approved for CPP disability benefits you in the long run. Please contact us for a free consultation over the phone with a legal professional.