In this article you can find long term disability (LTD) questions and answers, with a focus on Manulife Insurance. This information does apply and cross over to other Insurance claims, and should be used as an informative resource before you decide to appeal any denied insurance claim. If you have a long-term disability claim, or have been injured at work and can no longer carry out your employment duties, be sure to contact a long-term disability attorney. You may be entitled to more benefits and damages than you are led on and/or are seeking.
What is the WSIB?
WSIB stands for the Workplace Safety and Insurance Board, Ontario’s provincial worker’s compensation board.
This agency also works with employers to aid their “Injury at Work” prevention plans, in hopes of reducing disability claim frequency. If an employer analyzes the amount and types of injuries and claims at present, they can take that data and insure managerial steps are taking to reduce the injury/illness culprits, and ultimately reduce lost-time claims.
Injury at Work
If you have obtained an injury or illness due to your employment environment or duties, it is pivotal that you follow the suggested steps to ensure you get the proper leave and recovery support.
Step 1
- Obtain necessary medical treatment as soon as possible, especially in an emergent situation; get first aid or to a doctor or hospital. Your employer is responsible for providing transportation to receive medical treatment, and it is their duty to call an ambulance or assign someone to accompany you.
Step 2
Notify your supervisor about the injury, and how it occurred, as soon as possible. If your injury requires treatment from a health professional (beyond that of first aid treatment), your employer HAS to report the incident to WSIB.
If you fail to inform your employer about an accident causing injury, you may lose your rights to worker’s compensation benefits. If you are battling an occupational illness/disease, notification of such has a limitation period of two years (from when the disablement occurred, or within 2 years of learning that your disease/illness is work related)
Step 3
Report your injury or illness to WSIB, by filling out a Form 6 – Worker’s Report of Injury or Disease. In this form your will provide detailed information about your injury or illness, how it happened, and also grants you the ability to claim for benefits after a workplace injury or illness.
- You can file online, through WSIB’s eForm 6.
- Call and speak to a representative at: 1-800-373-0750 or (416)-344-1000 (TTY: 1-800-387-0050), or
- Fax a completed Form 6 at (416)-344-1000 or 1-888-313-7373
- Mail a completed Form 6 to:
Workplace Safety & Insurance Board
200 Front Street West,
Toronto, Ontario M5V-3J1
To find a PDF (printable) version of WSIB’s Form 6, as well as a comprehensive reference guide for filling out the form, click here for me information.
Step 4
If you lose time from work as a result of your illness or injury, you need to report such to WSIB. (Example: you do not feel well the following day post injury or illness, and you choose to stay home for the day due to that illness or injury, you need to report to WSIB).
You should report your injury or illness if you find yourself in the following situations:
- Your supervisor/manager tell you NOT to report a workplace injury or illness to the WSIB
- Your employer threatens you, and says you will lose your job if you report a workplace injury or illness
- Your employer tells you that your injury or illness is not covered by WSIB
- You’re told to use your sick days to recover from a workplace injury or illness, rather than reporting it.
The list above; are all cases of your employer acting illegally. If you find yourself in any of these situations, contact WSIB immediately, as well as long-term disability lawyer! Your employer is not acting in accordance to the Workplace Safety and Insurance Act, and should be reported immediately.
Your employer must meet and comply with the provincial worker’s compensation board requirements.
It is your employers responsibility to support their workers. If and when an employee takes leave for a disability, the employer should have an effective case management protocol, which includes notice of disability accommodation and rehabilitation.
You employer should have an effective return to work program, involving you, the insurance company, and Human Resources at your place of employment. If your employer does not have a Human Resources department, speak with your directing superior. It is your employer’s responsibility to provide the proper accommodation in duties and hours in order to allow for an easier, gradual return for an employee who is recovering from or is dealing with a long standing disability. It is your employer’s duty to control the risks of workplace injuries.
WSIB Compensation
WSIB worker’s compensation are a range of benefits which you are entitled to as a result of your workplace insurance. The benefits people are most familiar with are wage replacements during a leave from work due to a workplace illness or injury. There are a number of other WSIB benefits available to employees, including:
* Loss of Retirement Income (LRI) Benefit
* Benefit for Future Economic (FEL) Loss
* Non-Economic Loss (NEL) Benefit (for those who have become permanently impaired (PI) due to a work-related injury or illness.
* Health Care Equipment and Supplies
etc.
To find a full list of the benefits you may be entitled to, as well as more in-depth information on such, click here.
WSIB Hearing Aid Early Replacement Form
If you have suffered from a loss of hearing due to your employment duties or work environment, you may seek the medical attention of an Audiologist or Hearing Instrument Practitioner for hearing aids. If you are an employee or retired employee and have current hearing aids for less than 5 years, and have determined new hearing aids are required, a “Hearing Aid Early Replacement” form can be completed and sent to WSIB for pre-approval of a new hearing aid(s).
Remember that all supporting medical documentation is needed to support a WSIB claim. If you have any questions or concerns about the replacement of your hearing aids, do not hesitate to contact WSIB at 416-344-1000 or toll free at 1-800-387-0750.
Common Unanswered LTD Questions:
Below you will find information on common Manulife long term disability questions that are not so easily answered online, or through Manulife’s Insurance Booklet. If you have any further questions or concerns regarding your long term disability claim, or if you have been injured at work, feel free to call TSF Law today. We provide free consultations and are here to help you with any long-term disability needs.
How many benefits can I apply to if I have private insurance, on top of benefits from work?
Typically, insurance companies do not provide full coverage for the same claim. What tends to happen is that one plan will pay for the majority of costs, and the other plan can pick up the remainder of what tab is not covered. They cannot pay towards another insurance primary plan’s deductible. If both insurance policies have deductibles, you’ll have to pay before coverage of either plan sets in. Regardless of how insured you are, you do not get to choose which insurance plan will act as the primary, being the one that pays first. This is dependent on the situation you find yourself in, as well as some tactical input from yourself.
All workplace injuries and occupational illness/disease need to be reported to WSIB; this is the law. Since they will be the primary “insurance plan” to be notified about the incident, their coverage will set in first. Regardless though, you should submit a claim to any group benefits plan you have, or personal insurance. If you have any questions about a WSIB claim not providing the coverage you need for your incurred disability, or if you are facing a denied disability claim of any kind, after a workplace injury, contact a long-term disability lawyer immediately. The time you have to spare is limited and you are entitled to social and economic support in this time of struggle.
If you have endured an injury at your place of work, have injured yourself or have fallen ill due to the duties of employment, or the work environment itself, and you have been urged by your employer not to seek medical attention or submit a WSIB and/or an insurance claim, contact TSF Law immediately. This is against the law and you ARE entitled to leave and financial coverage while away from work.
Who is My Manulife Long Term Disability Contact?
Your Manulife contact is someone who will act as a case manager and aid your employer in easing you, the employee, filing your disability claim, receiving your benefits, and eventually transition back to the workforce. Your Manulife contact are also there to ensure that you are receiving the proper medical treatment, in a timely manner, with a goal of returning to work.
To find out who your direct Manulife LTD contact is, if not already provided by your employer, feel free to contact the Manulife insurance office specific to your coverage, by finding the exact number here.
How Long Is Disability Insurance?
The length of your disability coverage depends on the type of insurance policy you are covered by, and the claim you are pursuing.
The duration of your coverage is really dependent on your core plan and add-ons you may have purchased as part of your insurance policy. Be sure to read through your Manulife insurance benefit booklet and review your policy plan. If you have any questions or concerns about your Manulife insurance, contact your Manulife Insurance area contact, or go online here
for an in-depth look of Manulife Insurance’s Terms and Conditions.
Short Term Disability
Short term disability benefits are paid out to you, by your disability insurance, in the event that you submit a claim following an injury or illness occurring off the job. Compensation benefits, such as WSIB in Ontario, cover you when you obtain a work related injury or illness while on the job, and you employer is covered by WSIB.
If you are enrolled in a Group Benefit Plan, you are eligible to claim short-term disability benefits. It is important that you provide all the medical documentation you have to support your claim, and even more important, that you contact your employer for the necessary contact so that your disability claims manager is aware of your situation as soon as you become injured or fall ill.
Long Term Disability
Manulife long term disability typically expires or becomes under review after 2 years of receiving benefits. This time limitation is imposed because the insurance company wants to make sure you are making the proper efforts to recover from your illness or injury, as well as are taking the proper social and economic steps to regain employment and take part in today’s economy, even if this means gaining new training and applying yourself to a position that could be in a completely different field, but is supportive of your disability or illness.
Personal Accident Disability
This Manulife disability insurance helps protects your finances when an accident occurs and you are unable to do things such as pay your bills. Manulife’s personal accident health insurance provides protection to anyone, including full-time workers, stay-at-home parents, students, to the unemployed. They provide options for specific needs such as:
- Sickness Disability
- Sickness Hospitalization
- Accident Excess Medical (for medication, equipment, therapy, etc.)
- Accidental Death & Dismemberment
- Accidental Death
- Non-Occupation Loss of Income (provides an economical option to complement coverage provided in a Woker’s Compensation plan, such as WSIB)
- Strain and Sprain Rider
- Return of Premium
All of the additional options and the overall Personal Accident Disability plan, provided by Manulife Insurance, have specific limitations of coverage for total disability benefits. You can get a full overview of such by reviewing Manulife Insurance’s Personal Accident Disability Booklet, found here.
WSIB Disability
You have 6 months from the date of injury to claim benefits through WSIB. For a workplace illness, you typically have 6 months from the date of your diagnosis. WSIB provides short-term, long-term and permanent disability, depending on the nature of your claim and health care needs.
What are Manulife’s Stay at Work Services?
This is a paid program offered by Manulife insurance to companies with 25+ employees. It allows special intervention services to aid a workplace in preventing disabilities and absenteeism, as well as to help accommodate anyone with a disability by making the work environment more effective, and increase the company’s productivity overall. Some of their services include:
* Intermittent absence management
* Workplace accommodations
* Ergonomic Assessments
Can you file a Chronic Fatigue Manulife disability claim? Yes!
Manulife, in 2005, was found wrong, in BC provincial courts, to deny a disability benefits claim for chronic fatigue.
Manulife insurance looks at Chronic Fatigue / Chronic Fatigue Syndrome as being a condition under the Muscle and Bones section of their Manulife Insurance “Underwriting Handbook for Advisors”.
When submitting a claim with the condition of Chronic Fatigue, it must be well defined with supporting medical documentation. The type of insurance that covers a Chronic Fatigue Manulife disability claim include:
- Manulife Life Insurance
- Manulife Critical Illness Insurance
- Manulife Disability Insurance
- 180-day waiting period and exclusion for anxiety/depression
If you have received a denied Chronic Fatigue Manulife disability claim, contact a long-term disability lawyer today. They will be able to speak with the insurance company, on your behalf, and gain full understanding as to why you claim has been denied. If it is found that you claim was denied due to an administrative/clerical error, then your claim may be processed shortly. If your claim was denied due to bad faith, TSF Law will fight for full benefit coverage, as well as seek damages for the extended emotional and physical stress that a denied insurance claim can have on an employee.
Mental Health & Wellness in the Workplace
It is your employer’s duty to support overall health and wellness of their employees, and improve organizational health to reduce disability claims in the workplace. It is important that you work in an employment environment that fosters, proactively, a psychologically safe environment in order to reduce the number of mental health issues amongst employees. In 2011, Mental health disability claims were the #1 reasons for plan members to go on disability leave- this has only grown.
I have a denied Manulife claim, what do I do now?
Contact a long-term disability lawyer. TSF Law works on a contingency fee basis and provides free consultation services in person or over the phone. It is very important to our firm that no insurance policy holder settles with a denied claim when they are injured or dealing with an illness/disease as a result of a workplace accident or environment. There is always a way to get the social and economic help in a time of need and TSF Law has an in-depth knowledge of your legal rights when you are met with a denied Manulife claim. Contact TSF Law today, we are always there for you.
