Many employment contracts include insurance coverage for short and long term disability. Most employees never really have the need to use their temporary disability insurance, but it is reassuring to know that you are covered when you get a minor injury that might keep you out from work for a while.
You might be familiar with this scenario:
It starts with you getting advice from your physician that you need to get time off from work to heal from your injury or sickness. You review your employee handbook and find that it is covered under your temporary disability insurance coverage. You inform your employer and go to HR to fill out the forms and submit the documents. Weeks pass and no payment from either your insurance company or employer comes.
Now, you may have an insurance adviser tell you to apply for employment insurance while your previous claim is under review. Eventually, a notice arrives at your doorstep stating that you are not eligible for benefits despite the obvious advice of your doctor. Thus, you get financial burden on top of your injury or sickness.
What’s worse, you can also get a notice from your employer to go back to work because they are convinced you are already capable of assuming your position. This is due to the result of the review of your temporary disability application. If you don’t, you’ll be risking termination from abandoning your duties. This sounds complicated, but a Toronto disability lawyer can help you out.
When am I eligible for temporary disability benefits?
Read through your employee benefits handbook first and find out the insurance coverage given by your company. If they offer group disability benefit insurance, it would include short term cases. When you get sick or injured and need to get time off, you can get financial compensation to cover the medical costs of your treatment. Some also group this with a loss of income insurance, but it is good to note that the two are different.
You are eligible to apply for a benefit claim if the cause of your injury are within the allowed causes stated in your coverage. For instance, if you got injured from a DUI accident outside office hours and your coverage includes all non-work related accidents no matter the cause, you can apply for a claim.
How can I apply?
Most temporary disability insurance claims can be applied at your company HR office. This is due to the fact that although a separate insurance company provides the coverage, it is actually your employer who accepts the role as insurer. In other words, most group disability insurance companies describe their role as insurance providers on behalf of employers. This saves them from liabilities.
As for the process:
- First, you get an application form from either your company human resource office, your state’s insurance governing body, or the insurance company.
- Next, you fill out the form as needed and then collect the necessary documents.
- After, you complete fields in the form that need information from your employer or doctor.
- Fourth, get a physical condition validation from your physician. A complete medical record with a written recommendation from your physician that you need to get time off from work without question is the best document you can provide as support.
- Lastly, submit the form according to the given instructions.
Some companies let the HR do the processing for you while you wait, since most employees are clueless on how to claim for temporary disability. Whichever applies, be sure to know how your company handles such cases so you know who to follow-up when needed.
How much will I get?
Temporary disability insurance rates greatly depend on the insurance premiums paid by your employer and how much financial assistance you need. It can be some or all of the following:
- Reimbursements of your medical treatment costs and medication
- Therapy and treatment programs fully paid by the insurance for your recovery
- Fixed financial compensation meant to cover your loss of income that is usually around 80-90% of your monthly salary
- A fixed monthly compensation calculated based on your short term disability claim expense estimate.
Till how long can I continue receiving benefits?
Ideally, you should be receiving assistance until you officially go back to work and receive your first paycheck after resuming. However, this is only applicable if you go back to work immediately after the doctor gives a go signal that you are already physically fit.
What if my claim is denied? Do I need an insurance claim lawyer?
It cannot be avoided that some temporary disability claims are denied. As mentioned above, if you have applied and have not heard back from your company or insurance provider, you can approach an insurance advisor to review your application and see why it has not been processed yet. If you get a notice that you are not eligible and you think this is not the case, you can submit an appeal to the court. An insurance claim lawyer can help you.
In such situations, it is good to hire legal advice from experience short term disability lawyers. If this is your first time doing so, they can provide the steps that you need to take and ensure that you execute each one properly. Moreover, they are able to follow-up on the matter closely through their contacts.
It is not good to have additional worries when you are recuperating from injury or sickness. Leave your insurance claim needs to an expert so you can focus on recovering while waiting for the good news. Call us today at (905) 218-3668.