A Step-by-Step Guide to Making a Disability Claim in Canada
Are you suffering from a medical condition or injury that makes it impossible to work? Are you wondering what are the disability benefits for which you may qualify? Not sure what your next steps should be? In the process of making a disability claim?
If this sounds like you, then you are in the right place. In this article, we give you the big picture so you will know, step-by-step, what you should do when applying for any type of disability benefit in Canada.
1. Figure out the Disability Benefits Plans or Programs for which you may qualify
There are several types of disability benefits plans and programs in Canada. You do not have the automatic right to receive all of these benefits. Each has its own criteria for eligibility. Before making a disability claim, your first step is to take stock of the disability benefits for which you may qualify. It is possible you may qualify for more than one disability benefit.
The most common sources of disability income are as follows:
Sick Pay from Employer – Many employers offer to pay sick days as a workplace benefit. Sometimes you are able to bank up weeks or even months worth of sick pay. If you have access to sick pay, then this is the first thing you have to use when you go on disability leave.
Short-term Disability Benefits – Some employers offer short-term disability benefits or salary continuation benefits as a workplace benefit. The benefits are intended to provide disability income to people who need to be off work for 1-3 months. The length of time of these benefits varies from disability plan to disability plan. Not every employer offers these benefits, so you need to check to see if your employer offers them. If you don’t have short-term disability benefits, then you may qualify for Employment Insurance Sickness Benefits.
Employment Insurance (EI) Sickness Benefits – The EI Sickness program provides temporary income replacement benefits to eligible workers for up to 15 weeks. To qualify, your income must be reduced by at least 40%, you must be employed by a qualifying employer, and you must have already earned 600 hours of insurable employment.
Long-term Disability Insurance Benefits – Some Canadians are eligible to apply for long-term disability benefits. These benefits are intended to pay disability replacement income for several years, often to age 65. To be eligible for these benefits you must be covered under a disability plan or insurance policy. This could be a workplace group disability insurance policy provided by your employer or union, or it could be an individual disability insurance policy you bought yourself. You are normally eligible to apply for long-term disability benefits if your disability is caused by an illness or accident. If your disability was caused by a workplace accident, then the long-term disability benefits would overlap with workers compensation benefits.
Canada Pension Plan Disability – Many Canadian workers are eligible to apply for disability payments from the Canada Pension Plan. To qualify you must be under age 65, unable to maintain gainful employment due to disability, and have made recent contributions to the Canada Pension Plan. You have to be continuously disabled and off work for 4 months to before you can become eligible to receive payments.
Disability Tax Credit – The Disability Tax Credit is a non-refundable tax credit that reduces the taxable income of people with disabilities and/or people who are financially supporting a person with a disability. While technically it is not a form of disability income, if you qualify for the disability tax credit you may receive a retroactive tax refund from Revenue Canada. Depending on your income level and taxes paid, this refund can be tens of thousands of dollars paid back to you.
Workers Compensation Benefits – Most workers in Canada are covered by Provincial Workers Compensation Programs. It is law for most businesses to enrol in a workers compensation program, but here are some exceptions. Each province has its own workers compensation program and they go by many names, including the Workers Compensation Board, Worksafe and WSIB. To be eligible for workers compensation benefits you must be working for a employer that is enrolled a the workers compensation program and you must suffer a work-related injury.
Veterans Affairs Canada Disability Benefits – Members of the Canadian Armed Forces can be eligible for disability benefits under the Veterans Affairs Canada Disability Program. To qualify for this disability income, you must suffer from a disability from a medical condition or injury that is related to your service in the armed forces.
Provincial Disability Benefits or Income Support Programs – Each Province in Canada has its own disability income program for eligible residents. These provincial disability income programs are part of the social safety net and are usually the last option if you don’t qualify for any other form of disability income. Provincial disability support programs are based on both disability and financial criteria. In other words, you can only qualify for provincial disability support income if your personal and family income and assets fall below certain levels. Therefore, even though you are unable to work due to disability, you may not qualify for provincial disability support income if a family member has income, or if you have equity in your home, RRSPs, savings, etc.
2. Make sure you have your Doctor’s support
It is critical that you have your doctor’s support before you try to go on sick leave and apply for disability benefits.
To be blunt: making a disability claim without your doctor’s support is a waste of time, and can cause a lot of problems.
Without your doctor’s support, your employer will not recognize your absence from work as being on an approved sick leave. They will take the position that you are on an unauthorized leave and will take steps to terminate your employment.
If your own doctor doesn’t support you, there is zero chance that any disability benefits plan or program will approve your application for disability payments. Many disability plans will deny your application even if you have a supportive doctor.
What do you do if your doctor doesn’t support you?
It may just mean that your doctor needs more convincing. You should discuss your concerns to the doctor and do everything the doctor recommends to improve your symptoms and ability to work. Many doctors will support you once they believe you have done everything possible to try and remain employed.
In rare cases you may have a biased or uninformed doctor. This is very rare, but we have seen it happen. Some doctors have personal beliefs and biases against people who need to apply for disability benefits. Do not assume this is your doctor, just because he or she is reluctant to support you. Give your doctor the benefit of the doubt; however, if you have gone to great lengths to show the doctor you are in fact unable to work, then you may have to switch to a new doctor. This must be an absolute last resort because the simple fact that you changed doctors will be a red flag for the new doctor and also the disability benefits plans. They may think you are trying to manipulate the system.
3. Understand your situation and make a plan for transitioning from employment to being on sick leave
Once you have your doctor’s support, you can start the transition from employment to being on sick leave. It is important that you carefully manage this transition to protect your employment, your workplace pension, and your group medical plan.
It is common for there to be tension between you and your employer in the months (and even years) leading up to you going on a sick leave. Or perhaps you have taken sick leave in the past and need to do so again. Some employers are not friendly or understanding to employees who are ill and disabled. For this reason, it is very important that you get your doctor to write to your employer to confirm that your illness and disability are the reasons for your poor work performance and/or need to take a sick leave from work.
Some employers will pressure you into resigning your employment or to accept a “severance package”. This may seem like a good idea, but when you sign off on that deal there is a good chance you are also signing off on your right to make a claim for long-term disability benefits! This is almost always in the fine print and the money you get form the “severance” will pale in comparison to what you could have got from disability benefits.
Don’t retire from employment. You may be eligible for early retirement, but most disability insurance plans have a clause that says they don’t have to pay you if you “retire”. This is critical mistake you absolutely must avoid.
4. Get the Application Forms
Once you have things in order with your employer, you can start gathering the various application forms for disability income benefits. Each disability plan or program has its own unique forms and procedures you must follow when making a disability claim.
Here is where you get the forms:
Short- and Long-term Disability Benefits – You get the forms from your employer if you are covered under group disability plan through your workplace. If you are self-employed, you get the forms from your insurance broker or directly from the insurance company.
Employment Insurance Sickness Benefits – You get the forms from any Service Canada office or you can apply online through Service Canada.
Canada Pension Plan Disability – You can get the application package from any Service Canada office or you can download the application package online form Service Canada.
Disability Tax Credit – You can get the application forms from any Service Canada office or you can download the application form online from the Canada Revenue Agency.
Veterans Affairs Canada Disability – You can pick up the forms from any Veterans Affairs Canada Office or you can download the application online.
Workers Compensation Benefits – You must request the forms directly from the workers compensation program in your province. Here is a list of all the workers compensation programs with contact information.
Provincial Disability Support Programs – You must contact your provincial government department to get the application package.
5. Fill out the Application Forms and gather other supporting information
Fill out the forms and gather all the supporting information and documents. Most disability programs have 2-3 forms to be filled out when making a disability claim. One of the forms you fill out personally. Usually one of the forms is a medical report form for your doctor to fill out. With some disability plans (e.g., short- and long-term disability, workers compensation) there is also a form your employer needs to fill out.
It is your responsible to make sure the forms are filled out properly. It is very important that you review both your doctor’s report and the employer’s form for accuracy after they fill it out. You doctor may inadvertently forget to mention one of your medical conditions. Your employer may give an inaccurate description of your work duties.
We see many people do a very poor job when making a disability claim. This is how legitimate disability claims get denied. The claim representative making a decision to approve or reject your application do so based on the qualify of the information and documents you have given, and not based on the reality of your situation as you know it. You should read that sentence again. If you have done a poor job putting together your application, it is very likely your claim will be denied, no matter how legitimate your disability.
6. Submit your application and give any further information requested
Once you have the application prepared, you send it in to the disability plan or program. The disability plan or program will assign a person to review your application. This person is called a claim representative or adjudicator. The representative will call or write to you for more information. You should cooperate and give the requested information to the best of your ability.
7. Wait for a decision on your claim
Once you have submitted your application, and fulfilled any further requests for information, you then have to wait for the claims representative to make a decision. He or she will either approve or decline your claim. Normally it takes up to 30 days for the claim representative to render his or her decision. It can take longer in some cases. If you have been waiting months for a decision, then something fishy is going on and you should get to the bottom of it.
Still Feeling Unsure about making a disability claim? Sometimes a quick call can set your mind at ease and help you move forward with confidence. Call us now at 888-732-0470 for a free consultation