Most people applying for Canadian Pension Plan Disability or Long Term Disability benefits deal with an overwhelming amount of technical terms used by the government and the private insurance companies. Whether you intend to handle the application on your own or with the help of a long-term disability lawyer, it’s essential to understand some key terms.
Long Term Disability Glossary
Here are essential terms commonly used in long-term disability processes:
Attending physician statement: This is one of three critical standard forms. It’s your duty to make sure that a certified physician has completed this form, whether you already have a family physician or not.
Cost of living adjustment: This is an adjustment made to long term disability benefits and other forms of benefits you’re entitled to. Cost of living adjustments corrects the impact of inflation.
Change of definition date: This is the specific date when the ‘test for total disability’ shifts from ‘own occupation test’ to ‘any occupation test.’ It’s usually the 24-month mark. Make sure your insurance plan has this 24-month mark and take note of the specified date.
Cut-off date: This is the date when your long-term disability benefits were terminated.
Enrollment probation period: The time frame listed by the insurance policy or plan that must have passed before you are eligible to apply for disability benefits. This prevents employees from showing up at a workplace only to file a disability claim.
Employers form: This is the second of the three standard forms that should be completed for any disability benefits application. It should be done by your supervisor or employer. Just like the attending physician statement form, it is your duty to ensure the information provided in this form is accurately reported.
Internal appeals process: Contrary to lawsuits, internal appeals processes are assessed by the insurer. Because this is the same company that may have initially terminated or denied your disability benefits, the results might not change. But there are still ways to strengthen your claim, particularly in an internal appeal process. You should consult a lawyer to learn more about it.
Feature benefit: This is the period in which a worker who is totally disabled is eligible for disability benefits. The time frame generally starts from the day disability benefits were awarded until the maximum disability benefits date.
Notice of action: This is a court document that highlights the statement of claim. It is intended to notify the accused or defendant that you (the plaintiff) have commenced a lawsuit to resolve the ongoing disputes outlined in the statement of claim section.
Notice of claim form: This is the third of the three critical standard forms you must complete in your disability benefits application. This form allows you to provide in-depth information about your disability and its causes.
Notice of defense: After filing a notice of action, the accused will respond by issuing a notice of defense. This document includes the grounds the accused intends to use to defend themselves against the claim you have filed.
Net benefit amount: This is the total amount of your benefits paid after tax deductions and other relevant deductions.
Maximum benefit date: Suppose you were awarded disability benefits; you are supposed to continue receiving your disability benefits until you reach the maximum benefits date. It could be any date.
Offsets: These are non-negotiable reductions to monthly disability benefits payments. The rationale behind these reductions is that they prevent the disabled individual from ‘double-dipping’ in many sources of income or benefits. Offsets are usually specified in the insurance plan or policy.
Own occupation test: Prior to the change of definition date, the specific test for long term disability benefits is known as the ‘own occupation test.’ It is a test that carefully assesses the plaintiff’s ability to handle substantial duties in their line of duty.
The present value of the future benefits: This is the current value of future monthly disability benefit payments less the total value of monthly payments until the beneficiary has reached the maximum benefit date specified.
Statement of claim: Filing a statement of a claim means you have initiated a formal lawsuit against the insurance company or employer for your disability benefits. It must be included in the Notice of Action and should clearly outline the specific arguments you intend to raise against the accused if the matter proceeds to a court trial. Before you initiate a lawsuit, it’s important to ensure that your insurance policy gives you the right to sue. This is because some policies don’t allow the claimant to sue.
Statement of defense: After you have filed a statement of the claim along with the Notice of Action, the entity you have commenced the legal action against (insurance company or your employer) will respond to the lawsuit by filing a statement of defense along with the notice of defense. Generally, the statement of defense delineates how the accused plans to fight the lawsuit filed against them.
Statutory limitation period: This is a specific time frame within which legal actions should be commenced. Once the limitation time frame has passed, the court may reject the filed legal actions. (Consult with your lawyer early enough to ensure that your lawsuit is filed on time).
Termination letter: Long-term disability claimants who have been issued with a termination letter were initially approved for disability benefits but later deemed not eligible for total disability benefits. This usually happens around the two-year mark from the date the claimant suffered disabling injuries.
Total disability test: This test is also known as a ‘totally disabled test’ and seeks to answer the question, “is the disability applicant unable to work?” It’s important to find out whether this test will be assessed against the ‘any occupation test’ or ‘own occupation test.’
At Wagners Law Firm we provide free initial consultation for nearly all short-term and long-term disability claims. After the initial consultation, you will have an in-depth understanding of different aspects of your claim and how to assess the strengths and weaknesses of your long-term disability claim.