What You Should Know About Disability Insurance

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1 What You Should Know About Disability Insurance MS Society of Canada BC Division Revised August 2004

2 TABLE OF CONTENTS ACKNOWLEDGEMENTS INTRODUCTION 1 I KINDS OF DISABILITY INSURANCE 2 A GROUP DISABILITY POLICY 2 B INDIVIDUAL DISABILITY POLICY 3 II FULL-TIME AND PART-TIME WORK 4 III APPLYING FOR DISABILITY BENEFITS 5 IV APPEALING THE DENIAL OF DISABILITY BENEFITS 6 V ADDRESSES 7

3 WHAT YOU SHOULD KNOW ABOUT DISABILITY INSURANCE Multiple Sclerosis Society of Canada, British Columbia Division Kingsway Burnaby, BC V5H 4G7 Telephone (604) Fax (604) Toll Free For copies of this booklet, contact the Multiple Sclerosis Society of Canada, British Columbia Division Office. Created with the assistance of funding from The Law Foundation of British Columbia and The Notary Foundation of British Columbia. ACKNOWLEDGMENTS We wish to thank the Multiple Sclerosis Society of Canada, Alberta Division, for background material on this subject. We also thank the Multiple Sclerosis Society of Canada, British Columbia Division, for use of the document Questions and Answers on Disability Insurance Issues. Adrianne Boothroyd-Sampert (M.A.), Coordinator, VLAP

4 INTRODUCTION This booklet is designed to help you in three ways: To describe different kinds of disability insurance To assist you with applying for disability benefits from your insurance provider To assist you with appealing a denial of disability benefits This booklet is one of a series of five that have been developed as part of our (VLAP) to assist people with MS in resolving problems they may face involving income security. The other four booklets are: Advocacy MS and Human Rights CPP Disability Benefits Community and Legal Resources All of these booklets are available from the Multiple Sclerosis Society of Canada, British Columbia Division. The main objective of VLAP is to make legal information and advocacy support available by telephone, and in person to people living with MS in the Lower Mainland, Victoria, Nanaimo and Kamloops with the goal of expanding into other communities. VLAP offers an organized system to meet the specific advocacy needs of our members and utilizes a resource of volunteers who have legal expertise and/or advocacy experience to deliver the program. 1

5 I KINDS OF DISABILITY INSURANCE A GROUP DISABILITY POLICY The majority of working people who have any kind of disability insurance have group coverage. With this kind of policy, the insurance provider first looks at the size of the entire group that is being underwritten. There are no additional features in group disability insurance policies and no individual assessments. The insurance provider determines the premium rates by looking at the type of work done by the group that is applying for coverage, and charges rates to the employer or employee based on the risks associated with that industry. The type of coverage, such as short term and long term benefits, waiting periods, and benefit periods, are negotiated between the employer and the insurance provider. Some employers provide short and long term disability insurance; others provide only long term disability insurance (LTD). Employers usually re-negotiate group coverage annually. Disability group rates may increase if there have been high numbers of claims during the previous year. In most group long term disability policies, there is usually a clause that covers you for the first two years you can t work in your own occupational classification. This is called own occupation. After the first two years, however, the definition of disability usually changes to mean that you can t work in any occupation. Continuing benefits are then dependent on a number of factors, including whether or not you remain disabled according to the definition of the insurance provider. This definition is often a combination of medical factors, a percentage of pre-disability income, and suitable employment possibilities associated with your education. Some insurance providers offer retraining as part of their benefits package for people receiving long term disability benefits. Some long term disability plans will require that you apply for Canada Pension Plan (CPP) Disability Benefits as soon as you move from short term to long term disability. Most plans deduct CPP from the amount payable by LTD plan. 2

6 B INDIVIDUAL DISABILITY POLICY With this kind of policy, the insurance provider looks at the person who is applying for insurance and focuses on her or his occupational classification and health status. In general, the more education that is required to do your job, the higher the occupational classification and longer benefit period you may expect. The more physical the job you have, the higher the risk of disability, resulting in a lower occupational classification and a shorter benefit period. There are usually more claims made for work of a physically demanding nature and the insurance companies deal with this by providing benefits for a shorter period of time and charging higher premiums. The insurance policy underwriter will also look at all of your medical history before approving your policy. With individual disability policies, you can purchase additional features and benefits at an extra cost to customize your coverage for your particular needs. Examples of these additional features include a cost of living adjustment, partial or proportionate disability coverage, and own occupation, to name only three. Ask your insurance provider for more information about any additional features that you could add to your policy. The best kind of disability insurance policy is one that gives you these additional features, waives the pre-existing condition clause and allows for part-time work without jeopardizing income. 3

7 II FULL- TIME AND PART- TIME WORK For the purpose of income security, it is generally a better idea to work full-time until you cannot work anymore and then apply for disability benefits rather than reducing your work to accommodate your disability and applying for insurance afterwards. This is because your disability benefits are based on the number of hours worked or the amount of income you earned previous to leaving work. Work has many other benefits besides financial ones. These include meeting people s social needs, adding pleasure to one s life because of the opportunity to learn new skills, feeling and being productive and giving a sense of purpose to life. However, it must be your decision to determine how much and for how long you can continue working. Think about how MS is affecting your ability to work and your functioning in daily life. For some people, continuing to work may exacerbate their MS; for others, this may not be so. Some people may have debilitating fatigue as a consequence of forcing themselves to work full-time; others may not. You need to do what is best for you in the long term. 4

8 III APPLYING FOR DISABILITY BENEFITS Make sure you have read and understood your insurance plan. It is important to know whether there is a statement in your policy on preexisting conditions because this may affect your eligibility. There may also be a clause stating that the insurance provider has a right to refuse or that there can be non-compliance with recommended protocols. Further, your plan may state that to be eligible, you must be unable to do any as opposed to some work. Various other conditions like these may be placed on your eligibility. If you have an individual disability policy and you do not know or do not understand the details of your particular policy, contact the agent or broker who sold you the policy for clarification. If you have a group disability policy and you are not sure of your coverage, contact your union representative or the appropriate person in your Human Resources Department. Once you know what your plan states, provide the information and supporting documents that your insurance provider requests. Make sure the documentation you provide is correct, thorough and consistent, and keep copies for yourself. The following are some other details to remember about disability benefits provided by your insurance company: Most policies require that you be under the constant care of a physician Individual disability benefits are not taxable Some group disability benefits are taxable and others are not. If the premium is paid fully by the employee, the benefit is not taxable. If the benefit is partially paid by the employer, the benefit is taxable. Most plans are designed to be non-taxable You should keep a journal detailing your symptoms and activity level while receiving disability benefits You should keep copies of everything concerning your disability. This includes all correspondence from doctors, all results of tests and any other relevant documents. 5

9 IV APPEALING THE DENIAL OF DISABILITY BENEFITS Here is what you should do if you have been denied disability benefits through your insurance provider: If you have not already done so, obtain a copy of your policy so that you are very clear about qualifying conditions and whether or not you are in fact eligible to receive the insurance. Request the reasons for denial in writing. Unfortunately, unless your plan states so, the insurance provider is not required to give them to you. If you do qualify and you have been denied, ask your doctor to write a letter indicating that you do indeed qualify under your policy. The more specialized the physician, the greater the weight her/his opinion will carry. Send the physician s letter along with your own to the insurance company stating that you are disputing its decision. Most insurance companies have a policy for reviewing declined claims. If your disability insurance is provided through a bank, contact the bank s ombudsperson. If the suggestions listed above do not produce a satisfactory result in providing your disability benefits, there are a number of organizations you can contact for information and assistance. Their addresses and phone numbers can be found in Section V of this booklet. They include: The BC Human Rights Tribunal The Community Legal Assistance Society (CLAS) The Lawyer Referral Service The Legal Services Society The BC Coalition of People With Disabilities 6

10 VII ADDRESSES Multiple Sclerosis Society of Canada, BC Division Kingsway Burnaby, BC V5H 4G7 Telephone (604) Fax (604) Toll Free Multiple Sclerosis Society of Canada, National Office 175 Bloor Street East, Suite 700, North Tower Toronto, Ontario M4W 3R8 Telephone (416) Fax (416) Toll Free Multiple Sclerosis Society of Canada, Capital Region Chapter 1004 North Park Street Victoria, BC V8T 1C6 Telephone (250) Fax (250) Multiple Sclerosis Society of Canada, Central Island Chapter PO Box B 1533 Estevan Road Nanaimo, BC V9S 5X1 Telephone (250) Fax (250) Toll Free

11 Multiple Sclerosis Society of Canada, Cowichan Office of the Capital Region Chapter 6355 Woodgrove Place Duncan, BC V9L 5R4 Telephone/Fax (250) Multiple Sclerosis Society of Canada, Kamloops & Area Chapter St. Paul Street Kamloops, BC V2C 5T1 Telephone (250) Fax (250) Toll Free Multiple Sclerosis Society of Canada, Kelowna Chapter 1959 Kirschner Road Kelowna, BC V1X 4N7 Telephone (250) Fax (250) Multiple Sclerosis Society of Canada, West Kootenay Chapter 517 Nelson Avenue Nelson, BC V1L 2N2 Telephone (250) Fax (250) Toll Free Multiple Sclerosis Society of Canada, North Vancouver Island Chapter Box 656 Campbell River, BC V9W 6J3 Telephone/Fax (250) Toll Free

12 Multiple Sclerosis Society of Canada, Prince George Chapter Quebec Street Prince George, BC V2L 5N5 Telephone (250) Fax (250) Multiple Sclerosis Society of Canada, South Okanagan Similkameen Chapter 3373 Skaha Lake Road Penticton, BC V2A 3G6 Telephone (250) Fax (250) Toll Free Community Organizations Addresses: BC Coalition of People with Disabilities- Advocacy Access Program West Broadway Vancouver, BC V5Y 1R3 Telephone (604) Fax (604) Toll Free TTY (604) BC Human Rights Tribunal Robson Street Vancouver, BC V6B 5J3 Telephone (604) Fax (604) TTY (604) Toll Free (outside Lower Mainland) 9

13 Canadian Human Rights Commission-BC & Yukon Western Region 109 West Pender Street Vancouver, BC V6E 2N6 Telephone (604) Fax (604) Toll Free TTY Community Legal Assistance Society (CLAS)-Disability Law Program West Georgia Street Vancouver, BC V6E 3J7 Telephone (604) Fax (604) Toll Free Law Line Telephone (604) Toll Free (outside Lower Mainland) Dial-A-Law (phone & web service. Mandarin is available by phone only) Telephone (604) Toll Free

14 Lawyer Referral Service Telephone (604) Toll Free Legal Services Society Suite West Pender Street Vancouver, BC V6E 4G1 Telephone (604) Toll free (outside Lower Mainland) Fax (604)

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