Can You Work While You Are On Long Term Disability?
What is Long Term Disability (“LTD”)?
Long term disability is a benefit that is usually available through a group insurance policy (ie: through your employer) or may be purchased individually (you pay a monthly premium in exchange for disability coverage). It is intended to be “peace of mind” insurance that would act as a monthly income replacement benefit should you ever become unable to work due to physical and/or mental illness.
The benefits aim to partially replace a person’s income if they are suffering from a disabling condition.
Who qualifies?
Long-term disability plans usually will cover a person until the age of 65.
If you have long term disability benefits and you are unable to work due to a medical condition, you may qualify for LTD benefits. An application requires three forms:
- Plan Member Statement: a form filled by you indicating what precludes you from working,
- Plan Sponsor Statement: a form filled out by your employer outlining details of your employment, and an
- Attending Physician Statement: a form filled out by your doctor providing details of the medical condition(s) that prevent you from working.
Upon submitting these three forms, the insurance company will make a determination on your entitlement to benefits. They can either approve, deny or pend your claim (if further information is required).
How do you qualify?
The insurance company will review the totality of the information submitted in making a decision on your claim.
In most LTD policies, the insurance company will determine whether your condition meets the definition of disability as outlined in the policy. During the first two years, the insurer will evaluate whether your overall medical condition prevents you from completing the essential duties of your own occupation.
There are several medical conditions that may qualify you for LTD benefits (not an exhaustive list):
- Chronic pain, fibromyalgia, neurological issues, accident injuries, respiratory issues, long covid, cancer, sensory impairment (vision, hearing), migraines, autoimmune disorders, and mental health issues including anxiety and depression.
Can you work while on Long Term Disability?
Generally, a person who is claiming LTD is unable to work due to their medical condition(s). There may be instances where an employee may attempt a return to work on a graduated plan or on modified duties.
Each policy will have a recurrence period. This means if you are unable to successfully return to work at the same pace and hours you were working previously for a certain period of time (usually six months) will be considered a recurrence and will fall under your original LTD claim.
If you return to work and can complete your duties (past the recurrence period), your claim will be closed as you have successfully returned to work.
If you obtain another job, it all depends on what the job is, how much money you are earning and your capabilities in performing the job (whether you can sustain the job).
Recurrences and other employment can be tricky, it’s best to consult a lawyer in getting an accurate response to your particular situation.
What happens if you attempt either a gradual return to work (“GRTW”) or a modified return to work during your LTD claim?
Your insurance company may push you to attempt a gradual (or graduated) return to work plan or try to arrange modified duties with your employer. It is important to follow the advice provided by your medical providers. Sometimes, a gradual return to work can be successful, but often the insurance company will push an employee back to work when they are not ready. The GRTW may ultimately exacerbate your condition if it is too soon or too aggressive. The same can be applied to modified duties.
If the GRTW fails, you will revert back to the same claim you were on before (so long as it is within the recurrence period).
In terms of pay, the insurer may continue to pay your LTD benefit during the GRTW period or may offset your GRTW earnings from the LTD benefit. This depends on the amount of hours worked and the GRTW plan demands overall.
Why should you speak to a disability insurance lawyer?
It can be difficult to navigate all the moving parts between an insurance company and your employer while attending medical appointments and undergoing treatment. Your insurer may think you are ready to return to work and this is usually against the advice of your doctors.
If you feel unfair pressure being applied by your insurance company, please contact us. We can tip the scales and are here to help! We offer a free consultation for short and long term disability claims. Contact us online or call 416 640 2667.
Author – Aman Chaggar