Disability Claims and Benefits in Ontario

In Ontario, you do not need a lawyer to apply for disability benefits, or even to appeal if you have been denied benefits (although in complex cases, it is recommended). However, you do need to understand processes and your legal rights.

If you are suffering from an injury or medical condition that has rendered it impossible for you to work, you may need to start by identifying which benefits you qualify for. Here is a step-by-step look at what to do when applying for disability benefits in Ontario.

Determine Which Disability Programs or Plans You Qualify For

There are a number of disability benefits programs and plans in our province, and there is no automatic right to those benefits. Each benefit has a separate list of criteria for eligibility. Before you make a claim, you will need to determine which benefits you qualify for according to your situation. The most common types of income benefits include:

  • Sick pay – some employers provide their employees sick pay days. If you have access to such benefits, it should be the first thing you use when you have any type of health issue.
  • Short-term disability benefits – some employers offer short-term disability benefits as part of their workplace benefits. These are aimed at providing disability income to employees who need to be absent from work for a period of 1-3 months. The length of time can vary depending on the disability plan and not every employer offers such benefits.
  • Canada Pension Plan Disability – Canadian workers are entitled to apply for disability payments from the Canadian Pension Plan. In order to qualify, you have to be younger than 65, have made recent and sufficient contributions to the plan, and the disability must be both “severe” and “prolonged”.
  • Employment insurance sickness benefits – the EI Sickness Benefit program provides temporary income for up to 15 weeks. In order to qualify, your income has to have been reduced by 40%, you should already have a minimum of 600 hours of insurable employment, and met specific criteria for receiving EI sickness benefits.
  • Workers compensation – some staff in Ontario are covered by the Workplace Safety and Insurance Board. Some businesses are legally obligated to enrol in this program. To be eligible, you should be working for an employer who is enrolled, and have suffered a work-related injury.
  • Insurance LTD benefits – some Ontarians may be entitled to long-term disability benefits in the event of long term disability, however you must have an insurance disability plan. Benefits will vary widely depending on the insurance provider, however disability benefits are typically aimed at paying replacement income for a number of years, normally up to the age of 65.

Denied Claim? Appealing your Application

If you have applied for benefits, either through a Federal or Provincial Government program, or through an insurance provider, and your claim was denied for whatever reason, it is important to know that all government and insurance providers have an appeals process where we can present your case, and hopefully resolve your claim at this stage.

If the claim is still denied, this is when we would look at what legal options are available to us given the specifics of your case.  Our team of expert insurance and disability lawyers at Mackesy Smye are more than capable of helping to resolve your claims appeal and ensure you get the benefits you need.

Get started by completing our short, secure contact form and arrange your free consultation today.