What qualifies for long-term disability in Canada?

Look at what qualifies for long-term disability in Canada and other considerations when applying for disability benefits
What qualifies for long-term disability in Canada?

While disability plans may cover a lot of benefits, these are coupled with certain conditions and requirements. This article will discuss what qualifies for long-term disability in Canada and the options available for persons who need such benefits.

What are long-term disability benefits in Canada?

Long-term disability benefits are insurance plans that will substitute a part of your salary when you’re unable to work after becoming disabled. Your disability may be a result of an injury, an accident, or a sickness. It may be work-related or not.

These insurance plans may be offered by a private insurance company or by the federal or provincial government.

Private long-term disability benefits

Your employer may arrange for long-term disability benefits with private insurance companies. You, your employer, or both you and your employer must then pay for these insurance premiums, depending on what you agreed on.

Federal long-term disability benefits

Federal pension plans also offer long-term disability benefits. However, these may affect any disability benefits that you may receive from any private insurance policy and from provincial long-term disability programs.

Some of these federal government’s programs are:

  • Canada Pension Plan (CPP): establishes a federal pension fund and provides disability benefits for private sector employees and self-employed individuals
  • Government Employees Compensation Act (GECA): establishes the Federal Workers' Compensation Service for federal government employees

Provincial long-term disability benefits

Canadian provinces have also established their own workers’ compensation programs, disability programs, and pension plans. These may offer long-term disability benefits or some kind of support for disabled persons – whether short-term or long-term, work-related or not.

Some examples are:

Learn more about long-term disability laws in Alberta, their eligibilities, and how to claim such benefits.

What qualifies for long-term disability in Canada?

It is important to understand what qualifies for long-term disability in Canada before you apply for an insurance policy or apply under a government long-term disability program. Each insurance policy or long-term disability program differs from the other.

In general, there are common medical conditions that qualify for long-term disability in Canada:

  • Workplace-related injuries, illnesses, or diseases: dermatitis, asthma, impairment (hearing, eyesight, mobility)
  • Circulatory disorders/diseases: heart problems/diseases, hypertension, heart attacks
  • Nervous system disorders/diseases: epilepsy, Alzheimer's disease, Huntington's disease
  • Musculoskeletal disorders: arthritis, carpal-tunnel syndrome, rheumatism, scoliosis
  • Mental health disorders: anxiety, depression, bipolar disorder
  • Other diseases such as cancer

This list is not exhaustive. Certain medical conditions qualify for long-term disability under the insurance policy or the program you are claiming under.

There are other ways to determine what qualifies for long-term disability in Canada:

As stated in your insurance policy/contract

When you get an insurance policy from a private insurance company, your policy or contract will state what qualifies for long-term disability benefits.

When you’ve applied for an insurance policy with the help of your employer, you can also ask them directly. A copy of the insurance policy or contract may be held by your employer.

Find out what to do if you don’t your long-term disability payments in this article.

As defined in the law

When claiming for disability benefits under the CPP, the GECA, or any other provincial disability plan, you must check under its enabling law or regulations what qualifies for long-term disability.

For instance, what qualifies for long-term disability under the CPP would be:

  • mental or physical disabilities that prevent you from doing any substantially work, and
  • disabilities that are long-term and of indefinite duration, or
  • disabilities that will likely result in death

As for Ontario’s ODSP, what qualifies for long-term disability is defined under the Ontario Disability Support Program Act.

Under the Act, you will be considered as a person with disability if:

  • you have a substantial mental or physical impairment that is continuous or recurrent
  • your impairment is expected to last a year or more
  • your impairment results in a substantial restriction in your ability to work, care for yourself, or take part in community life
  • your impairment’s duration and restrictions have been verified by an approved health care professional

As such, when claiming for long-term disability benefits from any of these plans or programs, you will have to check on the specifics as stated in the law.

If you need help with looking up these laws and regulations, consult a lawyer in your area. If you live in Toronto, for example, contact a long-term disability lawyer in Ontario.

For an idea on lawyers’ fees, read our article on how much a long-term disability lawyer costs in Canada.

Who qualifies for long-term disability benefits in Canada?

There are several ways to qualify for long-term disability benefits in Canada. This will usually depend on your insurance policy and the insurance provider.

Be a “covered person”

First, you must have been enrolled in an insurance policy or a long-term disability program before you became ill or disabled. While there are some policies or programs that may offer retroactive application, this is rare. You might incur additional expenses if you enroll later.

You must also ensure that your insurance premiums are paid accurately. For example, if your employer agrees to remit these premiums to your insurance provider, you must check that this is being done.

Be a “disabled person”

Next, you must be able to establish that you are entitled to long-term disability benefits because you are now a disabled person. This applies to short-term or long-term disability.

You must show proof that your disability will prevent you from working within the minimum period stated in your insurance policy or in the long-term disability program.

For example, you must establish that you are unable to work for two years to be eligible for long-term disability benefits during this period.

After two years, if you’re still unable to work, you must establish your claim to receive long-term disability benefits until you turn 65 years old.

How much are long-term disability benefits in Canada?

Long-term disability benefits in Canada will replace around 60%-70% of your average income. Some may even be as much as 85%. However, this will depend on your long-term disability plan or insurance policy. Long-term disability benefits may be based on a certain percentage of your gross income or your net income.

Tax deductions may also affect your long-term disability benefits. Few private long-term disability plans may or may not be taxable. The same goes for government-managed disability plans.

How long does it take to get long-term disability benefits in Canada?

Once you’ve met what qualifies for long-term disability in Canada, your insurance or long-term disability provider may impose a “waiting period” before you can receive your benefits. It takes around 3 to 6 months before you can be eligible for long-term disability benefits.

There are some ways to tide yourself over during the waiting period:

  • receive short-term disability benefits through a group insurance plan or the federal government’s employment insurance (EI) sickness program
  • apply for paid time off with your company or employer by using your sick leave, vacation leave, or any other paid time off benefits

Have questions on what qualifies for long-term disability in Canada? Consult with a Lexpert best-ranked long-term disability lawyer.