Important Lon-Term Disability Terms and Definitions

Whether you are applying for Long-Term Disability (LTD) or Canadian Pension Plan-Disability (CPP-D) benefits, there is an overwhelming amount of technical jargon used by both private insurance companies and the government. Whether you are handling your application yourself or with the help of a lawyer, these keywords will be critical to understand.

For the complete glossary of key terms, you can order the free book “The Must-Read Guide to Winning Disability Insurance Benefits” written by Jeff Mitchell; a disability and personal injury lawyer. Along with a complete glossary, this book offers a step-by-step strategy to apply and win your disability benefits.

Long Term Disability Glossary

Attending Physician Statement: One of three standard forms. It is your responsibility to ensure that a physician completes this form, whether you have a family doctor or not.

Change of Definition Date: The date when the test for total disability switches from the “own occupation test” to the “any occupation test”, is usually at the 24-month mark. Be sure to check if your plan has one and be aware of the specified date.

Cost of Living Adjustment (COLA): An adjustment made to Disability Benefits (and other types of benefits) that corrects for inflation.

Cut-off Date: This refers to the date your benefits were terminated.

Employer’s Form: The second of three standard forms that must be completed in a disability benefits application. This form must be completed by your employer or supervisor. Like the Attending Physician Statement, it is your responsibility to ensure the information is carefully reported.

Enrollment Probation Period: A period of time listed by the plan or policy that must have passed before a worker is eligible to apply for disability benefits under the policy or plan. This aims to prevent employees from coming to a workplace only to make a disability claim.

Future Benefit: Time period in which an employee who is totally disabled is eligible for benefits. This period generally runs from the date benefits were awarded until the Maximum Benefit Date.

Internal Appeals Process: Unlike a lawsuit, internal appeals are assessed by the insurance company. Because this is the same organization that initially denied or terminated your benefits, results often do not change. However, there are ways to strengthen your claim in an internal appeals process.

For more information on LTD internal appeals click here.

For more info on CPP-D internal appeals click here.

Notice of Action: A court document that contains the Statement of Claim and notifies the defendant(s) that you have commenced a lawsuit in order to resolve the disputes that are outlined in your Statement of Claim.

Notice of Claim Form: The third of three standard forms that must be completed in a disability benefits application. Use this form to explain with great care the specific details of your disability.

Notice of Defence: Once you have filed your Notice of Action, the defendant(s) will respond by submitting a Notice of Defence. It includes the grounds the defendant(s) will use to defend themselves against your lawsuit.

Net Benefit Amount: The total amount your benefit payment will be after tax (and other) deductions will be made.

Maximum Benefit Date: This term refers to the date that you will continue to receive benefits until (e.g. 65). Usually, the Maximum Benefit Date occurs when the claimant reaches a certain date.

Offsets: Generally non-negotiable reductions to monthly disability payments. The theory behind them is that they prevent a disabled person from “double dipping” into multiple sources of benefits or income. Offsets will be specified in your policy or plan.

  • For more information on benefit payment offset amounts click here.

Own Occupation Test: Before the Change of Definition date, the test for LTD benefits is the own occupation test. This test assesses your ability to complete substantial duties of your own occupation.

  • For more information on the own occupation test and period click here.

Present Value of the Future Benefit: Refers to the current value of future monthly disability payments less total value of monthly payments until the Maximum Benefit Date.

Statement of Claim: By filing a Statement of Claim you begin a formal lawsuit against your employer or insurance company for your benefits. The Statement of Claim must be included in your Notice of Action and must clearly outline all of the arguments you plan on raising against the defendant should the matter proceed to trial. Warning! before initiating a lawsuit, make sure your policy or plan gives claimants the right to sue as some do not. If this is the case, you will be unable to sue for your benefits.

Statement of Defence: Once a Statement of Claim has been filed along with your Notice of Action, the person you have commenced the action against, usually your employer or the insurance company (the defendant) will respond to your lawsuit by submitting a Statement of Defence in their Notice of Defence. Their Statement of Defence will delineate how the defendant(s) intend to “fight” your lawsuit.

Statutory Limitation Periods: Stipulate a specific time period, within which all legal actions must be commenced. After the limitation period has passed, filed actions may be rejected by the court.

Termination Letter: Those who have been issued termination letters were initially approved for benefits but later deemed not totally disabled. Usually, this occurs at or around the 2-year mark from the date of disability.

Total Disability Test: Synonymous with “totally disabled test”, this test essentially asks: “is the applicant completely unable to work”. Make sure to confirm whether this will be assessed against the “own occupation” or “any occupation” test.

Long Term Disability Lawyer

NOVA Injury Law offers free consultation for all types of disability claims. There is no risk or obligation to proceed with your claim following the consultation. You will leave the consultation knowing how to assess the strength of your long term disability claim, whether a local lawyer with expertise in long-term disability matters can add value to your claim, and whether Jeff Mitchell is the right lawyer for your case.

Jeff Mitchell is Principal Lawyer and Founder of NOVA Injury Law. Jeff is experienced lawyer representing disabled clients win short term disability, long term disability, and Canada Pension Plan disability benefits.

Contact 1.800.262.8104 or to arrange for a free case review today.