Does a visual disorder qualify as a disability in Canada?
Since vision is crucial for an individual to be able to live unimpaired, it certainly counts as a disability. There is more than just total blindness, and the world isn’t easily navigated by an individual who struggles with their vision. In Canada, anyone who is blind or partially sighted to some degree would qualify as disabled.
Even though visual disorders count as a disability in Canada, winning a claim for long term benefits can still be challenging – but not impossible. Understanding the scope of your condition, the types of insurance benefits you qualify for, and how these claims work will be essential in receiving the benefits you deserve.
Employment and disability rights for visual disorders
Canadians and those working in Canada are protected under the Human Rights Act. Employees have the right to a discrimination-free workplace, and employers must accommodate anyone working there who lives with a disability. Those registered as blind or partially sighted are considered disabled under the Equality Act.
If you suffer from a visual disorder, you have rights, and your workplace should work with you to provide all the tools you need to complete your daily tasks. If you need time off for a reason regarding your visual disorder, then leave of absence is not an unreasonable request. Most employers won’t object to this if a doctor’s note is provided. The letter should state the need for time off and the amount of time required. A doctor's note may need to be resubmitted every three to six months for more extended periods.
If you are terminated due to your disability, you have the right to severance pay, and in some cases may be able to have your termination reversed.
Types of disability rights for visual disorders
Not all disability insurance plans are the same. Here are the typical benefits included in Canadian disability insurance plans:
Paid Sick Leave
Some workers will have a bank of sick time to use in the first days of disability. The intent of this benefit is to allow the worker to have a few days to get back to work. Some workers may have many weeks or even months of accrued time to use.
If you do not believe that you will be able to return to work before your paid sick leave is exhausted, be sure to complete an application for disability insurance benefits right away. You do not need to wait until you have used all your paid sick leave before submitting your application. Also, it is always easier to work on a disability application while you are being paid so don’t wait until your benefits have run out.
Another major reason not to wait to apply for STD Benefits is because of deadlines that may apply. You may miss the deadline to apply for benefits because you are being paid sick leave benefits.
Employment Insurance Sickness Benefits
Your alternative to paid sick leave is government provided employment insurance (EI) benefits. Most workers have fewer than 15 weeks of paid sick leave so EI benefits will make up the difference between the expiry of paid sick leave and a STD Benefit. EI Benefits must be applied for through the government. In order to apply, you must obtain a medical report from your doctor and a Record of Employment (ROE) from your employer.
Go to www.servicecanada.gc.ca for information on the EI sickness benefit and to download the application forms. Service Canada will not process your application until both the medical form and the ROE has been submitted, so be sure to book a doctor’s appointment and request your ROE right away.
Short-Term Disability Benefits
The first of two main benefits in most disability benefit plans are STD Benefits. The purpose of STD Benefits is to provide you with income while you are unable to work due to illness or disability. The Benefit is designed to cover short absences and not intended to be a long-term solution.
STD Benefits provide a weekly or bi-weekly payment for a number of months. The short pay periods are designed to provide you with uninterrupted income while you are absent from the workplace. Most often, you will be required to use accrued paid sick time before accessing your STD Benefits. While cashing in sick time may be frustrating for some, it is wise to accept this condition because the sick time should provide you with more income than the STD Benefit.
The STD payment typically provides for a percentage of your regular weekly earnings or a specific amount of money. The benefit payment calculation details are specific to the policy and set out in the insurance policy document.
Payment examples include:
• The worker will be paid 60% of his or her pre- disability weekly earnings, or
• The worker will be paid $500 per week, or
• The worker will be paid their pre-disability weekly earning, up to a maximum of $500 per week.
Most STD Benefits last between three and six months. If the group plan does not have a LTD Benefit, the worker will have no further benefits under the group policy.
Long-Term Disability Benefits
LTD Benefits are the second major element of most group disability plans. There are some plans, however, that only include LTD Benefits. If your plan has both STD and LTD Benefits, a disabled worker will ‘roll over’ to the LTD Benefit at the expiry of the STD period if they are eligible to do so.
Eligibility for LTD Benefits is not always a given. Workers often earn their eligibility to the Benefits through working continuously for the employer for a number of months.
Eligible workers will be able to make a claim for LTD Benefits if they have been out of work continuously for a specific period of time. This period of time is typically the length of the STD Benefit. This period of time set out in the policy wording is referred to as a “waiting period” or “elimination period”. LTD Benefits will not be paid prior to the elimination period; however, benefits will be paid for the total period of continuous disability if the claim is approved.
Benefit payments under a LTD Benefit are assessed based on a percentage of your pre-disability income. Typically, the benefit will be between 55% and 75% of your regular earnings, or a set amount of money per month. Other polices will have a net formula.
Payment examples include:
• The worker will be paid 66.7% of their monthly pre-disability earnings, or
• The worker will be paid $3,000 per month, or
• The worker will be paid 66.7% of his or her monthly pre-disability earning up to a maximum of $3,000 per month.
The exact payment formula will be set out in the policy document. Be sure to refer to your policy to confirm what the applicable payment formula is for your claim.
The LTD Benefit will make payments on a monthly basis for a set number of years (e.g. 5, 10, 20), or until you reach a certain age (e.g. 60, 65, 67). Some plans may have a benefit termination formula where a mixture of the years a claimant received benefits and the claimant’s age is used to calculate an end date. Generally speaking, the latest date where a claimant will be eligible for Benefit payments is called the Maximum Benefit date.
How to win disability benefits for a visual disorder
The first step in winning disability benefits for your visual disorder is getting an official diagnosis, which can involve various medical tests to identify the nature of your visual condition. You will need to work with your family doctor but will likely require input from a qualified eye care professional like an optometrist or ophthalmologist.
Testing will need to be done on your visual acuity and fields to succeed in your claim. A Snellen or eye chart and the random E test are standard for determining visual acuity. In Canada, a 20/200 is what would be classified by the WHO as ‘severe’ for visual impairment. This testing will strengthen your claim, but it’ll also help you find the best ways to treat your condition.
Keeping a record of how your visual impairment affects your ability to complete tasks at work will strengthen your claim. Insurance companies won’t know what you don’t tell them – and they won’t ask. Having a detailed explanation of the challenges you face at work can help prove the legitimacy of your claim and win you the benefits you deserve.
How to hurt your long term disability claim for a visual disorder
- Having a medical file that lacks specialist visits or vision tests
- Being uncooperative with those involved in your claim
- Omitting or being vague on the details of your condition and how it affects your ability to work
- Having statements that contradict what’s in your file
How to improve your long term disability claim for a visual disorder
- Presenting a medical file full of information and completed tests
- Being honest about your visual disorder
- Being credible and having proof to back up your claim
- Cooperate with those involved in your claim
Common reasons for denial of visual disorder claims
Even though visual disorders are undoubtedly disabling, insurance providers often seek to minimize or downplay your claim. They want to prove that your condition doesn’t render you unable to work and will usually find any hole in your claim. They will use missing information or medical testing as a reason to deny the claim.
The most common reasons for denial of visual disorder claims are insufficient medical evidence, or they don’t believe you’ve done everything in your power to stay employed. They want to see the long term disability benefits being used only as a last resort and will deny them if they feel there is more you can do.
You can appeal the denial, but the process is lengthy. Hiring a lawyer with experience in long term disability claims can streamline the process, and they can help you present a more robust file. Having an experienced lawyer to help you fill in those gaps within your claim can tip the scales in your favor to enjoy the long-term benefits you are entitled to and deserve.
What if your claim is denied?
Know that you are part of a large group of Canadians who have had their benefits denied by the insurer at some point during the course of a claim. Those who have been issued a denial letter are those who had their application rejected by the insurer. They were deemed eligible to apply for benefits, but not totally disabled and therefore were not approved for benefits. Those who have been issued a termination letter are those who were approved for benefits but were then found not totally disabled. The insurance company generally chooses to terminate benefits at or before the two-year mark from the date of disability.
For those who have been denied, some will be legit mate because the applicant is not in fact disabled. Other applicants are truly disabled but were simply denied by the adjuster because their application was not strong enough to warrant approval. Of course, the insurer would prefer that denied applicants forgo the appeal process and not sue for benefits.
For those who were approved and then cut off sometime afterwards, the insurer is attempting to ensure that the denial is accepted by the insured during the “own occupation” period. This is ideal for the insurer as it may prevent appeals or legal claims. Thus, it allows the adjuster to close the file well before the Change of Definition date occurs.
You cannot change the fact that the insurance company denied your claim. However, you do have complete control over what you do in response to the denial or termination of benefits.
The options available to the applicant will depend on what is permitted by their policy or plan. In most cases, the applicant can advance their claim to an internal appeal mechanism or commence a lawsuit. If a plan is through a non-profit disability benefit trust fund, it is likely that only an internal appeal mechanism will be available to them. For these workers, they have been denied the right to have a neutral court decide whether or not they are entitled to benefits.
WHAT IS THE DIFFERENCE BETWEEN A DENIAL LETTER AND A TERMINATION LETTER?
It is a bad day for any disabled worker when they receive a denial letter or termination letter. The letter is essentially a rejection of financial support in a time of need and it leaves most people very worried about their financial future. After receiving a letter, some disabled people experience severe declines in their mental or physical health because it feels like their expected safety net has been ripped out from beneath their feet.
What the disabled person does after receiving a denial letter or termination letter is critical. First, be sure that you keep a copy of the letter. Photocopy and safely store a copy of the letter before making any marks on the letter. Any competent disability lawyer will want to see a clean copy of the letter to review at an initial meeting.
The denial letter is also important as it offers a window into the insurance company’s decision-making process on your file. The letter should (but does not always) spell out what information was reviewed and what findings were made with respect to the information in your file. The insurer should explain why your application was denied, or why you are no longer entitled to benefits. For new claims, the denial will typically mention that while your injuries cause you to suffer some restriction, you do not meet the test for total disability. For cases where a benefit termination letter is sent, the insurer will often mention that activities (often from surveillance evidence or information from phone calls) are inconsistent with reported restrictions and limitations. The explanation provided in other circumstances will parrot select wording from the medical expert chosen by the disability insurer. Once you have sorted out why you were denied, you can then determine what you can do to attempt to overturn the unfavourable decision.
Warning! There is a lot of misinformation about insurance policies and the rights that come with them. Do not rely on the word of a union representative, co-worker, or supervisor to explain your rights and ideal strategy when facing an insurance benefits claim. This is especially so where there is no right to sue. While they may have the best intentions, they may not have the best advice. Contact an experienced disability lawyer to avoid a major claims mistake.
