Disability insurance can be divided into two categories: policies covering disabilities that arise from both injury and illness, and policies that only cover disabilities which arise from injuries or accidents.
To claim long-term disability benefits, you must have coverage through an insurance company and have paid premiums for the period in which you became disabled. This is true regardless of the type of insurance policy you have.
If you want to have more coverage, you will usually have to pay higher premiums. Because disability policies that cover both injury and illness provide a larger range of coverage, those premiums are typically higher than those for accident-only policies.
Having a less expensive accident-only policy can, however, be limiting. For example, if you became disabled or unable to work due to cancer, your accident-only policy would likely not cover you.
Here’s what to know about accident-only disability policies and what to do if you need coverage for an injury or illness.
READ MORE: 4 reasons why long-term disability claims are rejected, and how to fight back
How does insurance define an accident, illness or injury?
Accident-only policies usually include clauses of the following nature:
- Accident means an unexpected and sudden event due exclusively to an external force of a violent nature beyond the insured person’s control.
- Illness means a disease or sickness.
- Injury means accidental physical harm or damage sustained by the insured person while the policy is in effect.
Get daily National news
Accident-only policies also usually stipulate that they only cover disabilities resulting from an injury, not those due to illness. In other words, they specify that no disability benefits are payable for disabilities resulting directly or indirectly from illnesses, diseases or sickness.
READ MORE: How to successfully fight a long-term disability claim denial for long COVID
What should I do if I have an accident-only policy?
If you have disability insurance and you find yourself incapable of working due to an illness or injury, check whether you have an accident only-policy or not. If you are not sure what type you have, you can ask your insurer or the broker who sold you the policy.
If you do have an accident-only policy, it is important to characterize your injury as an accident when filing your claim and talking with the insurance company — to the extent that it’s true your disability arose from an accident. Typically, you only have one opportunity to convey to your insurer how your disability materialized. If you mischaracterize it, this can be the difference between your long-term disability claim being approved or not.
For instance, if you were moving and threw out your back while trying to lift a fridge, it would be better to clarify that you were injured while lifting the appliance as opposed to stating that you were suffering from chronic back pain. Before filing your claim, you should consider your policy’s definitions and determine whether your situation accords with an accident or injury as defined by your policy.
READ MORE: Long-term disability claim denied? This is why you need a disability lawyer
Benefits reinstated for someone hurt in an accident
In a case that I was able to resolve quite recently, my client fell out of bed, and his back began hurting progressively over a three-week period.
The insurance company tried to argue that since his back worsened over that three-week period, his disability was not due to an accident.
We successfully argued that his falling out of the bed was the accident, or an unexpected and sudden event giving rise to his disability, and his monthly benefit payments were reinstated.
Since coverage largely depends on the definitions of accident and injury in your policy, it’s often a good idea to speak to a disability lawyer, like my team at at Samfiru Tumarkin LLP, for a free consultation before submitting your disability claim.
Do you need help understanding your disability policy? Has your long-term disability claim been denied?
Contact the firm or call 1-855-821-5900 to get a free consultation from a long-term disability lawyer in Ontario, Alberta or British Columbia. Get the advice you need — and the compensation you deserve — from the most positively reviewed disability and employment law firm in the country.
Albert Klein is a disability lawyer and partner at Samfiru Tumarkin LLP, Canada’s most positively reviewed law firm specializing in employment law and long-term disability claims. The firm provides free advice on Canada’s only Disability Law Show on TV and radio.