If You’re Sick, Don’t Quit! You May Have Entitlements to Disability Benefits Through Your Employer
August 6, 2020 By: Denise Workun Read Time: 3 minutes
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It is common for employees suffering from physical and mental health issues to experience challenges at work.

Performance and productivity may suffer, relations with co-workers and managers may become strained, and there may be increased absenteeism to attend medical appointments.   Coping with fatigue, pain, anxiety, and other symptoms while juggling the demands of a heavy workload can be overwhelming.  Many injured or ill employees develop the perception, well-founded or not, that their employer is unfairly targeting them for discipline, investigation, or termination, adding to their stress and resulting in a further decline in health.

In such circumstances, medically vulnerable employees sometimes reach a point where they feel “enough is enough!” and are seriously tempted to just quit their job so they can focus on a recovery of their health.  However, before making such a life-changing and often financially devastating decision, it is important to first determine whether there are short-term and/or long-term disability benefits (STD/LTD) available as a term of employment.

If an employee voluntarily quits, disability benefits will likely be lost.  Moreover, obtaining replacement disability insurance coverage through a new employer’s group benefit plan or through an individual insurance policy will typically not be possible at least for a period of time due to the “pre-existing condition” exemption clauses that are a feature of most group and individual disability insurance policies.

If an employee voluntarily quits, disability benefits will likely be lost.

An employee’s legal position is not compromised by legitimately accessing available disability benefits.  To the contrary, an employee’s legal position will often be enhanced by taking a justified medical leave of absence from work, because doing so will trigger legal protections under human rights legislation and may highlight for the employer that a perceived performance issue is actually a medical issue.

Applying for disability benefits through an employer’s group plan usually involves the timely completion of forms by the employee and the employee’s family physician or treating specialist.  The employer must also file paperwork with the insurance company confirming, among other details, the employee’s rate of pay and last day worked.  Employees should also ask the employer for a copy of the insurance policy since the terms governing an employee’s entitlements to disability and other benefits are determined in accordance with the wording of the policy.

The key to successfully securing STD/LTD benefits is to proactively gather supporting medical evidence from physicians and other health care providers to demonstrate that the employee is “totally disabled by illness or injury from performing the essential duties of the employee’s own occupation”.  In gathering this medical evidence, it is important to inform health care providers that “total disability” must be established with reference to the occupation of the employee.  Applicants for disability benefits must therefore describe in detail to their medical professionals the duties and responsibilities of their occupation, the symptoms they are experiencing, and how these symptoms prevent performance of their essential job functions.

Insurers will request that diagnoses be specified, and a prognosis for recovery and return to work date be provided.  However, physicians should be cautioned against definitively committing to a recovery and return to work date.  It is perfectly acceptable, and in fact is the preferred approach if warranted by the facts, to present a guarded or unknown prognosis, once again supported by whatever complexity of detail is required to accurately describe the employee’s medical state and functional limitations at present and going forward into the future.

After the employee has been in receipt of long-term disability benefits under a group plan for a period of time, typically two years, the definition of “total disability” changes to an assessment of the employee’s medical capacity to work in “any occupation” for which the employee has the education, training and experience.  The definition sometimes includes a minimum income threshold, such as “any occupation for which the employee would earn 66.67% of the employee’s pre-disability earnings”.  It is more difficult to establish an entitlement to disability benefits under the “any occupation” definition of total disability.   However, once again, solid and comprehensive medical evidence can pave the way towards a successful claim.

Under most policies disability benefits are payable to age 65 provided the employee continues to medically qualify, so the financial implications of quitting work rather than accessing disability benefits can be significant.

Should you find yourself in a situation where your health is suffering with resulting consequences at work, it is important to proactively seek legal and medical advice rather than quitting your job.

This content is not intended to provide legal advice or opinion as neither can be given without reference to specific events and situations. © 2020 Nelligan O’Brien Payne LLP.

Service: Employment Law

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