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Disability benefits in Canada

Chaussette and the Pussy Cats — Mon, 01 Oct 2012 21:08:20 -0800

In Canada, what kind of (government) disability benefits can a separated, self employed person qualify for and how? The individual in question has been separated from an abusive partner for a couple of years. She is the parent of two young children, both who have health issues. She also has long-term health issues that are sometimes debilitating. In spite of all this, she has soldiered on with her business. However, this year, her earnings have dropped to below $10,000 -- they have plummeted and that's before she even takes out expenses, let alone stuff like childcare. She keeps thinking that her health will turn around, but it seems to be one thing after another.

She receives both child support and spousal support from her former partner. From what she can tell, she couldn't get provincial disability benefits, because her child support and spousal support would be too high.

The spousal support was calculated based on her earnings a few years ago. She knows she needs to go back to a lawyer and also discuss spousal support with her ex. However, she has asked what her options are for disability from the government.

She's not currently opted into EI through her business, but wonders if it would make sense to do so for this year (although her income is incredibly low and there's probably a one-yer waiting period anyway).

Also, she wonders if she would have to give up her business to get disability. This is frustrating, as she sometimes is very healthy for days, weeks or months. Sometimes, she can still do a small amount of work. And she's hopeful that she can turn things around. Normally, she earns far more than $10k a year and suspects that there is no sort of government disability that would be worth giving up her business for. A friend suggested she could incorporate and keep the earnings in the business and collect disability that way.

To be clear, she is not trying to scam the system. She is just someone dealing with long-term health issues and a lack of benefits (she has had one of her major illnesses since teen years and can't get typical disability through self coverage). She knows she can't get welfare, since she has assets. She just doesn't want to find out that there were options she didn't know about. It would be emotionally devastating to walk away from a business that, in many ways, is very successful, given all the health issues she has worked through.

Thanks for your time. I'll be posting in the thread for her.

Who can help me with disability insurance claims?

[insert clever name here] — Mon, 09 Apr 2012 12:48:57 -0800

I’m looking for advice on dealing with with employer provided disability insurance. I’m out of work due to illness, and I am having trouble navigating the disability insurance provided by my employer. Do I hire a lawyer? Are there other people that I can hire to help on my behalf? I’m in Wisconsin, if that helps. I tried googling this question, and I am finding both advocates and lawyers, and advocates that are lawyers but not which I should choose or how to choose one. I know WOM recommendations are the best, but I don’t know anyone that’s gone through this so I have no one to turn to for recommendations.

I went on medical leave this past fall. My work provided disability insurance, but navigating it has been a challenge, because my doctors are still investigating the cause so have no information on when I’ll “be better”. I was told that it takes 7-10 days to process a claim, but with follow up medical records, it took three months to receive roughly 6 weeks disability pay, which did not actually cover all the time I was out of work at that time.

Much back and forth and misinformation from the insurance company as to what I needed to provide them, they reopened my claim 2 months after my last payout. Their review of it is still pending.

Part of the problem is that the doctors are still investigating the cause of my illness, and because they don’t know what is wrong, they can’t say when I’ll be well enough to go back to work. After talking to the person at the disability insurance company working on my case, she said that without a return to work date, the best they can do is pay retroactively for the time out of work, after reviewing doctor records. BUT if I send the records too soon after they got the previous records, it extends the time for review, i.e. extending the time until I see any payment.

Add to the fact that last time my doctors office sent over records it took 8 days from the time they sent digital records from the local office to the copying service to mail them out, then another 15 days for the disability insurance company to receive them via postal mail.

This is all the quick version, there is much I left out, but what I desperately need to know is how to navigate the system or who could help me. Is there some profession out there to help me speed things up and smooth out the bumps while knowing when they’re getting the runaround? On top of everything else, I’m just too tired most days to harass whomever needs harassing to get this done.

If I need a lawyer, how do I find one? Should I get a recommendation from a generalist, or find a lawyer that specialises in disability? Or is there another profession that helps in cases like these?

(And if you have a specific reference for someone you would recommend, please include!)

Help with disability insurance post lay-off

truth1ness — Sun, 17 Apr 2011 11:40:01 -0800

Help! Got an injury before getting laid off, but doctor underdiagnosed me until after the lay-off. Can I still make a disability insurance claim with the company or is it too late? I need some help regarding an injury/disability I got before I got laid off. The crux of the problem is that I was injured (ankle) before getting laid off, but the doctor I went to under-diagnosed the injury and said I was fine to walk and go to work and just had to wear a brace. An HR person asked me about it and I basically told them what the doctor said and that I didn't need to go on disability insurance. Then they downsized and I was laid off. Well a few months later the injury kept getting worse and now I'm on my second back to back surgery to repair it a year later.

My question is, since the injury happened while I was employed, am I able to go back to the company and ask for disability benefits even though the wrong diagnosis was made during the job and the full diagnosis was made only after the lay off? Is it possible to make a claim now or is it too late?

I know I should have acted sooner but I didn't realize the full extent of the injury until later (and I didn't expect to need 2-3 surgeries). If I can show I was seeking help for the injury before getting laid off will that qualify me for retroactive disability benefits?

Fortunately I had COBRA to cover the surgeries, but I have not had any income this whole time and am running low on savings for living expenses. I can't get state unemployment benefits because I am pretty confined to my house and can't go to interviews or the unemployment office easily until this is over. I've heard there are social security disability benefits but I believe they are only for very long term chronic conditions. Please help!

Need advice about private disability insurance

Anonymous — Sun, 12 Sep 2010 16:24:09 -0800

I'm a Canadian who recently moved to the United States, and my financial advisor is strongly recommending that I get disability insurance. I've done all the prep work and been offered a policy. Now I need to decide whether to take it. Please advise me! The basics: I'm in my mid-forties; I make 200K a year; I am unmarried with no kids; my net worth is fairly low, and I am healthy, law-abiding and lead a low-risk lifestyle, with no pre-existing medical conditions. The policy I've been offered would cost me $4200/year and would pay out 60K/year tax-free until I turn 65 or become no longer disabled. Payments would kick in after one year: for the first year of disability I'd be dependent on my own savings. The company is RiverSource.

My advisor tells me I need the policy, because I'm completely dependent on my own salary. He says the policy is bulletproof: it's non-cancellable to age 65, it only requires examination by my doctor not theirs, and it offers five-year Own Occupation benefits.

I was raised in a country with a terrific social safety net, and only moved to the U.S. a few years ago, so I don't feel like I'm a great judge of what I need to do here to protect myself from catastrophe. I sort-of trust my financial advisor, but I also assume he's got a bunch of biases and attitudes I might not share. So here are my questions:

It seems to me that my financial advisor is correct and I'm exactly the kind of person who should get private disability insurance -- is that true?

This policy feels breathtakingly expensive to me, but is it actually reasonable?

Are there any red flags or things I should check into?

Does RiverSource have any particular reputation for this stuff?

One more thing. I've heard horror stories about people being denied benefits based on technicalities – mostly related to pre-existing conditions or misstated medical histories. And, I found that the experience of having my medical history gathered for this policy felt kind of sloppy (a couple of phone interviews and one in-person blood-taking), and seems sloppily documented in the policy itself. Which worries me. So, a few more questions:

1) Let's say I have a heart attack and become disabled. And let's say the medical history section of my policy contains information that is completely inaccurate, but also completely irrelevant to the disability – such as, it wrongly states that I have not received a moving violation in the past five years, whereas in fact I did. Could that be a problem?

2) Let's say I develop lung cancer and become disabled. And let's say the medical history section of my policy contains information that is slightly but probably not provably inaccurate, and is relevant to the disability. Such as, it states I smoked five cigarettes a day until 1995, whereas in fact let's say I sometimes smoked 10 cigarettes a day. Could that be a problem?

3) To get the policy, I needed to give blood. If it's possible that information from my blood test contradicted information in the medical history, what's the likelihood of that coming back to haunt me? Would the insurance company have an analysis of the blood that is kept on file and not shared with me? How long would they keep the blood itself?

4) Let's say I answered no to the question about whether I'd ever used marijuana. And let's say I had used it, frequently, a long time ago. Could that ever come back to haunt me, and if so, how?

Sorry for the super-specific questions. But the medical history section of the policy contains a number of errors/misstatements, all of them seeming to me to be either very minor or unlikely to ever be relevant, and I am trying to figure out the pros and cons of trying to get them corrected. (I am assuming getting them corrected would be really annoying, would take forever, and might result in the insurance company changing the terms of the policy or even cancelling it.)

Thanks for reading this very long post. I've read this question and this one --- they were both helpful: I am just looking for some more specifics. Please feel free to also point me towards any good general resources like this, from the Motley Fool.

Many many thanks to anyone who wades through all this and replies.

How to keep health insurnace for a struggling college student

Anonymous — Sat, 26 Sep 2009 08:55:47 -0800

We struggling to keep our over-18 child covered under our health insurance. She has a four year history of mental health struggles. She has been able to more or less stay in school as a full-time student but we aren't sure she can keep it up. The two strategies seemed to be to get the school to give her full-time status with a partial load due to disability or to convince the insurance company that she is not capable of "self-sustaining employment" Anyone have any experience with either route? Four years ago, our child got hit with major depression. There were two hospitalizations, intensive counseling and medication. Things are better than they were and she choose to go off to college with a sheaf of prescriptions, a new therapist lined up and an IEP to help reduce stress and accomodate ups and downs.

She struggled through fall semester with the minimum full-time load at a four year college. With several incompletes, she finally ended up with a D average. At the recommendation of the school she took off spring semester but took a full-time load in the summer. She did better (a C average). She has also had non-stop physical complaints (some physical, some psychosomatic). She decided to return home and go to community college. Three months of FT school in the summer plus four months in the fall should maintain her status as a FT student for the year. (per my reading of IRS regulations). However, school started on Monday and she is falling apart. At this point, I don't think she can handle a full-time load - I'm hoping for half-time.

So our insurance covers children after 18 if they are either full-time students or if the company determines that they are disabled based on (a) are a dependent for federal taxes purposes and (b)"incapable of self-sustaining employment" (This child's last job was as a summer camp CIT before her problems began.)

I've heard some people work with the school so that the IEP includes a condition that a lighter load counts as "full time" and that the insurance companies will accept that. Does it work? I'm afraid to ask anything to insurance company for fear they will cut her off.

With my older child, the insurance company just asked if she was a student but never required verification. However, since this child has huge medical bills, I don't want to take any chances.

How likely is an insurance company to accept her as transitioning from full-time student to disabled when the disability began four years ago? Since this is based on a mental illness and she has been sort of holding it together, has anyone had experience with this scenario?

By the way, our insurance is a fairly good plan administered by United Healthcare. The local school does not offer any student health insurance and given her claim history (doctor visits almost every week or more, not counting psych care), no company would write her an individual policy unless they had to do so.

You can contact me directly at need_advice1@yahoo.com

How to manage my debt and life as a whole

thegreatcokeolympics — Sat, 19 Sep 2009 12:34:41 -0800

How do I get my life on track with high debt and a chronic medical condition? So i'm 26 years old and have been completely on my own since i was 18. I come from a working class family who lives in a small dying town with no jobs. I knew if I was going to make something of my life in any way, I had to get out of there. Being so young and inexperienced, it's not like I could get a well paying job to support myself. And it's not like my family had any money to give me.
So 5 years ago, I took out many many loans and used that money to move myself across the country to " the big (and expensive) city" to attend college and hopefully start a new life there.

I also used the student loan money to pay for everything I would need to live on (mainly rent because the dorms were more expensive than studio apts, food, and school supplies) and even then it still wasn't enough, so I also worked full time in addition to going to school full time, just to make ends meet.

On top of this, to make matters more complicated, I also have a chronic medical condition. I have had it mildly since I was 10, but never had it addressed, or even diagnosed as to what it was, since my family lacked health insurance.

It was still fairly mild even when I moved here, but through the years got much more serious and I am now in constant daily pain and have some serious breathing issues. I tried to get health insurance on my own, but no plan would cover me due to the pre-existing condition. So I had no choice but to pay out of pocket for all medical expenses. Of course I had no out of pocket money to spare, so I used credit cards to pay all my medical bills.

And I never had enough credit to pay for anything medical that would truly diagnose me, so I resorted to many expensive pain management treatments only to be left with my condition progressively getting worse.

Now flash to present day, 5 years later, and I am $60,000 in debt from school, $10,000 from credit card debt. The job market is scarce and no one is hiring on staff. I've been taking very low pay freelance gigs which don't even amount to half of my expenses.

Currently, my bare minimum expenses amount to $1150 per month.

One of them being a health plan I pay 400 a month for after puting myself on a long waiting list for a government health plan that teams with private insurers to give coverage to high risk people. With this plan I was also able to finally get the tests I needed to diagnose me, only to discover (upon confirmation of 6 different doctor opinions to be sure) that I need a surgery that will cost a minimum of $30,000 depending on where I get it done, while knowing full well my insurance plan will most likely not cover because it is not a common surgery, though results are typically favorable.

I also pay 400 a month to see a physical therapist who I have been seeing for a year and a half and is the only source of pain relief I have found to help me (Insurance only covers 25% of 12 sessions a year, which I have already maxed out) Then pay 300 a month for my credit cards and 50 for my cell phone. And every 3 months, pay 150 forbearance fee for my student loans. That is it.

I had to leave my apartment and move in with a friend who is letting me stay there rent free until I figure something out. They are also fortunate enough to make a decent living and have been loaning me money to help pay my bills, eat their food, and use their computer. If anything, they've almost become my surrogate parent and it makes me feel like shit for puting them in that position, but I simply don't know what else to do.

I would get a second job anywhere I could find, but not only have those jobs even been hard to come by, but my health simply won't allow it at this point. I am extremely distressed, depressed, and hopeless. The biggest issues of all is the health and everything else seems to stem from it to make all the other problems worse. I don't know how much more bare minimum I can get in terms of cutting my budget when I'm already miserable and in so much pain.

I have considered going on disability, but I don't know if I would count since I still have been able to work, so long as the work isn't strenuous and I don't have to be on my feet all day.

I've considered welfare and bankruptcy but I'm not too sure how they work or if I would have to give up making enough money to pay for everything I need just to qualify. Or if bankruptcy will just ruin my credit enough to never be able to rent again.

I want to be responsible and make the best choice that will benefit me in the long run, but I don't know what that is or where to go. I really need some advice or clarity on this, so anything anyone has to say, please I'd love to hear it. Thank you.

Give me my money back, give me my money back-you bitch.

hollygoheavy — Tue, 16 Jun 2009 08:00:22 -0800

How do I appeal a long term disability claim that's been denied? I worked as a retail manager until this past February when I had a major hernia repaired. Because of the location, the type of repair that was done and complications I had with the surgical wound, my doctor has put me on "light duty" until the end of August. I have long term disability insurance, but they refused to pay anything after April 30th. In my particular job, I am required to work alone at times for up to 4 hours, I process shipments which come in boxes up to 75 pounds, I regularly move full tables of products and carry bags of products that weigh up to 30 pounds. In addition, I climb ladders which requires balance that I don't have anymore (per my surgeon) because the muscles that were repaired are my core abdominals which are responsible for balance.

The LTD company states that the reason they are denying further payment is because according to my "occupation" I don't require lifting. They further state that whether my "job" requires it or not isn't relevant, they go by occupation when making their decision. I told the case manager I wanted to appeal the decision, because I am unable to go to work until my surgeon releases me (he won't) and because I can't perform my job requirements I would be fired for incompetence (a technicality, but they have to have someone that can do the full job and I can't).

I had to request the appeal paperwork twice and received the 2nd set yesterday. Basically it was just a letter detailing their reasons for the denial and if I wanted to appeal, to call their 800 number. Obviously, that's been done several times over. I've left a message for the case manager to ask her exactly HOW to appeal this, but she hasn't returned my calls yet. I'm lost as to my next step since I really feel that this is just standard for them to deny as a matter of routine. (This is after they took nearly 7 weeks to determine it wasn't a pre-existing condition.)

Help me understand disability insurance please.

thebestsophist — Sun, 22 Mar 2009 20:44:27 -0800

How does disability insurance work for a freelancer? I am looking to start doing freelance work and am looking into health insurance and the like. Disability insurance normally pays a percentage of your normal monthly salary...but freelancers don't exactly have a a monthly salary...so how does it work? Is it even required? I see posters that say disability insurance is required by federal law for companies with one or more employees, does that include people that are self-employed?

Paying for cancer

Anonymous — Mon, 16 Mar 2009 12:25:47 -0800

I may have breast cancer. I do not have health insurance. What now? I am in my late thirties and the sole support of two teenagers. We live in California, and our closest family is in Florida. I am a long-term contractor at my current job, but no longer think they are going to hire me on, and so I have started looking for permanent work elsewhere. I don't have health insurance, and open enrollment has passed on my agency's health plan.

A hereditary breast/ovarian cancer risk factor, a BRCA1 deletion mutation, runs in my family. According to the literature, women with this particular mutation have an 80% chance of developing breast or ovarian cancer. My sister, my mother, my mother's sister, my grandmother's sister, and my grandmother's sister's daughter have have had breast or ovarian cancer. My mother, my mother's sister, and my grandmother's sister died from it. My sister was diagnosed stage 1/2 borderline, and had chemo and a bilateral mastectomy less than a year ago.

Well, yesterday I felt a lump in my breast. It was about the size of my fingertip to the first knuckle.

It could be nothing, but it could be cancer. If it were cancer, the treatment would probably be very aggressive -- meaning I may not be able to work.

If I got a diagnosis before securing insurance -- would that be a 'pre-existing condition' the company would not like to pay for?
And how do I get health insurance? Is 'Emergency Medi-Cal' or medicare an option?
If I had to go out on disability, I could not pay my rent. What if I moved to Florida to live with my dad -- how would that affect my state insurance and/or disability benefits? Would I apply here, then go there? Go there, then apply?

I don't mean to be hysterical. I know that it could very well be nothing at all. But it does seem like the timing of the diagnosis wrt insurance could be important, so I need to be smart about this. Hope for the best and plan for the worst, as they say.

Thanks for any advice you can give me.

Any reason not to accept a disability policy with exclusions I don't like?

Anonymous — Wed, 21 May 2008 13:44:18 -0800

Will accepting a disability insurance policy with pre-existing condition exclusions negatively impact my ability to get a policy without them later or have other negative effects? I've been offered a disability policy, but it contains an exclusion for all mental health conditions because I underwent therapy for anxiety following 9/11 (I lived a few blocks away). They've said there's no way to remove the exclusion. If I take the policy, am I putting a blot on my permanent record (or is there already one)? In the short term, I don't see this exclusion in itself as being a problem, but I'm worried about the secondary effects of accepting a policy with such exclusions.

I can of course shop around for another policy, but in the meantime, I'd like to be covered, and would cancel later if I found better coverage. Will there be negative ramifications to accepting this policy in the meantime? If you require more info, send email to askanoninsurance@yahoo.com.

Cobra termination

TigerCrane — Fri, 18 Apr 2008 09:41:22 -0800

I missed a Cobra Payment and they terminated me. How can I appeal their decision? I screwed up, got confused and missed a COBRA payment. They have terminated me as of Feb 29. They tell me that I can write an appeal letter. This will take fourteen days. Can anybody give me some advise as to what to say int the appeal letter?

If it makes a difference, I have bipolar disorder, and have recieved disability. I believe I am still officially disabled.

If I cannot get COBRA back, do I have any other options? My pre-existing condition (bipolar disorder) makes it impossible to buy regular insurance. Now that I have been cancelled due to non-payment, I no longer qualify for HIPAA. What are my options?

unravel disability insurance

__ — Fri, 20 Jul 2007 11:41:52 -0800

Tell me about disability insurance. I am self employed, 31 and would like to protect my income in the event of a disability. What are some pitfalls in the language of contracts that I need to look out for? Is disability insurance as important or more important than health insurance?

Can my wife collect disability and keep her current health insurance coverage?

Anonymous — Mon, 09 Jul 2007 21:55:56 -0800

My wife has been too sick to work for the past five years because she has Cushing's Disease. Her parents own a small business, and my wife has been "working" for them to get health insurance coverage. We'd like for my wife to collect disability, but I don't know if it would be possible to keep her current insurance coverage and collect disability at the same time. Help? My wife had coverage as a dependent until she turned 21, at which point she couldn't remain on her parent's policy. At that time, they put her on the payroll so she could have her own policy. She doesn't collect pay from her parents, just the health benefits. They pay for her insurance from their own money.

We realized that my wife could be collecting disability, but I don't know how that will affect her insurance. My wife does meet the criteria for collecting disability benefits, but I'm worried about the insurance coverage. Would we be able to pay for her current insurance out of pocket if she stopped "working" for her parents? Would she have to go on some sort of state insurance plan? Does it cost more to buy insurance individually? We live in NJ. I'm not sure as to the legality of our current situation, so I'd prefer to remain anonymous. You can e-mail disabilityinsurancequestion@gmail.com if you'd like. Thanks in advance!

Boring Insurance Question

libraryhead — Thu, 08 Mar 2007 01:42:52 -0800

I think I need disability insurance. I've just been offered a job that I want to take, only, because it's part-time (a job share, actually), it comes with no benefits. I'm covered on my husbands's medical plan, but I need to buy private disability insurance for the maternity leave (I'm not pregnant yet, but plan to be within a year or two).

I'm in Massachusetts, female, age 36, healthy -- any idea of what I can expect to pay? I'm still negotiating salary and want to take this extra expense into account.

I've no idea how much coverage I need, nor which types. Specific recommendations for good companies also would be very welcome.

Objective information sites about heart disease?

mischief — Mon, 23 Feb 2004 16:57:23 -0800

OK, guys, the smartass has been humbled. Last weekend I experienced what should have been a mildly stressful event for the average person. However, I have fairly advanced heart disease, and the anxiety put me in the emergency room with chest pains and arrhythmia despite my normal meds and my emergency tranquilizers.

The time has come for me to seriously consider disability, as totally distasteful as I find that. Does anyone know of some objective information sites, particularly regarding how to document my condition, beyond the basic primers that Google coughs up? ( Yes, I am pursuing this through my doctor, but I want a 'second opinion'. ;-P )