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The Short-Term Disability Claims Process

How to File a Short-Term Disability Claim in Alberta, Canada

Filing a short-term disability claim in Alberta, Canada, can be challenging, especially when managing the immediate impact of a disability on your life. This guide offers a straightforward, step-by-step outline of the typical process to assist you in navigating your claim. However, it's crucial to recognize that every situation is different, and more complex cases may benefit from legal guidance to provide tailored advice and assistance. For uncomplicated claims, the following steps will help you comprehend and handle the process of obtaining the necessary benefits.

Step by Step Guide to the Application Process for Short Term Disability benefits in Alberta, Canada

Step 1: Understand Provincial and Federal Disability Benefits Available to you

• Familiarize yourself with Alberta’s disability benefits system, including the Alberta Assured Income for the Severely Handicapped (AISH) program and other provincial assistance programs that may provide support for individuals with disabilities. Also familiarize yourself with the Canada Pension Plan Disability benefits program.  Both programs provide eligible disabled Albertans with monthly income replacement benefits and are available to those who are approved and also those who are denied private disability insurance benefits. Some disability insurers require their insureds to apply for these benefits and so in order to minimize any potential lag in receipt of income replacement benefits it is reasonable to apply as soon as possible if you meet the eligibility requirements for either or both programs. 

Step 2:  Review Your Policy and Alberta Regulations 

• Carefully review your short-term disability insurance policy to understand your coverage, eligibility criteria, and any specific requirements for filing a claim. Additionally, familiarize yourself with Alberta’s regulations governing long-term disability claims.  If you have any questions as to whether you meet the stringent requirements, feel free to call Weir Bowen LLP for a free telephone consultation.  Our experienced team of disability advocates would be glad to assist you.

Step 3: Notify your Employer and Insurance Provider 

• Notify your employer of your intent to file a short-term disability claim and request any necessary forms or information. This requires you to contact your insurance provider to initiate the claims process and obtain guidance on how to proceed.  It is important to provide this notification as soon as possible to ensure you are meeting the policy's notice requirements.  These notice requirements can be as short as 30 to 60 days from disability onset and missing the deadline will typically result in a denial of your claim.  If you have been denied a claim for this reason, it is still recommended that you contact an experienced disability counsel to confirm whether the notice requirement was applied appropriately or whether you have a valid excuse making you eligible for the equitable remedy of relief from forfeiture.

Step 4: Gather Medical Documentation 

• Gather all of the relevant medical documentation that you can to support your disability claim.  At a minimum, your insurance provider will require your treating physician to fill out a form that explains your condition and reasons for work absence.  It is recommended that you also ask your physician to draft a detailed letter that more fulsomely describes your symptoms and how they affect your ability to continue in your occupation, at least temporarily.  It is insufficient for your treating physician to provide you with a simple “excuse [name] from work for [days]” letter.  It would be unfair to the insurer to allow these simple letters to be the baseline for coverage.   If you have multiple medical treatment providers who concur that you should be off of work, then ask for fulsome written letters from each of them.

Step 5: Complete the Claim Forms 

• Complete the short-term disability claim forms provided by your insurance company, ensuring accuracy and thoroughness in documenting your medical condition and employment history. Follow any specific instructions provided by your insurance provider for completing and submitting the forms.  It is critically important to fill these forms out with utmost good faith.

Step 6: Submit Your Claim to Your Insurance Provider 

• Submit your completed claim forms and supporting documentation to your insurance provider according to the instructions provided. Retain copies of all documents for your records and consider sending the documents via certified mail or another trackable method to ensure that they are received.

Step 7: Await Decision and Follow Up 

• Await a decision from your insurance provider regarding your short-term disability claim. Follow up with your insurance provider regularly to ask about your claim's status and provide any additional information or documentation requested.  It is understandable that this is a stressful time and perhaps the application process has overwhelmed you.  If this is the case, have someone contact the insurer to explain your current situation instead of letting it sit.  It is important for the insurer to be kept apprised.

Step 8: Seek Legal Advice if Necessary

• If your short-term disability claim is denied or if you encounter challenges during the claims process, consider seeking legal advice from a lawyer who is knowledgeable about disability law. A lawyer can help you understand your rights, navigate the appeals process, and advocate for your interests.  At Weir Bowen LLP, we have a team of lawyers with extensive experience with these claims and who are willing to provide free telephone consultations.  Always err on the side of consultation. 

Step 9: Appeal a Denied Claim 

• If your short-term disability claim is denied, you have the right to appeal the decision internally with your insurer.  However, we recommend that you seek a consultation with a lawyer experienced in disability law before you make the decision to file the internal appeal.  This is because a disability advocate can either provide you with invaluable information on the internal appeal process or the lawyer could potentially recommend that you skip the internal appeal all together and recommend that you proceed directly with a disability lawsuit.  If you decide to file an internal appeal, follow the instructions provided by your insurance provider for appealing a denied claim and consider enlisting a lawyer to strengthen your appeal. 

If your short-term disability claim is denied or you encounter difficulties during the claims process, consider seeking assistance from a knowledgeable professional well-versed in disability law. They can provide guidance, advocacy, and representation to help you navigate the appeals process and pursue the benefits you deserve. At Weir Bowen, our team of experienced professionals is dedicated to assisting individuals with short-term disability claims.

Our team at Weir Bowen LLP is knowledgeable in Disability Law and is here to assist you when you are in need. Contact us for personalized guidance and support throughout the claims process.