In Canada as in the rest of the world, economic activities are starting anew as the sanitary measures surrounding the Covid-19 pandemic are progressively softened.
As you may already know, access to physical and mental care has been greatly restricted over the last two (2) years. In fact, more than 353 00 medical procedures (including surgeries) had to be postponed throughout all ten (10) provinces (source), paramedical firms were put out of business, and services revolving around psychological support were interrupted. To make matters worse, multiple instances of traumatic stress were observed in certain spheres of activities due to work overloads and a decrease in global income.
In such a context, several experts foretold that temporary disability benefits would have to be paid for extended periods of time, and that accident insurance policies would be issued in record-breaking amounts.
In the following paragraphs, we explain the difference the CNESST draws between « temporary » and « permanent » disability, as well as how disability insurance works in the province of Québec.
Inability to work
Inability to work refers to any situation on account of which an individual in unable to perform their duties – either because of physical or psychological constraints. Such a situation may have been caused by a work-related accident or an occupational (or non-occupational) disease.
In most cases, « inability » refers to a total or partial disability which is temporary rather than severe or permanent.
Section 95 of the Act respecting the Québec Pension Plan defines the word « disability » as follows : “A person shall be considered to be disabled only if Retraite Québec declares him to be suffering from a severe and prolonged mental or physical disability. A disability is severe only if by reason thereof the person is incapable regularly of pursuing any substantially gainful occupation.” (source)
In regards to individuals older than 60, disability will be acknowledged only when it prevents one from performing their paying duties on a regular basis.
In case of a work-related accident
Québec Pension Plan
Created in 1966, the Québec Pension Plan aims at providing workers with an adequate retirement pension. Nowadays, the Pension Plan also pays benefits to workers suffering from severe and permanent disability – provided that they have not yet reached the age of 65.
Admissibility
In order to be compensated by the Québec Pension Plan, disability must be severe, permanent, and without any foreseeable prospect of improvement.
Any individual who has been declared disabled by an insurance company or another ministry or government agency will be automatically considered inadmissible.
Disability pension – Requirements
The individual who is recognized as « disabled » by Retraite Québec and meets the following requirements will be declared admissible to a pension :
- They have not yet reached the age of 65;
- They are suffering from severe and permanent disability (which Retraite Québec’s medical staff has acknowledged);
- They have sufficiently contributed to the Québec Pension Plan while they were working;
- They are not entitled to a full (i.e. unabated) compensation for loss of income by the CNESST
Disability pension – Additionnal amount
A fixed amount will be paid to individuals who have benefited from the retirement pension for more than eighteen (18) months and can no longer cancel it in order to receive a disability pension.
Difference between « temporary » and « permanent » disability
According to the CNESST, temporary disability corresponds to the period of time during which a worker is unable to perform their duties on account of a work-related accident. Such disability remains temporary regardless of how long it lasts, since it is recommended that the worker resume their regular activities as soon as possible.
Permanent disability consists in the definite inability of a worker to carry out any paying activity according to a medical report issued by the CNESST. In such a case, the latter will compensate the worker until they reach the age of 68.
Compensation will only be ordered if:
- The injury caused by the workplace accident is so serious that the worker is unable to perform any job – no matter how simple;
- The victim’s overall condition is chronic and prevents them from following a regular schedule.
Permanent disability is seldom declared in regards to individuals younger than 55. In fact, the CNESST manages those claims in a specific way by recommending that the employer reassign the victim (who suffered from a work-related accident, an occupational disease, or a relapse) to a less demanding position.
How to challenge a ruling made by the CNESST
Comment fonctionne l’assurance invalidité ?
Disability insurance brings financial relief to workers who sustained work-related injuries or an occupational disease – as well as to their families.
Whether you are temporarily unable to work or permanently disabled, you should be entitled to benefits ranging from 60% to 85% of your regular salary and wages until a maximum amount (or a fixed deadline) is reached.
- Remember : The word « permanent » refers to the nature and extent of your disability. It does not mean that you will receive benefits for the rest of your life.
Here are the steps you must go through in order to receive benefits from an insurance company:
- Filing of a claim
- Approval of the claim
- Waiting period running from the onset of the disability to the moment at which the payment of benefits begins (from one (1) month to one (1) year);
- Payment of monthly benefits until the compensation period expires or the individual returns to work.
Categories of disability insurance
Short-term disability insurance
This type of insurance covers the injured worker for a fixed amount of time that cannot exceed six (6) months. Compensation will remain lower than 70% of the worker’s usual income, whereas the waiting period is shorter than in the case of a long-term disability insurance.
As short-term disability insurance is usually provided (and paid for) by the employer, contact the Human Resources department about admissibility requirements (number of hours worked, available sick leaves, etc.)
Comment faire une réclamation?
Long-term disability insurance
This type of insurance kicks in when the following benefits end :
- Short-term disability insurance
- Vacation leave credits (paid by the employer)
- Employment insurance
Benefits are paid for a longer period of time and may even continue until the worker turns 65.
Group disability insurance
This type of insurance is made available to all the employees of a given company, or to all the members of a professional association. Generally speaking, contribution to a group disability insurance plan is mandatory and the guarantees offered are set in advance.
Personal disability insurance
This type of insurance is purchased by a single person (a freelance worker, for instance), who is allowed to select the guarantees and coverage options that best suit their needs.
H3: Is it really tax-free?
You might be required to pay income tax on the benefits disbursed by your insurance company:
- If your employer pays all (or any portion of) your disability insurance premiums, you might have to pay income tax;
- If you pay all your disability insurance premiums yourself, the benefits you receive will be tax-free.
In doubt, request further information from your employer or insurance company.
Public disability pension plan
The federal and provincial governments of Canada created and implemented several protection plans aimed at compensating workers who fall prey to accidents or illnesses. Such public insurance programs cover, among other things, the care provided by hospitals, professional fees paid to healthcare professionals, and the cost of medication. A few examples are provided below.
Disability pension plans provided by the government of Québec:
- Public health insurance (Régie de l’assurance maladie du Québec – RAMQ);
- Compensation of work-related accidents (Commission des normes, de l’équité, de la santé et de la sécurité du travail du Québec – CNESST)
- Québec Pension Plan (Retraite Québec – RRQ)
Disability/illness protection plans offered by the government of Canada:
Is your insurance company denying you coverage?
Whatever your insurance company is alleging in order to deny you coverage, the Accident Solution law firm will be able to handle your group or personal, ,long-term or short-term disability insurance claim.
Armed with a thorough, wall-to-wall knowledge of the legal framework governing the insurance industry, our attorneys know how to enforce your rights, negotiate aggressively with your insurance company, file the required legal proceedings (if necessary), and, ultimately, obtain the benefits you are entitled to.
Accident Solution will manage your case from beginning to end (namely from the drafting of your claim to the collection of your benefits) while keeping a keen eye on all applicable delays and deadlines.
