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OTIP Long Term Disability Claims

This might seem like a very niche topic for the Toronto Injury Lawyer Blog as it relates specifically to Ontario teachers seeking to claim, or who have been denied long term disability benefits by The Ontario Teachers Insurance Plan (OTIP)

The reality is that there are a lot of teachers out there. Teachers have access to long term disability benefits and tend to read blog posts like this. Teaching is a difficult profession where bad days get noticed very quickly by the students and aren’t tolerated. Going in to teach a class day in day out in pain when you aren’t there 100% mentally isn’t good for anyone.

OTIP long term disability polices are some of the most complicated long term disability policies out there. It’s not because OTIP is trying to be difficult towards its membership, or has intentionally made the policies complicated to confuse teachers and to trick them out of getting benefits. It’s just that there are a lot of moving parts for teachers, and a lot of money at stake.

For starters, teachers on average earn a very good and stable income. They generally receive regular raises, and they have access to rehabilitation benefits to help them get better. Teachers are unionized employees as well which adds another layer of potential confusion (like why isn’t my union helping me pursue the long term disability claim?).

Teachers pay into the Ontario Teachers Pension Plan (OTPP). If a teacher isn’t working, then they aren’t able to make any contributions into the plan which will impact how much they will receive when they become eligible to claim a pension. This is a big deal when it comes to retirement planning. Will the teacher have made enough contributions into the OTPP in order to retire comfortably; or will they need to seek out another source of income post retirement? How will going on disability, or being denied disability benefits impact the teacher’s contributions into the OTPP?

The OTPP is not the only pension plan which teachers contribute into. They, like all tax paying Canadians make contributions into the Canada Pension Plan (CPP) and are eligible to receive CPP Disability benefits before the age of 65 in the event that they meet the definition of disability along with the requirements under CPP.London-Head-Shot-Brian-Goldfinger-201x300

Under OTIP policies, teachers are also able to receive long term disability benefits in they event that they are NOT completely disabled. There are provisions contained in the LTD policy for partial disability and for a disability which has impacted their income such that they are not able to earn 60% of their pre-disability earnings. We refer to this as a means test. This means that if a teacher had been working full time, and now, on account of a disability is only able to work part time and cannot earn at least 60% of their pre-disability earnings, that they will quality for long term disability benefits.

OTIP policies also contain a cost of living allowance (COLA clause) which provides that the monthly disability amount will increase by a certain percentage (often 2%) each year as a safeguard against inflation. This is a big benefit for the disabled teacher given that the monthly disability figure will increase each year. But, this also makes calculating benefits moving forward more tricky. It even gets tricker when you factor in the cost of any setoff payments. The mathematical formulas need to be updated each year with each increase in benefits, so it’s not a one size fits all calculation.

In our law firm’s dealings with OTIP, we have seen that they legitimately want their teachers to return to work. A teacher has worked his/her whole life to enter the teaching profession. You just don’t throw all of that hard work away. The majority of teachers we have met want to get back to teaching instead of being stuck at home unable to work. They love teaching! Never being able to teach again would defeat all of the hours they’ve spent devoted to their profession and getting to where they are today. We can also agree that we can never have too many good teachers who are ready, willing and able to work. There are the altruistic reasons for OTIP wanting to get their teachers back to work. But there are financial reasons for that as well. If the teacher returns to work, that means that they are no longer on claim. Not only will OTIP not to have to pay for long term disability benefits moving forward, but it’s one less disability file for their adjusters to manage. A closed file for an insurer is a good file.

Approximately 40% of claims which OTIP sees from teachers are related to anxiety, depression or mental illness. That means that the injuries are invisible and they are subjective. Somebody has to believe that the disabled person is sick because their anxiety, depression or mental illness will not show up on any x-ray, MRI, or CT Scan. You don’t get a wheelchair or a cast when you are depressed. It’s an invisible disability. Teaching is a stressful and difficult profession. If the teacher does not have a support system in place to deal with the disability, things can fall apart quickly. A big part of this support system is having a supportive family, and a supportive family doctor. The family doctor (or nurse practitioner) is a very important element to these claims. The OTIP policies provide that a disabled person be under the regular care of a doctor, specialist or nurse practitioner. Not having one is no excuse under the policy. The policy doesn’t care if your doctor retired, died, or if you’re on a waiting list for a new doctor. If you don’t have a doctor, or are not seeing your doctor regularly, OTIP can, and will either deny your claim, or terminate benefits altogether because you’ve violated the terms and conditions of their policy. One of the quick tips we give to teachers (and other disability claimants) where they don’t have a family doctor, is to use a walk in clinic as your pseudo family doctor while you’re waiting to get one. That way you can show OTIP that you are making best efforts to get regular treatment due to the delays in the public health system in finding a family doctor. Hope that helps!


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