When illness or injury prevents you from working, long‑term disability (LTD) benefits are supposed to provide financial security. Unfortunately, many people discover that getting or keeping LTD benefits is far more difficult than expected. Insurance companies frequently deny or terminate claims, even where a person is genuinely unable to work. Understanding your rights early can make a significant difference in protecting your benefits. Below are the most common concerns people have about long‑term disability claims in Ontario, and what you should know if you are dealing with an LTD claim.
Why Was My Long‑Term Disability Claim Denied?
One of the biggest frustrations for disabled workers is receiving a denial letter even though their doctor supports their claim. Insurance companies commonly deny LTD claims for reasons such as alleged lack of medical evidence, claims that the person is not “totally disabled,” arguments that the person can perform sedentary or alternative work, missed deadlines or incomplete forms, pre‑existing condition exclusions, surveillance or social media monitoring, and disagreements with the treating physician’s opinion. In many cases, a denial does not mean the claim is invalid. It simply means the insurer has taken a position that may need to be challenged.
Can the Insurance Company Cut Off My LTD Benefits After Paying for a While?
Yes — and this happens frequently. Many policies have two stages. In the first stage, usually the first 24 months, you qualify if you cannot perform the duties of your own occupation. After that period, the definition of disability usually changes and the insurer may stop benefits if they believe you can perform any occupation for which you are reasonably suited by education, training, or experience. This change in definition is one of the most common reasons insurers terminate benefits after two years.
What Should I Do If My LTD Claim Is Denied?
Receiving a denial can be overwhelming, especially when you are already dealing with a medical condition. Important steps include carefully reviewing the denial letter, gathering additional medical evidence, and seeking legal advice early. Updated reports from doctors and specialists can strengthen your claim, and a lawyer experienced in disability law can review your policy, assess the insurer’s position, and determine the best strategy. Many LTD denials are successfully challenged once additional medical evidence or legal pressure is applied.
Should I Appeal the Insurance Company’s Decision?
Most insurers offer an internal appeal process. However, there are important considerations. Appeals are usually reviewed by the same insurance company that denied the claim in the first place, and the process can delay resolution while the legal deadline to start a lawsuit may continue to run. For this reason, many LTD disputes in Ontario are resolved through legal claims rather than internal appeals.
How Long Do I Have to Challenge a Denial?
Strict time limits apply. In Ontario, the limitation period for many LTD claims is generally two years from the date you knew or ought to have known that the insurer denied your claim. Waiting too long can permanently prevent you from pursuing benefits even if the denial was unfair.
What Medical Conditions Qualify for Long‑Term Disability?
Many different medical conditions can qualify for LTD benefits if they prevent you from performing your job. Common examples include chronic pain or orthopedic injuries, mental health conditions such as depression or anxiety, cancer, neurological disorders, autoimmune conditions, traumatic brain injuries, and cardiac or chronic illnesses. The key issue is not the diagnosis alone, it is whether the condition prevents you from working.
Do I Need a Lawyer for a Long‑Term Disability Claim?
While some claims proceed without legal involvement, legal representation can significantly improve outcomes when benefits are denied or terminated. A disability lawyer can help interpret complex insurance policy language, challenge insurer medical assessments, obtain stronger medical evidence, protect limitation periods, and negotiate or litigate to recover benefits. Most importantly, legal guidance allows you to focus on your health while your claim is handled strategically.
Speak With a Long‑Term Disability Lawyer in Toronto
If your long‑term disability claim has been denied, delayed, or terminated, you may still be entitled to benefits. Landy Marr Kats LLP represents individuals across Ontario in disputes with disability insurers. Our team works to hold insurers accountable and pursue the benefits our clients are entitled to receive.
If you have questions about a long‑term disability claim, contact our office to discuss your situation. There is no fee unless we get you money. Contact us.