If you need financial and medical support due to a serious health issue, one option is to use your long-term disability (LTD) benefits. In Ontario, these benefits can help pay the bills and support your recovery.
Here, we’ll discuss the basics of long-term disability claims in Ontario, including where to start and what steps to take if your claim is denied or you encounter problems. For more information, you should also consider consulting an LTD lawyer.
What are long-term disability claims in Ontario?
LTD benefits are a type of insurance coverage that gives you monthly financial and medical support when you cannot work due to a policy-specified disability. This may include serious illnesses or injury, which can be work-related or not.
These benefits are in contrast to your short-term disability benefits, which only last for up to three months to a year. In most cases, you can transition from short-term disability benefits to LTD benefits, if granted by your insurer.
Below is a short video which explains how LTD claims work in Ontario:
Need assistance with your LTD claims? Reach out to the best long-term disability lawyers in Ontario as ranked by Lexpert.
Read next: How much does a long-term disability lawyer cost in Canada?
Sources of long-term disability benefits
There are many sources of LTD benefits for Ontarians. These can be private or government led. As with other provinces/territories, LTD benefits can come from:
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employer-sponsored insurance plans: usually offered as part of your workplace’s benefits, especially when your work involves hazards and has a high risk for illnesses and injuries
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private insurance policies: these are coverages that you bought personally, which may or may not complement other insurance plans, such as your employer-sponsored plan
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government disability benefits or plans: examples are the federal Canada Pension Plan Disability (CPP-D), the Workplace Safety and Insurance Board (WSIB) for provincially regulated workplaces, and the Ontario Disability Support Program (ODSP) for those who have limited income and assets
In the case of private LTD plans, the policy is the contract between you and your insurance company, as well as your employer if applicable. All details are explained in your policy, which is issued to you upon enrollment in the long-term disability plan.
On the other hand, if it is a government-issued LTD benefit, the law will provide you with all the information that you need.
Duration of long-term disability claims
One of the most common questions people ask is for how long would you be receiving your LTD benefits. While there is no fixed period, these benefits usually last:
- for as long as you live
- when you reached a certain age (e.g., 65 years old)
- for a certain number of months or years (e.g., 120 months).
This period is set in your policy or in the program you’re enrolled in. When any of these conditions are met, your LTD benefits will be terminated, usually after you receive a notice.
If you can’t find information on the timeframe in any of your documents, you can reach out to your insurance provider or an LTD lawyer for assistance.
Related to the duration of your long-term disability benefits are the other reasons for termination, such as:
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medical improvement: the benefits will cease once you have fully recovered from your disability, which can be certified by doctors
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non-compliance with the policy: for instance, not following your medical or medications plan or returning to work against the policy
That is why it is important that you understand your policy, including the duration of benefits and reasons for termination, to prevent your benefits from being terminated after you’ve been approved.
How can I apply for long-term disability claims in Ontario?
After using up your short-term disability benefits (and any other benefits your insurer requires you to use), you can start preparing for your LTD claims application. In most cases, the waiting period for your long-term disability claims application is the time you would be receiving your short-term disability benefits.
The specific process and qualifications will depend on your policy and insurer. In any case, we’ll discuss the usual steps and things to keep in mind when applying for long-term disability claims in Ontario.
Qualifications for LTD claims
First, it’s important to know if you're eligible for LTD claims. Here’s a rundown of the most common qualifications:
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medical proof: this is provided by your insurer-approved doctor and includes the reports they must submit and the results of your treatment plans
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incapacity for work: your disability or injury, as medically proved, must be severe enough that you cannot return to your job or do any other work
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“disabled” under the policy: your condition must qualify with your policy’s definition of “long-term disability”
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compliance with pre-conditions: your policy might require certain conditions, which you must meet before you qualify for LTD benefits
During and after two years
The eligibility requirements for LTD benefits are different from the first two years of your disability and after this period:
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first two years: you must show that you cannot return to your previous job due to the disability
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after two years: in addition to being unable to return to your previous job, you must show that you cannot perform any other job because of your disability
How to apply for LTD benefits
While each provider has different requirements, here’s an overview of the application process for LTD benefits in Ontario:
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know what to submit: prepare the required documents, such as application forms from your insurer, medical records, proof of meeting pre-conditions, and documents from your employer if your injury is work-related
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submit to your insurer: along with the documents required from your doctor, you must submit your application within the time prescribed by your insurer (e.g., during the waiting period or while you’re on short-term disability)
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follow-up regularly: be in constant communication with your insurer and quickly respond whenever they request additional requirements or have further inquiries
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comply with any assessments: your insurer will usually require further medical exams, assessments, or other tests; complying with all of them is essential for your claim’s approval
If you want to learn more about how LTD claims work, here are some tips from a lawyer’s perspective:
Consult with the best law firms in Ontario for LTD benefits if you have any questions regarding your claims.
What should I do if my long-term disability claims are denied?
If your application for long-term disability claims in Ontario is denied, your legal remedies will depend on the reasons for the denial. At this point, having an LTD lawyer is recommended, so that your next steps will not lead to further negative results.
Here are some suggested actions after your initial application for LTD claims is denied:
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review the denial letter: first, you must understand your insurer’s reasons for denying your claim since they cannot deny your long-term disability payments without any basis
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file an appeal: you may file an internal appeal or reconsideration with your insurer, which must be done within the period specified in the policy or the denial letter
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submit additional documentation: based on the reason for the denial, you can attach other documents (e.g., supplementary medical proof of your disability)
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file a lawsuit: when all else fails, and when your lawyer sees it as necessary, you may file a case against your insurer for unfair denial of your LTD claims
How can lawyers help with long-term disability claims in Ontario?
If you’re not sure whether you need a lawyer or not, you can consider the ways a lawyer can help with your LTD claims:
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during enrollment: when looking for LTD benefits that suit your resources and family situation, talking to a lawyer first would be helpful
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review your policy: the documents you have may be full of legal terms, which your lawyer can explain so you can fully understand your policy
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when applying: even though a lawyer is not required when preparing your LTD claims, it is recommended to get legal assistance to help ensure your application is free from errors
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when denied: having a lawyer is important once your LTD claims have been denied, as they can guide you on what to do next or can negotiate on your behalf with your insurance company
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when terminated: if your LTD benefits are terminated prematurely without proper reason or procedure, your lawyer can help you determine your legal options
LTD claims in Ontario: shifting towards your full recovery
Understanding how long-term disability claims in Ontario work can make a tough time a little easier. If your claim is denied or you feel stuck, reaching out to a lawyer can make a real difference. With the right guidance, you can focus on your health and let the experts handle the paperwork.
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