What does “totally disabled” mean in Ontario?

The term “totally disabled” is often misunderstood. If you’re dealing with a long-term disability (LTD) insurance claim in Ontario, it’s crucial to understand what this term means and how it can affect your eligibility for benefits.

In LTD policies, “totally disabled” doesn’t mean you’re entirely unable to function or care for yourself. Instead, it means you are unable to perform the essential duties of your job due to an illness or injury. It’s a myth that being “totally disabled” means you can’t do any work at all. Even if you can perform some tasks, you may still qualify for LTD benefits if you’re unable to handle “substantially all” of your job duties.

How do insurance companies define “totally disabled”?

Insurance providers use two key definitions of “totally disabled”:

• Own Occupation: At the outset of your LTD claim, insurers assess whether your condition prevents you from performing the essential duties of your current job.
• Any Occupation: After two years on LTD benefits, the insurer’s focus shifts. They will determine if you can perform any job for which you are reasonably qualified based on your training, education, or experience.

Importantly, “any occupation” is not as broad as it sounds. The job must be one that generates at least 60% of your pre-disability income.

Real-life examples of total disability cases in Ontario

Our firm has successfully helped thousands of clients who were wrongfully denied LTD benefits due to their insurer’s narrow interpretation of “totally disabled.” Here are a few examples:

• Sandra Bullock’s LTD Benefits Restored After Legal Victory: The mother of two had her LTD benefits denied by Sun Life. The insurer argued that her ability to care for her severely developmentally delayed son, Jacob, meant she could return to work, despite medical evidence of major depressive disorder, anxiety, and migraines. Our $5.3-million claim against Sun Life secured the compensation she deserved. Read more about her win.
• Abused Teacher Wins LTD Claim: An Ontario teacher who suffered a sever brain injury was deemed unable to work, despite her insurer’s initial denial of benefits. We fought on Julie’s behalf to ensure she received the compensation she was owed. Insight into Julie’s saga.
• Paraplegic Man’s Fight for Recognition: Mitch’s insurer argued that he wasn’t “disabled enough” to qualify for benefits. Canadian media covered his plight and Samfiru Tumarkin LLP’s response. Learn more about Mitch’s case.

What to do if your LTD claim is denied

Insurers often deny LTD claims by arguing that the individual isn’t “totally disabled” under their policy. If this happens, here are the steps you should take:

1. Consult Your Doctor: Ensure your medical records fully document your condition and its impact on your ability to work.
2. Contact an LTD Lawyer: Don’t rely on an insurer’s internal appeal process—it rarely leads to a successful outcome. A disability lawyer at Samfiru Tumarkin LLP can help you understand your rights and build a strong case.
3. Focus on Timelines: You typically have a limited time to pursue legal action after your claim is denied. Acting quickly is crucial.

Watch: 3 myths about total disability in LTD claims

How we can help

At Samfiru Tumarkin LLP, we’ve successfully challenged insurance companies across Ontario, ensuring our clients receive the LTD benefits they deserve. Our team can:

• Work with your doctors to strengthen your claim
• Gather medical documentation to support your case
• Negotiate directly with your insurer to secure compensation
• File a legal claim if necessary

Dealing with LTD claims can be complex, and having a knowledgeable disability lawyer can make a significant difference.

Our disability lawyers also handle short-term disability (STD), life insurance, critical illness, and mortgage insurance claims in all Canadian provinces (excluding Quebec), while the employment lawyers at Samfiru Tumarkin LLP handle non-unionized workplace matters in Ontario, Alberta and B.C.

Get the compensation you’re owed

You don’t have to face the stress of an LTD denial alone. Get a free LTD consultation today to learn how we can help you secure the benefits you’re entitled to.