Long-term disability denied in Ontario: Your rights

Long-term disability (LTD) benefits in Ontario play a crucial role if you can’t work because of an illness or injury. It’s a type of insurance that provides you with the financial support you need when you’re unable to generate income for you or your family.

Unfortunately, it’s not uncommon for insurance companies in the province to deny legitimate LTD claims in order to bolster their bottom line.

In some cases, the denial can leave claimants shocked, confused, and afraid as they try to figure out how they are going to support themselves and their loved ones without access to disability benefits.

If your insurer turns down your legitimate LTD claim, don’t lose hope.

An experienced disability lawyer at Samfiru Tumarkin LLP can help you review your legal options.

WATCH: Disability lawyer James Fireman explains the three things you need to know when your LTD claim is denied on an episode of the Disability Law Show.

Common reasons LTD claims are denied in Ontario

Long-term disability insurance companies in Ontario are constantly looking for ways to deny long-term disability claims.

By not providing you with benefits, they are able to increase their bottom line.

Here are common reasons insurers often give when denying LTD claims in Ontario:

• You filed late: If you don’t meet the timelines for submitting your claim and all other documentation, you could jeopardize your ability to qualify for disability benefits.
• Not “totally disabled”: This is a misleading term created by insurance companies. They say you’re “not totally disabled” when they think you can still work despite your disability and health challenges
• Not enough medical evidence: Your claim might be denied without enough medical evidence to prove your disability affects your ability to work. It’s essential to provide detailed medical records and doctor’s opinions to support your claim.
• Insufficient treatment: You aren’t following an appropriate treatment plan or adhering to treatment recommendations, and can’t provide a good excuse as to why.
• Pre-existing condition: Some insurance policies exclude coverage for conditions that existed before the policy started.

If your insurance provider identifies one or more reason to turn down your LTD claim, don’t lose hope. You have a right to ask questions and learn more about their decision.

An experienced disability lawyer at Samfiru Tumarkin LLP knows the right questions to ask, and how to determine if the insurance company has made mistakes when denying your claim.

If my insurer denies my claim, should I get the decision in writing?

The short answer is yes. The denial letter from your insurance company will explain why your LTD claim was turned down.

It should also address:

• How to appeal the insurer’s decision
• The two-year limitation period within which you can pursue a legal claim

In some cases, insurance companies will try to explain over the phone why you were denied or cut off disability benefits. Before ending the call, insist that you would like to receive their decision in writing.

Once you receive the denial letter, gather any other relevant documents (i.e. your policy, application forms, etc.) and contact an experienced Ontario disability lawyer at Samfiru Tumarkin LLP.

We can review your situation, identify the mistakes made by the insurer while handling your LTD claim, and help you secure the compensation you deserve.

LEARN MORE
• Disability Law Show: Mistakes people make when denied LTD
• Invisible illness and long-term disability claims: Your rights
• Disability in the workplace: Rights for employees

Should I get supporting medical information from my doctor before filing my claim?

Yes. If your doctor says you can’t work because of your illness or injury, you should qualify for long-term disability benefits.

When filing your LTD claim, your insurer will require your doctor to fill out a physician statement. Before submitting it, double-check that the form was properly completed.

A common excuse used by insurance companies to turn down claims is that the claimant didn’t fill out their application properly.

• Example: A man worked for a manufacturing company in Toronto for 12 years. While on the job, he slipped and broke his right leg. After assessing his injury, his doctor said he should be off work for at least three months. The man was completely surprised when his insurer informed him that his LTD claim had been denied because his application form wasn’t filled out properly. After further review, it turned out that his doctor only completed a section of the physician statement.

You should also ask your doctor to provide you with referrals to as many treatment providers and specialists as possible. The more medical documentation you can provide, the higher the likelihood that your LTD claim will be approved.

SEE ALSO
• Doctor and Treating Health Professional Reports
• Disability Law Show: Common LTD insurance tactics

If my long-term disability claim is denied, should I appeal?

Appeals rarely work. If your LTD claim is denied, you are better off filing a legal claim instead.

In Ontario, the appeals process is typically handled by the same insurance company that denied you disability benefits in the first place.

It’s used by insurers to stall out the two-year window, or limitation period, that you have to take legal action after your claim has been denied.

Once the two years are up, the insurance company doesn’t have to pay your LTD claim and you can’t file a legal claim to get the money you are owed.

SEE ALSO
• Disability Law Show: Why you shouldn’t appeal a denied LTD claim
• Disability lawyer discusses Ontario woman’s life insurance denial
• Sun Life reinstates long-term disability coverage after legal action

I already appealed, what should I do now?

If you appealed the insurance company’s decision to turn down your long-term disability claim, and were unsuccessful, you may still have options.

As long as it hasn’t been two years since your LTD claim was denied, an experienced Ontario disability lawyer at Samfiru Tumarkin LLP can review your situation and help you secure the compensation that you are entitled to.

Your top priority should be your health and recovery. Once we are formally hired to represent you, we will communicate with the insurer on your behalf.

How we can help

If your long-term disability claim is denied in Ontario, or you are cut off from your disability benefits, contact the experienced disability law team at Samfiru Tumarkin LLP.

We know the law and regularly resolve LTD, life insurance, and mortgage insurance claim denials.

Several of our lawyers previously worked for insurers, which means we know how they operate, why they make certain decisions, and how to enforce your rights.

We have helped thousands of clients, including Julie Austin and Sandra Bullock, hold insurance companies accountable after their claims were denied or cut off prematurely.

Our disability lawyers in Toronto and Ottawa provide free consultations and we don’t get paid unless we secure the compensation that you are legally entitled to.