OTIP Long-term Disability Claim Denied in Ontario: Your Rights

This resource explains what happens if OTIP (Ontario Teachers Insurance Plan) denies your long-term disability (LTD) claim in Ontario, why they deny benefits, what action you can take to win your benefits and get compensation, and other facts about LTD denial by a well-known insurance company in the province.

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Can OTIP deny my LTD claim?

OTIP can’t deny your claim for long-term disability benefits if you are legitimately disabled and unable to work for a long period of time. If your treating doctor (or doctors) provides documentation that states that you can’t perform your duties due to an injury or illness, OTIP must pay you as per the policy.

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Why does OTIP deny LTD claims?

OTIP has a number of common reasons for denying your LTD claim. These include situations where:

• They do not consider you to be “totally disabled“
• Disagreement with your doctor’s opinion
• Insufficient medical evidence to support your claim
• The possibility of you working in a different occupation
• Evidence from surveillance that suggests you can work
• You may have a pre-existing condition

It’s important to understand that just because OTIP provides a reason for denying an LTD claim in Ontario, it doesn’t necessarily mean that their reason is correct or accurate. Insurers often make mistakes or misinterpret information, and their decision may be based on incomplete or inaccurate facts. It is also in an insurance company’s best interest to deny claims, because it means they can keep more money in their pockets and increase overall profit for the company.

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What should I do if OTIP denies my LTD claim?

There are some key things you should do if OTIP denies your LTD claim in Ontario:

• Don’t panic. It’s understandable to feel stressed or worried when your claim is initially denied. But know that a denial is not necessarily the end of the road.
• Get the denial in writing. OTIP’s denial letter should explain why they denied your claim, and will identify what you need to address.
• Gather medical info from your doctor: If you haven’t already done so, make sure you have all relevant medical data about your disability that will support your request for benefits.
• Contact a disability lawyer: You should contact an Ontario long-term disability lawyer at Samfiru Tumarkin LLP immediately for help. Our experienced team will provide you with a free consultation so that we can review your unique situation and the details of your denial, and help understand what your rights are. From there we can determine the best course of action to win your benefits and get proper compensation from OTIP.

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Can I appeal OTIP’s denial?

Yes, you can appeal OTIP’s decision to deny your long-term disability claim in Ontario.

The appeal is a review process carried out internally by the insurance company, rather than a third-party or governmental body. In other words, you are asking OTIP to review their reasons for rejecting your request for LTD benefits in the hopes that they will change their mind.

• LEARN MORE: Appeals and long-term disability FAQ

Through our years of experience with thousands of clients, we have found that insurance companies rarely approve benefits following an appeal. It is in the insurer’s best interest to maintain their position on your claim and continue to deny LTD payments while you are unable to work. They may also use the appeal process to eat into the amount of time you have to take legal action against them to get compensation.

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Is there a better option than an appeal?

While there is a chance that you can get your benefits through an appeal, there is a better option available in Ontario: You can pursue a legal claim through a long-term disability lawyer at Samfiru Tumarkin LLP.

How a disability lawyer can help

Dealing with a denial of long-term disability benefits can be an overwhelming experience. At Samfiru Tumarkin LLP, we understand the challenges that our clients face when their insurance company abandons them. Our experienced LTD lawyers for Ontario can provide a number of benefits for someone who has been denied disability payments by OTIP, including:

• Providing an understanding of your rights: We can review the details of the denial and explain what your best course of action is. You will be able to make an informed decision about how to proceed, and understand the benefits of filing a legal claim.
• Dealing directly with OTIP: We reduce your stress and anxiety by becoming your representative. Our team will handle the process from start to finish, including all communications with OTIP. Instead of having to handle countless phone calls, emails and your insurers tactics, you can focus on your recovery
• Navigating the complex legal system: Our lawyers know how to use the legal process quickly and efficiently to get you results. Fighting for compensation and winning LTD benefits is our specialty.
• Understanding how OTIP thinks: Our disability lawyers once worked for large insurance companies. We know how they think, what their tactics are, and how to beat them at their own game.

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How long do I have to file a legal claim against OTIP?

You have up to two years in Ontario to file a legal claim for compensation after OTIP denies your request for LTD benefits. Once those two years have passed, you have likely lost your ability to take advantage of Canada’s legal system to get you the money that you are entitled to through your disability insurance policy.

Even if you think that two-year window has closed, we recommend you contact our team immediately to find out if you still have legal options.

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How long does it take to win an LTD denial?

The amount of time it takes to potentially win your LTD claim against OTIP can depend on a number of factors. Every case is unique and can vary in terms of complexity. In some instances, our team can resolve matters with the insurance company after a few simple exchanges, while other cases may take a few months to secure compensation.

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How much does it cost to fight an LTD denial in Ontario?

At Samfiru Tumarkin LLP, you don’t pay anything until you win your claim against OTIP for LTD benefits or compensation. Our disability lawyers are only paid when we settle your case.

This is called a contingency fee arrangement. It allows people who might not be able to afford a lawyer to have access to justice in Ontario and across Canada. Our fees are calculated as a percentage of what we recover, plus disbursements – no hidden fees.

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I just applied for LTD but feel I’m going to be denied

If you think there’s a chance that OTIP may reject your claim for LTD benefits, don’t hesitate to contact our team for a consultation to find out how you can best prepare for the denial.

SEE ALSO
• Long-term disability FAQs
• Rights when denied LTD for mental health
• WATCH: Disability Law Show

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OTIP LTD Denial Lawyers in Ontario

If your LTD claim is denied by OTIP in Ontario, Samfiru Tumarkin LLP stands ready to help. Our team, including long-term disability lawyers in Toronto and Ottawa, knows how to respond to the insurer.

While your health and wellbeing may not necessarily be in their best interest, it is our top priority. Before you walk away from your rights, call us for a free consultation to find out how our involvement can make a difference. We help individuals all across Canada (excluding Quebec) at all stages of their OTIP LTD claim, including applying for benefits, looking at the appeal process and applying legal pressure to secure the money you need when you can’t work.

We’ve helped countless Canadians, like Sandra Bullock and Julie Austin, get the compensation they deserve after being turned away by their insurer. Call Canada’s most positively reviewed law firm at 1-855-821-5900, email Help@DisabilityRights.ca, or contact us online for a FREE consultation.