Who Qualifies for Long-Term Disability (LTD) in Ontario?

If you’re unable to work because of illness or injury, long-term disability (LTD) benefits are meant to replace a portion of your income. But many Ontarians are surprised to learn that qualifying for LTD is not as straightforward as insurers make it sound.

Below, we break down who qualifies for long-term disability in Ontario, how insurers interpret eligibility, and what actually matters when benefits are approved — or denied.

What Does “Qualifying for LTD” Mean in Ontario?

To qualify for long-term disability benefits in Ontario, you must meet the definition of “total disability” set out in your insurance policy.

Most LTD policies are provided through:

• Employer group benefit plans
• Private disability insurance policies

Each policy is different, but almost all follow a two-stage definition of disability.

The First 24 Months: Own-Occupation Disability

For the first two years of an LTD claim, most Ontario policies use an own-occupation definition.

This means you qualify if:

• You can’t perform the essential duties of your own job
• Due to illness, injury, or medical condition
• Despite reasonable treatment and accommodation

👉 This does not mean you must be bedridden or completely incapacitated.

Many people qualify for LTD even if they:

• Can perform some daily activities
• Can work limited hours
• Can do different work — just not their job

After 24 Months: Any-Occupation Disability

After the first 24 months, most LTD policies switch to a stricter any-occupation test.

At this stage, you must show that:

• You are unable to work in any occupation
• For which you are reasonably suited by:
  • Education
  • Training
  • Experience

This is where many LTD claims are cut off, even though the person is still medically disabled.

Insurers often argue that:

• You could do “sedentary work”
• You could retrain
• You could perform a theoretical job that doesn’t exist in reality

This shift is a major reason why benefits are reduced or terminated after two years.

Medical Conditions That Commonly Qualify for LTD

There is no official list of qualifying conditions in Ontario. What matters is how your condition affects your ability to work.

That said, LTD benefits are commonly approved for conditions such as:

• Chronic pain
• Fibromyalgia
• Depression, anxiety, PTSD
• Long COVID
• Neurological conditions
• Autoimmune disorders
• Cancer and post-treatment complications
• Musculoskeletal injuries
• Brain injuries

Importantly, mental health and “invisible” disabilities absolutely qualify — despite frequent insurer pushback.

Do You Need “Objective Evidence” to Qualify?

Insurers often demand “objective medical evidence,” but Ontario courts have repeatedly confirmed that:

• Not all disabling conditions produce objective test results
• Credible medical opinions matter
• Consistent treatment records matter
• Functional limitations matter more than diagnoses

If your doctor supports your inability to work — and your limitations are real — you may still qualify, even without imaging or lab results.

Can You Still Qualify If You Work Part-Time or Try to Return?

Yes. Attempting a return to work does not automatically disqualify you from LTD.

In fact:

• Many policies encourage trial returns
• Failed work attempts often strengthen a claim
• Working sporadically does not equal employability

Unfortunately, insurers sometimes use good-faith efforts against claimants.

Why People Who Qualify Still Get Denied

Many Ontarians who meet the legal test for LTD are still denied because insurers:

• Misapply the policy definition
• Ignore medical evidence
• Rely on paper reviews
• Cherry-pick surveillance or social media
• Focus on diagnosis instead of function

How Much LTD Pays (and Why It Matters)

Qualification is only one part of the picture. Even approved claimants often receive less than expected due to offsets, caps, or policy limits.

When Qualifying Isn’t the Problem — the Insurer Is

Understanding who qualifies for long-term disability in Ontario is the first step. The harder part is enforcing your rights when insurers don’t apply the rules fairly.

If your LTD claim has been denied, delayed, or cut off — especially after the two-year mark — legal guidance can help you understand whether the insurer got it wrong.

At Samfiru Tumarkin LLP, our disability lawyers regularly help Ontarians challenge unfair LTD decisions and get benefits back on track.