If you can’t work because of a serious illness, injury, or medical condition, long-term disability benefits can replace part of your income.
For many people in Ontario, LTD benefits are a financial lifeline. They help cover bills, mortgage payments, rent, medication, treatment, and daily living expenses while you focus on your health.
Unfortunately, insurance companies don’t always make the process easy.
Many people are told their claim is missing medical proof. Others are approved at first, only to have their benefits cut off later. Some are pressured to return to work before their doctor says they are ready. Others are told they are “not totally disabled” — even though they still can’t do their job.
This guide explains how long-term disability works in Ontario, why claims are denied or delayed, what happens after two years on LTD, and when you should speak with a disability lawyer.
On This Page:
- 1. What Are LTD Benefits?
- 2. How Does LTD Work?
- 3. What Does “Totally Disabled” Mean?
- 4. Medical Conditions That Qualify
- 5. LTD, CPPD, and Other Supports
- 6. Why is LTD Denied?
- 7. What to do After Denial?
- 8. Deadline to File a Claim
- 9. Fired on LTD
- 10. Forced Back to Work
- 11. Speak to a Lawyer
- 12. Why Choose Samfiru Tumarkin LLP
- 13. FAQs
What Are Long-Term Disability Benefits in Ontario?
Long-term disability benefits are insurance payments for people who can’t work because of a disability.
In Ontario, LTD coverage usually comes from:
- an employer group benefits plan
- a private disability insurance policy
- a union or association plan
- an individual insurance policy purchased directly from an insurer
LTD benefits usually replace a percentage of your regular income. The amount depends on your policy. Many plans pay around 60 to 70 per cent of your pre-disability earnings, but some pay more or less. Your policy may also include a monthly maximum.
How Does Long-Term Disability Work in Ontario?
Every LTD policy is different, but most claims follow the same general path.
1. You Stop Working Because of a Medical Condition
Most LTD claims begin when your doctor says you can’t safely continue working because of your illness, injury, or symptoms.
This can involve a physical condition, mental health condition, chronic pain condition, neurological condition, cancer, post-viral illness, or another serious medical issue.
2. You Go Through the Elimination Period
The elimination period is the waiting period before LTD benefits begin.
In many policies, this is 90 to 120 days. During this time, you may rely on:
- Sick leave
- Short term disability Ontario
- Employment Insurance sickness benefits
- Vacation pay
- Savings or other income supports
Your policy will set out the exact waiting period.
3. The Insurance Company Reviews Your Medical Evidence
To qualify for LTD, you must provide medical evidence showing that your condition prevents you from working.
This can include:
- Doctor’s notes
- Specialist reports
- Test results
- Treatment records
- Functional assessments
- Medication history
- Psychological or psychiatric reports
- Rehabilitation records
The insurance company might ask for more forms, updates, medical records, assessments, or statements from your doctor.
4. You Are Assessed Under the “Own Occupation” Test
For the first two years of most LTD claims, you usually qualify if your medical condition prevents you from doing the essential duties of your own job.
This is often called the own occupation period.
You don’t usually have to prove that you can’t do every job in the world. You need to show that your disability prevents you from doing your specific job in a safe, reliable, and sustainable way.
5. After Two Years, the Test Often Changes
After about 24 months, many LTD policies change from the own occupation test to the any occupation test.
This is one of the most important moments in a long-term disability claim.
At this stage, the insurance company may argue that you can work in another job, even if you can’t return to your old position. However, the new job must usually be reasonably suited to your education, training, experience, and medical limitations.
Many people have their benefits cut off around the two-year mark.
What Does “Totally Disabled” Mean?
“Totally disabled” does not mean you are helpless, bedridden, or unable to do anything at all.
In many LTD claims, the key question is whether your medical condition prevents you from working in a meaningful, safe, and reliable way.
You may still qualify for long-term disability even if you can:
- Leave your home
- Drive short distances
- Take care of basic personal needs
- Attend appointments
- Do light household tasks
- Have some good days
- Perform certain activities for short periods
Insurance companies often focus on what you can do for a few minutes or a few hours. But LTD claims should look at whether you can actually sustain work on a regular basis.
If your symptoms prevent you from working consistently, safely, and productively, you may still be totally disabled under your policy.
What Medical Conditions Qualify for LTD in Ontario?
There is no single list of medical conditions that automatically qualify for long-term disability benefits.
The real issue is whether your condition prevents you from working.
Medical conditions that can qualify for LTD include:
- Depression
- Anxiety
- PTSD
- Bipolar disorder
- Chronic pain
- Fibromyalgia
- Chronic fatigue syndrome
- Long COVID
- Cancer
- Multiple sclerosis
- Heart disease
- Neurological conditions
- Severe back, neck, or joint injuries
- Autoimmune conditions
- Post-concussion syndrome
- Serious medication side effects
Invisible illnesses are often challenged by insurance companies because they may not show up clearly on scans, X-rays, or blood tests. That does not mean they aren’t real. Mental health conditions, chronic pain conditions, and fatigue-related conditions can all support a valid LTD claim.
LTD Benefits, CPP Disability, and Other Income Supports
Private LTD benefits are different from government disability programs.
However, these benefits can interact.
CPP Disability and LTD
If you receive LTD benefits, your insurance company may require you to apply for Canada Pension Plan Disability benefits.
If CPP Disability is approved, your insurer will often deduct that amount from your LTD payments. This is called an offset.
- For example, if your LTD benefit is $3,000 per month and CPP Disability pays $1,200 per month, your insurer may reduce your LTD payment by $1,200.
This does not always mean you receive more total money each month. In many cases, the CPP Disability payment simply reduces what the insurance company has to pay.
ODSP and LTD
ODSP is a separate Ontario government program for people with disabilities who meet financial and medical eligibility rules.
Not everyone with an LTD claim qualifies for ODSP. Not everyone on ODSP has private LTD insurance. The rules, payments, and eligibility tests are different.
If you have private LTD coverage, it is important to understand what your policy says before making decisions about other benefits.
Why Are Long-Term Disability Claims Denied in Ontario?
Insurance companies deny or cut off LTD benefits for many reasons.
Common reasons include:
- The insurer says there is not enough medical evidence
- The insurer disagrees with your doctor
- Your symptoms are considered “subjective”
- Your condition is invisible or hard to measure
- Forms were incomplete or filed late
- The insurer says you don’t meet the “total disability” test
- Your benefits were reviewed after two years
- Surveillance was used against you
- An independent medical examination was used to challenge your claim
- The insurer says a pre-existing condition exclusion applies
- You were pressured to return to work before you were ready
What Should You Do If Your LTD Claim is Denied?
A denial is not the end of your claim.
It is also not proof that the insurance company is right.
If your LTD claim is denied, delayed, or cut off, take these steps as soon as possible.
1. Get the denial letter
Ask for the denial or termination decision in writing.
The letter should explain why the insurance company refused to pay benefits or stopped paying benefits.
2. Do not rely only on the insurer’s appeal process
Many insurance companies encourage people to file an internal appeal.
The problem is that the same insurance company that denied your claim is usually reviewing the appeal. Internal appeals often do not fix the problem and can waste valuable time.
In many cases, a legal claim is more effective than repeated appeals.
3. Keep getting treatment
Continue following your doctor’s treatment plan.
Do not stop medical care just because the insurance company denied your claim. Ongoing treatment records can be important evidence.
4. Ask your doctor for detailed medical support
A short note saying you are “off work” might not be enough.
Your medical evidence should explain:
- Your diagnosis or symptoms
- Your restrictions and limitations
- How your condition affects your ability to work
- Your treatment plan
- Your prognosis
- Why you can’t perform your job duties
- Whether a return to work is medically safe
5. Speak with a long-term disability lawyer
LTD claims involve strict deadlines. Waiting too long can hurt your case.
A disability lawyer can review your policy, denial letter, medical evidence, and appeal deadlines. They can also deal directly with the insurance company on your behalf.
How Long Do You Have to Sue an LTD Insurer in Ontario?
In many Ontario LTD cases, there is a two-year limitation period to start a legal claim.
However, the deadline can be complicated. The start date is not always obvious, and it may depend on the wording of your policy, the denial letter, and the facts of your case.
Do not assume the insurance company will warn you before the deadline expires.
If your LTD claim was denied, delayed, or cut off, speak with a disability lawyer as soon as possible. Missing a limitation period can prevent you from recovering the benefits you are owed.
Can You Be Fired While on Long-Term Disability in Ontario?
Your employer can’t fire you because you have a disability.
In Ontario, employers have a duty to accommodate employees with disabilities to the point of undue hardship. This can include medical leave, modified duties, reduced hours, workplace changes, or a gradual return to work when medically appropriate.
However, some employers try to end employment while a person is on LTD. They may argue that the employment contract has been frustrated because the employee has been away for a long time and there is no reasonable chance of returning to work.
These cases are highly fact-specific.
Can the Insurance Company Force You Back to Work?
Your insurance company can ask for medical updates, treatment information, and return-to-work plans.
But your doctor plays a key role in deciding whether it is medically safe for you to return.
If the insurer is pressuring you to return before your doctor clears you, be careful. A failed return to work can make your health worse and complicate your claim.
Before agreeing to a return-to-work plan, make sure:
- Your doctor supports it
- Your restrictions are clearly documented
the plan is realistic - Your employer can accommodate your limitations
- You are not being pushed back too soon
- You understand how the plan affects your LTD benefits
Should You Speak with a Long-Term Disability Lawyer?
You should speak with a long-term disability lawyer if:
- Your LTD claim was denied
- Your benefits were cut off
- Your insurer says you are not totally disabled
- Your insurer says there is not enough medical evidence
- Your benefits were stopped after two years
- Your insurer is relying on surveillance
- You were sent to an independent medical examination
- Your insurer is pressuring you to return to work
- Your employer terminated you while you were on disability leave
- Your are worried about missing a legal deadline
The earlier you get legal advice, the easier it may be to protect your claim.
Why Choose Samfiru Tumarkin LLP?
Samfiru Tumarkin LLP is one of Canada’s leading long-term disability law firms.
We help people across Ontario take on major insurance companies after LTD claims are denied, delayed, or cut off.
Our disability lawyers regularly deal with insurers such as:
- Manulife
- Sun Life
- Canada Life
- Desjardins
- RBC Insurance
- Blue Cross
- Industrial Alliance
- Equitable Life
- Co-operators
- Beneva
Some our disability lawyers once worked for insurance companies. Because of this experience, we uniquely understand how insurance companies handle disability claims. We know the tactics they use. We also know how to build strong legal claims that put pressure on insurers to pay the benefits our clients are owed.
Samfiru Tumarkin LLP has earned thousands of positive client reviews across Canada. You can read real client feedback on our lawyer reviews page.
We work on a no-win, no-fee basis for long-term disability claims. That means you don’t pay legal fees unless we successfully resolve your case.
Proven Results from Samfiru Tumarkin LLP
Our firm has a historic track record of taking on major insurers and forcing them to pay out without dragging families through endless trial delays:
- Sandra Bullock vs. Sun Life: Following prominent national media coverage and our firm’s filing of a $5-million legal claim, we successfully negotiated with Sun Life to have Sandra’s disability benefits completely reinstated.
- Julie Austin (Ontario Teacher): We legally challenged OTIP’s wrongful benefit denial for this educator, ultimately securing $110,000 in retroactive compensation and full restoration of her ongoing benefits.
- Mitch Murphy: When an insurer arbitrarily denied coverage to Mitch despite his suffering from permanent paralysis, our legal team stepped in, dismantled the insurer’s medical assessment, and held them fully accountable.
Speak with an Ontario Long-Term Disability Lawyer
If your LTD claim was denied, delayed, or cut off, don’t wait.
The insurance company has professionals protecting its interests. You should have someone protecting yours.
Contact Samfiru Tumarkin LLP today to speak with an Ontario long-term disability lawyer.
We help clients across Ontario, including Toronto, Ottawa, Mississauga, Brampton, Hamilton, London, Windsor, Kitchener, Waterloo, Barrie, Kingston, and surrounding communities.
You’re not out of options.
Frequently Asked Questions About Long-Term Disability in Ontario
How much does long-term disability pay in Ontario?
Many LTD policies pay around 60 to 70 per cent of your pre-disability income, but every policy is different. Your benefits may also be subject to a monthly maximum or reduced by other income sources, such as CPP Disability.
How long does long-term disability last?
LTD benefits can continue until you recover, return to work, reach the maximum benefit period in your policy, or reach age 65. Your policy and medical evidence will determine how long benefits can continue.
What is the elimination period for LTD?
The elimination period is the waiting period before long-term disability benefits begin. In many policies, it is 90 to 120 days.
Can LTD benefits be cut off after two years?
Yes. Many policies change the definition of disability after about two years. At that point, the insurer may assess whether you can work in another suitable occupation, not just your own job.
Can I get LTD for anxiety or depression?
Yes. Mental health conditions can qualify for LTD if they prevent you from working. The key is strong medical evidence showing how your symptoms affect your ability to perform your job.
Can my insurer watch me or check my social media?
Yes. Insurance companies sometimes use surveillance or social media reviews in LTD claims. However, surveillance can be misleading and does not always prove that you can work.
Should I appeal an LTD denial?
Be careful. Internal appeals often go back to the same insurance company that denied your claim. In many cases, legal action is stronger than repeated appeals. Speak with a disability lawyer before deciding.
Can I be fired while receiving LTD benefits?
Your employer can’t fire you because you have a disability. Employers in Ontario have a duty to accommodate disabilities to the point of undue hardship. If your employer ends your job while you are on LTD, get legal advice before signing anything.
What if my insurer says there is not enough medical evidence?
This is one of the most common reasons LTD claims are denied. You may need more detailed reports from your doctor, specialist, psychologist, psychiatrist, or treatment provider explaining your restrictions, limitations, and inability to work.
When should I contact a disability lawyer?
Contact a disability lawyer as soon as your claim is denied, delayed, cut off, or challenged. LTD claims have strict deadlines, and waiting too long can put your benefits at risk.