Long-term Disability Claims in Ontario (2024 Guide)

Discover key information on long-term disability (LTD) claims in Ontario in our detailed guide.

Learn what LTD is, how it compares to short-term disability, and what conditions qualify. Our guide also helps you understand the types of disability benefits, how to file a claim, reasons for denial, and the next steps after a claim denial.

Gain valuable knowledge from Samfiru Tumarkin LLP’s extensive experience to navigate the LTD claims process more confidently and effectively.

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What is long-term disability in Ontario?

In Ontario, long-term disability (LTD) is a type of insurance plan that provides individuals with a continuous income in the event that they are unable to work due to a severe or prolonged disability. This is essential for those who find themselves facing medical conditions or disabilities that impede their ability to maintain consistent employment over an extended period.

The insurance plan offers financial assistance, covering a percentage of the individual’s regular income, ensuring economic stability during the times when the disabled person cannot work.

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Who is eligible for LTD in Ontario?

You are eligible for LTD benefits in Ontario if:

• You are an Ontario resident.
• Have an insurance plan through your employer or a private provider.
• Have worked for your employer for a qualifying period, if identified by your insurance policy.
• Have a long-term injury, illness, or medical condition preventing you from working.

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How does LTD differ from Short-Term Disability?

LTD claims differ greatly from short-term disability (STD) claims.

In Ontario, STD benefits cover temporary disabilities, providing benefits quickly and usually at a higher percentage of one’s salary for a few weeks to several months (sometimes up to 80% or more). LTD benefits cater to more prolonged or severe disabilities, offering sustained financial support, often at a lower percentage of pre-disability earnings, over several years or up to retirement age after a longer waiting period.

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What qualifies for long-term disability in Ontario?

Any illness, injury, or disability that significantly impairs your ability to work for a long period of time qualifies for LTD. Qualification is determined by:

• Functional Impairment: How your condition affects your ability to perform daily activities and job duties.
• Severity of Condition: The extent to which your condition limits your ability to work.
• Policy Guidelines: Specific criteria and definitions outlined in your insurance policy.

Example

A diagnosis of depression alone may not qualify you for LTD benefits. The impairment caused by depression must prevent you from performing your job duties. Mild depression might not qualify, but more severe cases that significantly impact daily functioning and work performance may.

Types of Conditions

Here are categories and examples of conditions that commonly qualify for LTD benefits:

• Musculoskeletal Disorders
• Mental Health Conditions
• Neurological Disorders
• Cardiovascular Conditions
• Respiratory Disorders
• Cancers
• Autoimmune Diseases
• Digestive Disorders
• Injuries and Accidents
• Chronic Fatigue and Pain Syndromes
• Hearing or vision impairment

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What is the Elimination Period?

In Ontario, the elimination period for long-term disability (LTD) benefits is the waiting time between the date you suffer an injury or illness and when you start receiving benefits. It is also known as the “qualifying” period. This period is usually 17 weeks but can range from 3 months to a year, depending on the policy. A longer elimination period often means lower insurance premiums.

During this time, you won’t receive LTD benefits, but you can use short-term disability (STD) insurance for financial help until the elimination period ends. The elimination period also gives the insurance company time to review your claim and decide if you qualify for LTD benefits.

How Employment Insurance (EI) Works with LTD

If you don’t have STD insurance but qualify for LTD, you can apply for EI sickness benefits. EI provides temporary financial assistance for up to 15 weeks while you are unable to work due to illness or injury. This can help cover your expenses until your LTD benefits begin.

You can’t receive EI and LTD benefits at the same time in Ontario. If you receive both EI and LTD benefits at the same time, you must inform your insurance company and the EI office. Usually, your LTD benefits will be adjusted (offset) by the amount you received from EI. This means your LTD payments may be reduced to account for the EI benefits. It is important to report any overlap to avoid overpayment issues and potential repayment demands.

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How much does LTD pay in Ontario?

In Ontario, LTD insurance typically pays between 60% to 80% of the beneficiary’s pre-disability gross income. However, the exact amount can vary based multiple factors, such as the specific LTD insurance policy, the beneficiary’s salary, and the severity and type of disability.

Here are some additional points to consider:

• Policy Caps: Some policies have a maximum monthly benefit cap. Even if a percentage calculation suggests a higher amount, the payment will not exceed this maximum cap stipulated in the policy.

Since there are variations in LTD insurance policies and individual circumstances, you should consult the specific insurance policy or contact the insurance provider to get accurate and personalized information regarding the LTD benefit payment.

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LTD Deductions in Ontario

It is common for your LTD payments in Ontario to be reduced by other payments you receive, including CPP disability, WSIB, and severance pay. These reductions, often called “offsets,” can vary significantly depending on the specifics of your insurance plan. It’s crucial to read your plan carefully to understand how these deductions may affect your benefits.

Additionally, the tax implications of LTD benefits depend on who pays the premiums:

• Employer-Paid Premiums: If your employer pays some or all of the LTD insurance premiums, the benefits you receive will be taxable as income.
• Employee-Paid Premiums: If you pay 100% of the premiums, your LTD benefits will be tax-free.

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How long can you be on long-term disability?

In Ontario, long-term disability benefits can last until you are well enough to return to work or until the coverage period ends, which is usually at age 65. Some policies provide benefits for a fixed term, such as 5 or 10 years. The duration depends on your specific insurance policy and continued medical eligibility.

It’s essential to note that coverage periods can vary, so it’s crucial to review your specific policy to understand the exact duration of the benefits available to you.

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Types of Ontario disability benefits

Ontario offers various disability benefits, each with specific purposes, eligibility criteria, amounts, and durations. These benefits are provided by private insurance companies, the Ontario provincial government, or the Canadian federal government.

Long-term Disability Insurance Ontario

LTD benefits from the private sector are provided, managed, and paid for by LTD insurance companies in Ontario. To access these benefits, you must enroll in an insurance program and pay monthly premiums.

There are two main types of LTD insurance:

• Individual Disability Insurance: Purchased directly, this insurance is tailored for high-income individuals, professionals, and business owners. It provides specific, pre-determined monthly payments, often based on income loss, and can continue up to or beyond age 65. If you fully cover the premiums, the benefits are tax-free.
• Group Disability Insurance: Commonly included in employment benefits packages, this insurance is available to employees, union members, or professional association members. It covers both short-term and long-term disability benefits, replacing a portion of your income (usually 60-80%) during periods of disability. Terms vary, and factors such as CPP disability and severance packages may influence the benefits you receive, so review your group insurance plan carefully.

Employment Insurance Sickness

EI sickness benefits are short-term federal benefits for workers unable to work due to illness or injury. To qualify, you must have recently worked in Ontario and paid into the EI program. Eligible individuals receive 55% of their usual earnings, up to $650 weekly, for up to 15 weeks. You can’t receive EI sickness benefits and short-term or long-term disability benefits simultaneously.

Applying is straightforward: you’ll need to provide some documents, like a medical certificate. For more details and to apply, you can check the government’s official guidelines.

Workers’ Compensation Insurance (WSIB)

The Workplace Safety and Insurance Board (WSIB) oversees workers’ compensation in Ontario. It covers medical costs and income loss for work-related injuries or illnesses. To qualify, you must be employed by a company covered by WSIB. The program pays 85% of your wages, up to an annual limit of $110,000. Income loss payments stop at age 65, but medical coverage can continue for life.

• LEARN MORE: The difference between LTD and WSIB

You can check with the WSIB to find out if your employer is covered by this type of insurance.

Ontario Disability Support Program (ODSP)

The ODSP provides long-term disability assistance for Ontario residents with significant financial needs and substantial disabilities. It offers:

• Income Support: Up to $1,308 per month for living expenses, potentially for life, but reduced at age 65 due to CPP payments.
• Employment Support: Assistance for disabled individuals who want and can work but need support.

The Ontario government provides a resource to help you understand if you are eligible for ODSP.

Canada Pension Plan Disability (CPPD) Benefits

CPPD benefits are federal long-term disability benefits for individuals unable to work due to severe and prolonged disabilities. To qualify, you must have contributed to the Canada Pension Plan. Monthly payments average $1,078.06, up to a maximum of $1,538.67, continuing until age 65.

LEARN MORE:
• Monthly payment dates for CPP
• How long do CPPD benefits last?

The federal government supplies a resource that explains how to apply for CPPD.

Disability Tax Credit (TDC)

The DTC is a non-refundable tax credit aimed at reducing the income tax for people with disabilities or their supporting persons. To qualify, a medical practitioner must certify your severe and prolonged impairment on Form T2201, submitted to the CRA. Approval may open access to other supports, such as the Registered Disability Savings Plan (RDSP).

The federal government provides more information about eligibility for the DTC.

For more detailed information on each type of benefit, visit our Disability Law FAQ.

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How do long-term disability benefits help?

Long-term disability benefits in Ontario provide essential financial support when you are unable to work due to severe illness or injury. These benefits, managed by insurance companies or through work-based plans, help you cover daily living expenses, offering economic stability during challenging times.

Receiving long-term disability benefits allows you to focus on your health and recovery, reducing financial stress. It ensures that you can maintain a sense of normalcy and security despite facing health challenges.

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How to apply for long-term disability benefits in Ontario

To apply for long-term disability in Ontario, start by confirming you have LTD coverage, either through your employer or an independent broker, and that your disability has kept you off work for an extended period.

Follow these essential steps to prepare and submit an effective claim for LTD benefits:

1. Get a diagnosis

You should consult with your doctor to properly diagnose your condition and enhance the validity of your disability claim.

Depending on the disability, getting a diagnosis can be a challenging process, but it’s an important step in securing disability benefits. Having a clear diagnosis helps strengthen your disability claim, increasing the chances of it being approved. Without a confirmed diagnosis, obtaining benefits may be more difficult.

2. Gather medical documents

Collect comprehensive medical documentation from your doctor or healthcare provider detailing the diagnosis, its symptoms, treatment plans, and how the condition impairs daily functioning.

3. Complete the application form

Carefully complete the application forms for LTD benefits provided by the insurance company. Ensure that all sections are filled out accurately and thoroughly to represent the impact of the disability on your ability to work.

Submit your application form along with all necessary documentation, including medical records, an Attending Physician’s Statement from your doctor, and any other required forms or information, to the insurance company.

4. Follow up

Regularly follow up on the status of your application. Be prepared to provide additional information if the insurance company asks for it.

5. Review decision

Once the insurance company makes a decision about your claim for disability benefits, review it carefully. If approved, ensure you understand the terms, amount, and duration of the benefits.

6. Seek legal advice

Contact the Ontario LTD lawyers at Samfiru Tumarkin LLP for a FREE consultation if the insurance company denies your claim for benefits. Our experienced legal team has spent decades successfully advocating on behalf of thousands of Canadians when their disability benefits are denied. We can help you navigate the process, with the goal of winning your LTD benefits or compensation from your insurer.

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Why are LTD claims denied in Ontario?

In Ontario, insurance companies often deny valid long-term disability claims for a number of reasons. They rely on a list of different reasons for denying this crucial lifeline when you need it most.

Here are some common factors that lead to the rejection of disability claims:

• Not “totally disabled“
• Inadequate medical evidence
• Filing your disability claim or documentation late
• Pre-existing conditions
• Failure to follow a treatment plan

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What happens if my LTD claim is denied in Ontario?

If your LTD claim is denied in Ontario, don’t lose hope. The first step in this challenging situation is to contact Samfiru Tumarkin LLP, a trusted name in handling LTD claims effectively and compassionately. Our experienced LTD lawyers for Ontario are equipped to offer strategic advice tailored specifically to navigate the complexities of your case.

Experiencing a denial can be disheartening, especially after investing significant effort in gathering necessary documents to show the seriousness of your disability. However, it’s not the end of the road. Immediate action is essential. By reaching out to our team, you ensure that your case receives the attention and expertise it requires. While appealing the denial through your insurance company is an option, it is often not the most advantageous on for several reasons.

Choosing Samfiru Tumarkin LLP means choosing a proven, strategic approach. Our dedicated team specializes in managing LTD claims across Ontario and Canada, providing personalized guidance and unwavering support throughout the process. Remember, you’re not alone. We are committed to fighting for your rights, ensuring that you receive the benefits you rightly deserve, and making the journey as stress-free and successful as possible.

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How to appeal an LTD claim denial in Ontario

We understand how disappointing and challenging it can be when your LTD claim is denied. It might feel like a setback, but remember, you still have options.

One such option in Ontario is the appeal process offered by the insurance company. At first glance, this might seem like a promising route — a chance to present your case again, hoping for a favourable reevaluation.

However, you’re asking the very same entity that denied your claim to overturn their own decision. Based on our extensive experience, successful LTD claim appeals are rare. Insurance companies often use the appeal process to wear you down and eat up the limited amount of time you have to file a legal claim for proper compensation.

Having a knowledgeable ally in your corner, like a disability lawyer at Samfiru Tumarkin LLP, can improve your chances of winning your benefits or compensation.

If you have been denied LTD in Ontario, call our team for a FREE consultation before you file an appeal with the insurance company. Once we review your situation, we will tell you if filing a legal claim is a stronger option than spending time submitting multiple appeals.

If you do decide to file an LTD appeal in Ontario, here’s a guide to help you through it:

1. Understand the reason for denial

Begin by carefully reading the denial letter. It will provide specific reasons why your claim was denied. This information is crucial for your appeal.

2. Get to know your policy

Try to understand the key parts of your insurance policy, especially those that talk about how you can appeal a denial. Make sure you are clear about the timelines you need to follow.

3. Collect more information

It might be helpful to gather more medical information or opinions that support your claim.

4. Write an appeal letter

Write a letter explaining why you think the denial was wrong. Try to be as clear and simple as possible.

5. Submit your appeal

Make sure you send your appeal and any extra information as soon as possible, keeping within any deadlines.

6. Keep track of your claim

Be sure to check on the status of your appeal. It’s also important to be ready to give any extra information to the insurance company if they ask for it.

7. Contact Samfiru Tumarkin LLP if you lose your appeal

If your appeal for LTD benefits isn’t successful, don’t lose hope. Contact our team immediately for a FREE consultation to find out what your next steps should be.

Our experience

Some of our lawyers once worked for insurance companies. We know how they think, why they deny legitimate disability insurance claims from people who are too sick or injured to continue working – and we know how to obtain the compensation you are legally entitled to.

Because our firm has a leading reputation in Canada as effective and tenacious advocates, insurance companies are more likely to pay you what you are rightfully owed. Don’t walk away from your rights. That’s what the insurance company wants you to do. Contact us for a free review of your case, and get the answers and assistance you deserve.

The disability lawyers at Samfiru Tumarkin LLP are nationally recognized leaders in insurance and disability law. We provide the public with access to their legal rights through programs like our ongoing Disability Law Show on TV, online resources (including FAQs on long-term disability), livestreams, more than one thousand media interviews, and constant advocacy.

Contact Canada’s most positively-reviewed disability law firm today at 1-855-821-5900 for a free consultation. You can also submit any questions you have about your LTD rights to help@disabilityrights.ca, and a long-term disability lawyer at Samfiru Tumarkin LLP will answer them promptly.