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 medical conditions qualify for long-term disability in Ontario?

Long-Term Disability (LTD) in Ontario covers a wide array of medical conditions that interfere with your ability to work over a prolonged period. The determination of eligibility largely depends on the nature and severity of the condition, as well as specific policy guidelines and definitions of disability stipulated by the insurance provider.

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?

The elimination period in LTD insurance is the waiting time between the start of your disability and when you begin receiving benefits. It is also known as the “waiting” or “qualifying” period.

Usually lasting 90 to 120 days, this period varies by policy. During this time, you won’t receive LTD benefits, but you can use STD insurance for financial help until the elimination period ends. A longer elimination period typically means lower insurance premiums.

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How much does LTD pay in Ontario?

Long-Term Disability (LTD) benefit payments in Ontario varies based on multiple factors, such as the specific LTD insurance policy, the beneficiary’s salary, and the severity and type of disability.

Here are some key points to consider:

• Percentage of Income: LTD insurance typically pays between 60% to 80% of the beneficiary’s pre-disability gross income. However, the exact amount can vary based on the terms of the specific insurance policy.
• 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.
• Additional Income Considerations: If the beneficiary is receiving additional income benefits, such as those from Canada Pension Plan Disability or WSIB, the LTD benefit amount might be reduced accordingly to avoid income duplication.
• Tax Implications: LTD benefits may or may not be taxable, depending on how the premiums were paid. If the employer paid the premiums, the benefits are usually taxable. If the beneficiary paid the premiums, the benefits are often received tax-free.
• Duration of Benefits: The duration for which one can receive LTD benefits also varies. It often depends on the nature of the disability and the specific terms set forth in the insurance policy, such as reaching retirement age or recovery from disability.

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.

Understanding the terms of the specific LTD policy, being aware of additional income sources, and considering tax implications are vital in determining the exact LTD benefit payment in Ontario.

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How long does long-term disability last?

LTD benefits are designed to provide support for an extended period when someone is unable to work due to a disability in Ontario. These benefits generally continue until either the individual no longer meets the policy’s definition of “disability,” or they reach the end of the specified coverage period, which is often up until the age of 65.

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

There are many different types of disability benefits available in Ontario, each with their own purpose, eligibility, amounts and duration.

These benefits are provided by private insurance companies, the Ontario provincial government or the Canadian federal government.

Long-term Disability Insurance Ontario

This type of long-term disability benefit in Ontario is sourced from the private sector, being provided, managed, and paid for by insurance companies. To access the benefits when needed, it is essential to enroll in the insurance program and consistently pay the monthly premiums.

There are predominantly two kinds of long-term disability benefit plans available through LTD insurance companies in Ontario: Individual Disability Insurance and Group Disability Insurance.

• Individual Disability Insurance is a personalized form of insurance, purchased directly and designed primarily for high-income individuals, professional service providers, and business owners. Purchasers of this insurance receive specific, pre-determined monthly payments that are often based on income loss and may continue up until or even beyond the age of 65. Notably, if you fully cover the insurance premiums, the benefits received are tax-free. It’s a popular choice among high-earning professionals due to its clarity in benefits and tax advantages.
• Group Disability Insurance, on the other hand, is commonly included in employment benefits packages and is available to employees, union members, or members of professional associations. This insurance encompasses both short-term and long-term disability benefits, which are geared towards replacing a portion of your income during periods of disability. The short-term benefits offer a percentage of your income for a limited time, benefiting a significant number of Canadians. Long-term benefits kick in following the expiration of short-term benefits or EI Sickness benefits, usually covering between 60% to 80% of your income, subject to certain maximum thresholds. It’s essential to carefully review the terms of your group insurance plan as various factors such as CPP disability and severance packages may influence the benefits you receive. Moreover, the tax implications of these benefits can vary based on who contributes to the insurance premiums.

By thoroughly understanding your insurance plan or seeking professional advice, you can navigate and optimize the disability benefits available to you.

Employment Insurance Sickness

The Employment Insurance (EI) sickness benefit is a short-term benefit from the federal government, helping workers who can’t work due to illness or injury. To get this benefit, you must have recently worked in Ontario and paid into the EI program.

If eligible, you’ll get 55% of your usual earnings, up to $650 weekly, and you can receive this for up to 15 weeks. Remember, you can’t get EI Sickness Benefits and short-term disability benefits at the same time. If you do, you might have to pay back the EI benefits.

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)

Workers’ Compensation in Ontario is a specialized provincial long-term disability benefit overseen by the Workplace Safety and Insurance Board (WSIB). It covers most industries and workplaces in Ontario, and pays for medical costs and loss of income.

To be eligible for WSIB, you must experience an injury or illness caused by work, and be employed in Ontario by a company that is covered by the WSIB program.

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• The difference between LTD and WSIB

WSIB pays 85% of your wages, with a maximum annual earnings limit of $110,000. While the income loss payments stop at age 65, the medical coverage can continue for life.

If you are not sure if your employer is covered by this type of insurance, you can check directly with the WSIB.

Ontario Disability Support Program (ODSP)

The Ontario Disability Support Program (ODSP) is another provincial long-term disability assistance program managed by the Ministry of Children, Community and Social Services. It is designed to meet the unique needs of people with disabilities who are in financial need, or who want and are able to work and need support.

To be eligible for ODSP, you must be a resident of Ontario, be in financial need, and have a substantial physical or mental disability that is expected to last a year or more, making it difficult to care for yourself, take part in community life or work. Applying for ODSP benefits involves two steps. First, the government looks at your financial eligibility. If you meet the criteria, your disability status will then be evaluated.

If you qualify for ODSP benefits, the payment is up to $1,308 per month, which can run for life, but at a reduced amount at age 65 due to CPP payments. ODSP provides two types of support:

• Income Support: Helps people with disabilities who are in financial need pay for living expenses, like food and housing.
• Employment Support: Offers help to people with disabilities who can and want to work but need assistance.

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

Canada Pension Plan Disability (CPPD) Benefits

The Canada Pension Plan Disability (CPPD) benefit is a federal long-term disability benefits designed to provide you with financial support if you are unable to work due to a severe and prolonged disability. It is run by Employment and Social Development Canada (ESDC).

You are eligible for CPPD in Ontario if you have contributed to the Canada Pension Plan and have a long-term physical or mental disability that prevents you from working regularly.

CPPD payments are deposited monthly, for an average amount of $1,078.06, up to a maximum of $1,538.67. These payments go until age 65.

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

To apply for CPPD, you need the necessary documentation, including medical information about the disability.

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

Disability Tax Credit (TDC)

The Disability Tax Credit (DTC) is another long-term disability benefit in Canada provided by the federal government. It is a non-refundable tax credit run by the Canada Revenue Agency (CRA) aimed at helping people with disabilities or their supporting persons reduce the amount of income tax they may have to pay.

To be eligible for the DTC in Ontario, you need to be a taxpayer in Canada. If you have a disability and are not a taxpayer yourself, you’re still eligible to claim the benefit if you are financially dependent on someone who pays taxes, allowing the benefit to be directed towards that person.

The DTC is unique as it provides a refund of federal taxes already paid, instead of offering monthly payments.

Applying for the DTC involves a straightforward process. A qualified medical practitioner must fill out and certify the Form T2201 (Disability Tax Credit Certificate) confirming that you have a severe and prolonged impairment. This form is then submitted to the CRA for approval.

If you’re approved for the DTC, the credit could reduce the amount of tax you owe and could also open the door to other federal, provincial, or territorial support, such as the Registered Disability Savings Plan (RDSP).

If your child has a long-term disability, you may be eligible for the child disability benefit, receiving monthly payments from the Federal Government. Eligibility requires qualification for the Canada Child Benefit, and your child must also meet the disability tax credit criteria.

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

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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 file a long-term disability claim 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 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.