What LTD Benefits Are, How They Work, and What to Do If You’re Denied
If you’re unable to work due to illness or injury, long-term disability (LTD) benefits are designed to replace a portion of your income. In Prince Edward Island, these benefits usually come from private insurance policies through your employer or an individual plan — not the government.
Unfortunately, many PEI workers find that LTD claims are delayed, reduced, or denied, even when their medical condition hasn’t changed.
This guide explains how long-term disability works in PEI, how much LTD pays, how long benefits last, and what to do if your claim is denied.
What Is Long-Term Disability (LTD)?
Long-term disability insurance provides monthly income replacement when a medical condition prevents you from working for an extended period.
Most LTD policies:
- Begin after short-term disability (STD) or sick leave ends
- Pay a percentage of your pre-disability income
- Continue as long as you meet the policy’s definition of disability
LTD benefits are contractual, meaning the rules come from your insurance policy — not PEI employment standards legislation.
How Long-Term Disability Works in PEI
In most cases, LTD coverage in Prince Edward Island is provided through:
- Employer group insurance plans
- Individually purchased disability insurance policies
Your entitlement depends on:
- The wording of your LTD policy
- Medical evidence from your healthcare providers
- Ongoing insurer reviews of your condition
Insurance companies routinely reassess claims, even after benefits have been approved.
How Much Does LTD Pay in PEI?
Most long-term disability policies pay 60% to 70% of your gross income, up to a maximum monthly amount set by the policy.
Your actual payment may be reduced by:
- Canada Pension Plan (CPP) Disability benefits
- Other disability or income replacement benefits
- Partial return-to-work earnings
Some LTD benefits are taxable, while others are tax-free, depending on who paid the insurance premiums.
How Long Do LTD Benefits Last?
LTD benefits typically last:
- Until you no longer meet the policy’s definition of disability
- Until a maximum age (often age 65)
- Or until benefits are terminated by the insurer
Many claims are cut off around the 24-month mark, when the policy definition of disability changes.
Who Qualifies for Long-Term Disability Benefits?
Qualification depends on your policy’s definition of disability, which usually changes over time:
First Stage: “Own Occupation”
You may qualify if you can’t perform the essential duties of your own job, even if you could theoretically work elsewhere.
Second Stage: “Any Occupation”
After a set period (often 24 months), you must show you can’t perform any occupation for which you are reasonably suited by education, training, or experience.
This transition is one of the most common reasons LTD benefits are terminated.
Why LTD Claims Are Denied or Cut Off
Common reasons insurers deny or stop LTD benefits include:
- Claiming insufficient medical evidence
- Arguing you can work in another occupation
- Surveillance or social media monitoring
- Alleged failure to follow treatment
- Paperwork or deadline issues
A denial does not mean the insurer is correct — it means they are disputing your entitlement under the policy.
What to Do If Your LTD Claim Is Denied in PEI
If your LTD claim is denied or terminated:
- Do not assume the decision is final
- Do not rush to appeal without legal guidance
- Do not rely solely on the insurer’s explanation
Early action can make a significant difference in protecting your benefits and your long-term financial security.
When to Speak With a Disability Lawyer
LTD disputes are legal issues, not just medical ones. Insurance companies interpret policy language strictly — often in their own favour.
Speaking with a disability lawyer can help you understand:
- Whether the denial is defensible
- What evidence actually matters
- How to challenge unfair insurer decisions
- The best strategy to protect your benefits going forward
Get Help With a Long-Term Disability Claim in PEI
If your LTD benefits were denied, delayed, or cut off, early guidance matters.
A short conversation with a PEI long term disability lawyer at Samfiru Tumarkin LLP can help you:
- Understand why your claim was denied
- Determine whether the insurer followed the policy
- Protect your right to ongoing benefits
👉 If your long-term disability benefits are at risk in Prince Edward Island, getting clear legal advice early can make a meaningful difference.