Applying for Long-Term Disability Benefits

Long-Term Disability Insurance: The Basics

Many people feel understandably discouraged when they receive a letter denying their claims for long-term disability benefits. 

Denial letters are intentionally worded to give you the impression that your condition isn’t serious enough to make you eligible for disability benefits. However, insurance companies routinely deny LTD claims, even when the insured has a strong case for benefits. 

If your long-term disability claim was denied, don’t give up or lose hope. Partner with a long-term disability lawyer in Toronto that is passionate about protecting your rights.

1. Applying for LTD benefits

When applying for LTD benefits, you will have to fill out an application form created by the insurance provider. You can find this form on the insurer’s website, or you can ask your employer for it.

The application form will consist of a section for you to complete, as well as a section for your doctor to complete.

You will be required to provide information, including when your disability started, what your symptoms are and what your job duties include.

Your doctor will complete their portion and include your specific limitations and restrictions, how these restrictions affect your ability to work, and your prognosis and treatment plan.

The insurance company may require additional medical documents to support your claim and will receive them directly from your doctor.

In order to receive LTD benefits, you must be disabled from working in your own occupation. This does not mean that you must be completely physically disabled from performing all aspects of your job. Rather, it means that you must be unable to perform the substantial and important functions of your job.

Note that, after two years, in order to continue to receive disability benefits, you must be disabled from working in any occupation. You may also receive a phone call from someone from the insurance company to ask you questions.

The insurance company will then use all of this information to assess whether or not you will be approved for LTD benefits.

2. The Qualifying Period (also called the Elimination Period)

There is usually a qualifying or elimination period, which can range from 90 to 180 days, during which no long-term disability benefits are paid.

What financial support does an employee have during the qualifying or elimination period?

An employee may have access to short-term disability insurance (STD) through a group or individual plan of insurance.  Indeed, the normal pathway to long-term disability often involves applying for STD first, and then applying for long-term disability after the STD benefits lapse.

There may be other avenues of financial support for those without STD insurance. For example, they may eligible for Employment Insurance (EI) sickness benefits, which can provide you with up to 15 weeks of financial assistance if you cannot work for medical reasons.




3. Amount of Benefits / Payments (and Deductions)

After the qualifying period, you will be fully approved for LTD benefits if the insurance company agrees you are totally disabled and unable to perform your job.

Your policy language determines how much you will receive. Typically, LTD benefits are between 60-75% of your regular earnings.

Policies may also provide that benefits last to the age of 65 or for a set number of years.

Your disability benefits may be reduced so that your total income from all sources does not exceed a certain amount. For example, the policy may state that your total income from all sources is not to exceed 85% of your pre-disability earnings if the benefit is taxable or 85% of the pre-disability net earnings if the benefit is non-taxable.

Benefit amounts may also be reduced by other benefits that a person receives or is entitled to receive from sources specified by the policy wording.

Examples of deductions that may be made from an LTD benefit include:

  • Canada pension plan (CPP).
  • Workers’ compensation (WSIB) or similar coverage.
  • Group, association or franchise plan.
  • Retirement or pension plan.
  • Earnings or payments from any employer, including severance payments and vacation pay.
  • Self-employment income.
  • Government plans, except those that are excluded, such as EI benefits.

4. Ongoing Communication

When you are receiving long-term disability benefits, the insurance company will require ongoing communication with you and your doctor(s). You will likely have to submit additional medical documentation on an ongoing basis to continue to receive LTD benefits.

The insurance company will also check in to ensure that you are following your doctor’s prescribed treatment plan. If you fail to follow your doctor’s recommendations, your LTD benefits can be cancelled.

Keep in mind that your LTD benefits can be cancelled at any time should the insurance company decide that you are no longer totally disabled, or you are not following your obligations as set out in the insurance policy.

5. Duration of Coverage

An LTD policy generally continues until the person is able to return to work, no longer meets the definition of disabled, the person breaches the terms of the policy, or the person reaches retirement age (age 65) . Though, some policies only pay benefits for a fixed period of time (such as 5, 10, or 15 years).

6. Change in Definition

Whereas for the first two years the employee must only prove that they are disabled from performing their own occupation (called the “own occupation period”), thereafter, the employee must prove that they are disabled from performing any occupation to which they are reasonably suited.

Because the test for “any occupation period” is quite a bit more onerous than the “own occupation period,” insurance companies will typically resist paying benefits during the “any occupation period”.

It is generally in the lead-up to this change in definition that the insurer will send the insured to one or more independent medical examinations (IMEs), with the aim of gathering medical evidence to use to support termination of the benefits.

Often, the insurer will employ surveillance too.

Learn More

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LTD Denied?

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Disability Resources

Frequently Asked Questions About Long-Term Disability

What are Long-Term Disability Benefits?

Long-term disability benefits (often called “LTD” benefits) are monthly income-replacement payments made to a person who cannot work because of a disability. To be eligible for benefits, you must be a covered person under a disability plan (either a group insurance plan through your workplace or association, or an individual plan).

When should I apply for Long-Term Disability Benefits?

While you aren’t eligible to receive long-term disability benefits until after your policy’s elimination or waiting period, you can and should begin the application process as soon as you anticipate that your disability will continue to prevent you from being able to work. LTD claims can take weeks to prepare and submit. You will also likely be asked by the insurance company to provide further information, medical records and reports which add to the delay in processing your application. Most long-term disability policies also have a limit for the length of time after becoming disabled that you are allowed to make a claim. If you do not apply for benefits before the deadline set out in your policy, your insurance company will deny your claim.

What are the differences between short-term and long-term disability insurance?

Every insurance policy has its own wording, guidelines and coverages, but both short-term and long-term disability policies typically provide a percentage of an employee’s earnings as income replacement if the employee qualifies for benefits. An employee can only start receiving LTD benefits after their Employment Insurance or short-term disability coverage has ended. Some of the differences between short-term disability and long-term disability coverage include: • Short-term disability insurance sometimes provides a higher percentage or maximum payment than LTD benefits, however, LTD benefits are paid over a much longer period of time. • Short-term disability benefits typically only cover an employee’s earnings whereas long-term disability benefits tend to include rehabilitation and medical expense coverage. • Claims processing happens a lot faster with short-term disability benefits as they are meant to be approved within days or weeks of an employee applying for them. LTD claims can take months to process after they have been submitted. • LTD benefits can be stopped after a specified period of time (usually two years) if the insurance company feels that the employee is able to work in another occupation to which they are reasonably suited. Short-term disability policies are not subject to this change in the definition of what is considered a 'disability'.

What is a long-term disability lawyer?

A long-term disability lawyer is one that specializes in disability insurance law. As LTD lawyers in Toronto, we know what it takes to file a successful claim, how to handle a denial and how to litigate LTD claims in court. The sad truth is that insurance companies tend to look for any reasons to deny LTD claims and often the only way to get the benefits you’re entitled to is by having a long-term disability lawyer on your side who knows the ins and outs of the process.

When should I call a long-term disability lawyer in Toronto?

Ideally, the best time to call a long-term disability lawyer is before you file your claim. A trustworthy long-term disability lawyer in Toronto will review your policy, understand the criteria for filing a successful claim and put together the documentation you will need to give yourself the best chance of getting your application for benefits approved. Most people, however, only call a long-term disability lawyer after their claim for LTD benefits is denied. If the insurance company denies your claim, call a long-term disability lawyer immediately. You may still be able to receive the benefits you deserve, but there are time limits for making a legal claim against the insurance company. This is often the only way to ensure that they fairly consider your application for benefits.

How do I find a long-term disability lawyer in Toronto?

Finding the right long-term disability lawyer in Toronto is an important process. The person you choose will be responsible for getting you the compensation you’re entitled to when you need it most. Read disability lawyer reviews and consider a consultation to ensure the lawyer is equipped to provide the assistance you need, and at a reasonable price. At Ertl Lawyers, we offer free consultations to better understand your case and walk you through your options.

How long do long-term disability benefits last?

Long-term disability payments are either paid for a set number of years (e.g., 2, 5 or 10 years) or until the policyholder reaches a certain age (usually 65 years old).

How much does long-term disability pay?

The amount of the disability payment is set out in the policy of insurance, but it will be based either on a fixed amount (e.g. $2,500 per month) or else calculated as a percentage of your salary (mostly between 60% and 75% – and frequently it is 66.7%)

How quickly can I get long-term disability payments?

It depends on the language of your policy. That said, all long-term disability insurance plans will have something called a “qualifying period” (also called a “waiting period” or "elimination period"). This period is typically between 90 and 120 days long. You must be disabled for the entire waiting period before you can receive long-term disability benefits.

What am I supposed to do during the “qualifying period” if I need financial support?

Some employers provide their own paid sick leave or short-term disability plan. So, you should start there. Otherwise, you can apply for Employment Insurance (EI) sickness benefits. EI sickness benefits can provide you with up to 15 weeks of financial assistance if you cannot work for medical reasons. You could receive 55% of your earnings up to a maximum of $573 a week. You must get a medical certificate to show that you’re unable to work for medical reasons. Medical reasons include illness, injury, quarantine or any medical condition that prevents you from working.

How “disabled” do I have to be in order to get long-term disability benefits?

You must be “totally disabled” from your current occupation. However, this does not necessarily mean that you have to be completely physically incapable of performing all aspects of your job. The test is whether your injuries prevent you from performing the substantial and important duties of your job.

How do I prove that I am disabled?

You will need medical evidence. Usually, when you apply for LTD benefits, your doctor will have to fill out a form (often called the "Physician's Statement"). You may wish to meet with your doctor before he or she completes the Physician’s Statement to ensure the doctor includes all relevant information about your disability. The doctor should attach all supporting documentation such as test results, specialist consultations reports and any other records that support your claim.

The insurance company is asking for more information, what should I do?

If you can, you should provide the insurance company with the requested information. In the case where you have provided all of the relevant documents to the insurer, it may be appropriate to direct the insurance company to speak with your doctor directly, particularly where the insurer has any outstanding concerns or questions related to your disability.

What happens if my application for long-term disability benefits is denied (or terminated)?

You will receive a "denial letter" explaining that your application for long-term disability benefits has been denied, and the reason why. The denial letter will also set out the time frame during which you can make an appeal. Most of our clients contact us after they receive a denial letter. We offer a no-obligation, free consultation. We will help you understand the reason for your denial, and we will discuss your options with you.

Should I appeal the denial (or termination) of my disability benefits?

It depends. If your condition has worsened or changed in a significant way, or you have additional medical documentation to support your claim, it might be worth appealing your denial. However, in many cases, we find that our client’s condition is generally unchanged, they remain disabled, and they have already provided complete medical documentation. In these cases, it probably makes sense to commence a legal claim instead. Caution: It is important that you consult an experienced long-term disability lawyer to discuss your options and strategy.

Why did my insurance company stop my benefits after two years (even though my condition hasn’t improved)?

Under most long-term disability plans, the insured will receive benefits (typically for two years) if they are totally disabled from performing their "own occupation". After two years, the policy will only pay out benefits if the person is totally disabled from performing "any occupation". This is called a "change in definition".

Are long-term disability benefits taxed?

It depends on who pays the premiums. In a group insurance plan, long-term disability benefits are untaxable if you (and the other plan members) pay 100% of the premiums. If your employer pays any portion of your premiums, your benefits will be taxable (unless your employer includes the premiums in your taxable income.

After being denied long-term disability benefits, my employer is pressuring me to return to work, what should I do?

If you have been denied long-term disability benefits and are being pressured to return back to work, you should consult with a long-term disability lawyer. Generally, the employer should be informed that you are either appealing the denial or that you are hiring a lawyer to dispute the denial. Returning to work before you are healed is a recipe for trouble. You are likely to aggravate your disability. We find that returning to work prematurely often results in an irreparable breakdown in the employer/employee relationship, often resulting in the termination of the employee. Caution: Often, when an employee is denied benefits, the employer will seek “additional” information from the employee (e.g. medical information) or continual “updates”. Many times, the employer is setting up the employee. Meaning that if the employee doesn’t provide sufficient information to justify their disability, the employer will say that the employee has “abandoned” their job.

What benefits are available to me if I become disabled?

Depending on the nature/cause of your injury or illness, the terms of any plan of insurance you might have, and what government programs are available, your options for financial support could include: • Short-Term Disability or Weekly Indemnity Benefits through a group insurance plan; • Employment Insurance (EI) Sickness Benefits; • Long-Term Disability Benefits through a group plan or private/individual policy; • Disability Creditor Insurance (under your mortgage or credit cards); • Critical Illness Insurance; • Accidental (Death) or Dismemberment Insurance; • Workplace Safety Insurance Benefits (WSIB); • Ontario Disability Support Plan (ODSP); • Ontario Works (OW); • Income Replacement Benefits (IRB’s); • Tort Damages (personal injury); • Accident Benefits (motor vehicle); • Extended Health Care benefits; • Trillium (extended health benefits); • Canada Pension Plan Disability (CPPD); and • Disability Pension (employer).

Can my employer terminate me if I am receiving long-term disability benefits?

For the most part, an employer is entitled to terminate an employee for any (or no) reason, as long as the employer provides proper notice or pay in lieu of notice (i.e., severance). However, if an employee’s termination is because of (or influenced by) the person’s disability, the employer may be liable for human rights damages. Discrimination based on disability is prohibited under Ontario’s Human Rights Code. In certain circumstances, the employer may also be liable for additional monetary damages which can compensate an employee for the emotional harm caused by the “manner” of the termination (i.e., moral damages). Further, sometimes (though it is relatively rare), an employer can suffer “punitive” damages, which is the court's way of punishing heavy-handed, reprehensible conduct. You should always consult an employment and long-term disability lawyer if you have been terminated from your employment for any reason, regardless of whether you applied for LTD benefits or were receiving long-term disability benefits around the time of your termination or not. Putting aside possible human rights violations based on disability, many employees are wrongfully terminated by not receiving the notice or pay in lieu of notice they are legally entitled to upon termination.

What happens if I can never go back to work?

From an employment law perspective, if it is determined that you are not likely to ever return to work, then your employment relationship may be "frustrated". In such a case, the employer is not obligated to provide you with any notice or severance, except for that which is required under the Employment Standards Act, 2000. This situation is rare because it can take years before a contract is said to be frustrated.

Are long-term disability benefits reduced by the amount of any severance pay I get after termination?

It depends on the plan. Many long-term disability plans provide that severance pay will be deducted from long-term disability benefit payments.

Is severance pay reduced by the amount of long-term disability benefits/payments I get?

Current case law provides that where the employee has paid 100% of the premiums of the disability plan, then the employee can receive both severance pay and long-term disability benefits. Meaning, there is no deducting one from the other.

How much does a disability lawyer cost?

How much a disability lawyer will cost depends on your specific needs. The overall costs depend on the work required on your case, associated timelines, and other circumstances. Contact our disability lawyers in Toronto to book a free consultation and get a quote based on your unique needs. We offer fair and flexible pricing including contingency fees where you don’t pay unless and until we get you money from the insurance company.

How can I find a disability lawyer near me?

If you’re wondering "how can I find a disability lawyer near me," you’ll be happy to learn that we are long-term disability lawyers equipped to help individuals across Ontario. Contact us today and get connected with an LTD lawyer who can help you wherever you are located..

Where do Ertl Lawyers offer long-term disability legal services?

Ertl Lawyers provides long-term disability legal services across most of Ontario. Our long-term disability lawyers are available in: • Western Ontario (Windsor, London, Kitchener-Cambridge-Waterloo, Guelph, Brantford, Sarnia) • Central Ontario (Barrie, Orillia, Peterborough) • Southern Ontario and the GTA (St. Catharines-Niagara, Hamilton, Burlington, Oakville, Milton, Halton Hills, Brampton, Mississauga, Toronto, Caledon, Aurora, Markham, Newmarket, Richmond Hill, Vaughan, Whitchurch-Stouffville, Pickering, Ajax, Whitby, Oshawa, Bowmanville, Clarington, Brock, Scugog, Uxbridge, Port Hope) • Eastern Ontario (Belleville, Kingston, Brockville, Ottawa, Cornwall), Northern Ontario (North Bay, Sudbury, Timmins, Sault Ste. Marie)

Long-Term Disability Benefits Denied?

Ertl Lawyers provides expert representation in long-term disability matters.

The vast majority of disability cases are resolved through negotiation and mediation – and that’s because insurance companies know that we are passionate about our clients’ rights.

How we can help you:

free disability policy analysis

free case assessment

applying for disability benefits

appealing a denial or termination of your long-term disability benefits

disputing a denial through a legal claim

handling all communications with your employer

protecting your employment

prosecuting human rights claims

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