Ontario Disability Claims
What is a disability claim?
Disability claims provide income replacement when illness or injury prevents you from working. STD typically covers the early period after you stop working; LTD is meant for longer absences. CPP-D is a federal program for severe and prolonged disabilities.
Many LTD policies use a two-stage test: first whether you are unable to perform the essential duties of your own occupation, and later (often after about 24 months, depending on the policy) whether you are unable to work in any occupation for which you are reasonably suited. Always check your specific policy.
This page is for employees with group benefits, individuals with private disability policies, and self-employed professionals with personal coverage.
Common reasons claims are denied or cut off
• Limited or inconsistent medical documentation
• Records, surveillance, or social media that appear to conflict with reported limits
• A pre-existing condition exclusion applied to your claim
• Missed forms, late proof-of-loss, or incomplete attending physician statements
• The “change of definition” period (for example, after about 24 months)
• Disputes over whether you meet the policy’s disability test
• Alleged non-compliance with reasonable treatment or rehabilitation
• Failure to attend an insurer-scheduled independent medical exam (IME) or assessment
• Return-to-work attempts that are misinterpreted as full capacity
• Social media posts or hobbies taken out of context
Why get a legal review early
Deadlines in policies - and in the law - can be short. Early advice helps preserve rights and avoid steps that harm your claim.
A strong record comes from consistent medical evidence: clear reports from your family doctor and specialists that describe symptoms, diagnoses (where available), functional limits, and expected course.
Internal appeals and lawsuits are different paths. Sometimes an internal appeal is useful; other times it causes delay without new evidence. Get advice on the best strategy for your situation.
If you were also terminated or are negotiating severance, disability and employment issues often interact with EI and CPP-D. Coordinated strategy matters.
What we review (checklist)
• Your benefits booklet and full policy wording, including definitions of disability
• Elimination/waiting periods, offsets, and maximum benefit calculations
• Exclusions and pre-existing condition clauses
• Denial or termination letters and the insurer’s reasoning
• Medical records, specialist reports, and functional/occupational assessments
• Essential job demands and how your limitations affect them
• Treatment plans, rehabilitation participation, and compliance requirements
• Insurer-scheduled IMEs, functional capacity evaluations (FCEs), and surveillance concerns
• Payment structure, arrears/backpay issues, and interest
• Practical settlement options and documentation needs
Internal appeal vs. lawsuit
An internal appeal asks the insurer to reconsider based on updated evidence and policy terms. Timelines are often short and may involve multiple appeal “levels.”
A lawsuit is a formal claim in court. It can lead to negotiations, mediation, and, if needed, a trial. The better path depends on your evidence, policy language, and timing. Get tailored advice before you choose.
CPP Disability and EI Sickness coordination
Policies often require you to apply for CPP-D, and any CPP-D amounts may be deducted from LTD benefits. EI Sickness benefits may bridge the gap before LTD begins.
Coordinating applications, ROE details, and payment timing helps reduce overpayments and ensures accurate offsets.
Timing & deadlines
Policies set proof-of-loss and appeal windows, and there can be contractual and statutory limitation periods to start a lawsuit. These time limits vary.
Act promptly and get advice before signing releases, withdrawing claims, or agreeing to repayment terms.
Our Ontario-focused process
Intake & document review: we gather your policy, denial letters, and medical records, and confirm timelines.
Policy & medical analysis: we map the disability test to your functional limits and job demands.
Strategy & evidence plan: we identify gaps, organize medical opinions, and choose appeal or litigation steps.
Negotiation, litigation & resolution: we pursue the appropriate path, explain options in plain language, and keep you informed.
We explain fees up front and in writing. No results are promised or guaranteed.
Who we help across Ontario
We assist individuals with group or private disability coverage across Ontario, including Toronto, Ottawa, Mississauga, Brampton, Hamilton, London, Kitchener-Waterloo, Markham, Vaughan, and Windsor. Virtual consultations are available province-wide.
What to send us
• Benefits booklet and full policy wording
• Denial/termination letters and all insurer correspondence
• Completed claim forms and attending physician statements
• Family doctor and specialist records, imaging, and test results
• Job description and physical/cognitive demands analysis (if available)
• Recent pay information and benefit statements
• CPP-D and EI application status and decisions
• Record of Employment (ROE) and any return-to-work/rehab plans
• Any surveillance notices or IME/FCE requests
• A simple timeline of events and symptoms
FAQs
Should I appeal internally or start a lawsuit?
It depends on your policy, timelines, and the strength of new evidence. Get advice early to avoid delays that can hurt your claim.
Do I have to apply for CPP-D?
Many policies require a CPP-D application and will offset the amount if approved. It can also help document the severity of your condition.
Can the insurer make me attend an IME or FCE?
Policies often permit reasonable examinations. Not attending can jeopardize benefits - speak with a lawyer about your obligations and rights.
What happens at 24 months on LTD?
In many policies, the test changes from “own occupation” to “any occupation.” Evidence needs may shift to show why you still meet the policy test.
Can I work part-time or try a gradual return?
Sometimes. Some policies allow rehabilitative or partial benefits, but rules vary and may affect payments. Get advice before you start.
Will my LTD be taxable?
Tax treatment can depend on who paid the premiums and policy terms. Seek individualized tax advice.
Speak with an Ontario disability lawyer
Book a confidential consultation to understand your options in clear terms so you can decide how to proceed. You’ll get practical guidance on evidence, timelines, and next steps.