If you’ve become disabled and unable to work due to an illness or injury, you’re probably worried about how you’ll pay your bills and provide for yourself and your family. Long-term disability (LTD) benefits are supposed to give you financial protection when a disability leaves you unable to work – but the process of getting those benefits can be confusing and overwhelming, especially when you’re already dealing with a medical condition. Many people have lots of questions: What conditions qualify for LTD? How do I apply? What happens if I’m denied? If you’re feeling lost and frustrated trying to figure out long-term disability in Ontario, know that you’re not alone. In this article, we’ll explain in plain language how LTD works, your rights, and what you can do to get the benefits you need and deserve.
In Ontario, there are two main types of long-term disability insurance: individual policies you purchase yourself and group policies you get through your employer.
Individual LTD Policies: are ones you buy on your own, usually through an insurance broker or financial advisor. You choose the insurance company, the amount of coverage, the waiting period, and other policy features. Premiums are based on your age, health, occupation and the coverage you want. Individual policies are fully underwritten, meaning the insurance company will assess your health and risk factors before deciding to insure you. If you qualify, you pay the premiums, and the policy belongs to you, even if you change jobs.
Group LTD Policies, however, are provided by your employer as part of your benefits package. Your employer chooses the insurance company and the basic policy terms, and the premiums are typically shared between you and your employer. You’re automatically enrolled without having to go through underwriting. The main advantage is that group coverage is often heavily subsidized by employers, so it’s more affordable than buying an individual policy. The downside is that coverage is tied to your job – if you change employers, you usually can’t take the policy with you.
While there are important differences, the key thing to remember is that both individual and group LTD policies are supposed to provide you with income protection if you become disabled and can’t work. If your claim is unfairly denied, you have the right to challenge that decision and get the benefits you deserve, regardless of your policy type.
If you can’t work because of an injury or illness, short-term disability (STD) benefits can provide you with income replacement while you recover or for the time that you are substantially disabled.
To qualify for STD, you must meet the definition of disability set out in your disability plan. This typically means providing medical proof that you are unable to perform the essential or substantial duties of your own occupation due to illness or injury.
To apply for STD, you should:
If approved, you will receive a portion of your regular earnings (usually 60% to 100%) for a set period of time or until you are able to return to work. Normally, payments are made by automatic deposit from the day following the completion of the elimination period.
While the exact procedures may vary by employer and insurance company, the general process is similar. Below are links to the STD information pages for some of the major group disability insurance providers in Canada:
Remember, if your STD claim is denied, you have the right to appeal the decision or sue your disability insurance company for the wrongful denial of disability benefits. If your short-term disability benefits have been denied, reach out to our experienced disability lawyers, who can help you fight for the benefits you deserve.
Similar to short-term disability, long-term disability benefits are a type of insurance that provides you with a portion of your income if you become disabled and unable to work for an extended period of time due to illness or injury.
In Ontario, LTD benefits usually begin after a waiting period (known as the elimination period) and once any short-term disability benefits have been exhausted. Most LTD plans in Ontario replace 60-70% of your regular income and may be payable for a specified number of years or until you reach age 65, depending on the policy terms.
When you make a long-term disability (LTD) claim in Canada, the first two years are crucial. This period is known by most disability insurance companies as the “own occupation” phase. During this time, your disability insurer will consider you disabled if your medical condition prevents you from performing the essential or substantial duties of your specific job (although each policy working is slightly different).
The “own occupation” provision means that you qualify for benefits if you cannot do the job you were doing when you became disabled. The insurance company will look at the specific tasks and responsibilities of your job and determine if your medical condition hinders you from performing them.
For example, suppose you were working as a chef when you developed a chronic hand tremor. Your job requires precise knife work and handling hot dishes, which your condition now makes difficult or impossible. Under the “own occupation” provision, you would likely be eligible for LTD benefits because you can’t perform the essential tasks of your specific job as a chef. Similarly, if you’re a commercial electrician, suffer from the onset of serious epileptic seizures and cannot mount ladders to do your job – you would qualify for long-term disability benefits.
To determine if you qualify for benefits under the “own occupation” provision, the insurance company will typically require medical evidence from your doctor(s) outlining your condition, symptoms, and how they impact your ability to work. They may also ask for information from your employer about your specific job duties.
It’s important to note that during the first two years, the insurance company does not assess whether you can work in any other job or occupation but your own. They are solely focused on whether you can perform the duties of the job you held when you became disabled.
This “own occupation” phase is designed to provide you with financial support while you are unable to work in your specific job due to a disability. It gives you time to focus on your health, treatment, and potential recovery without worrying about finding a new job or adapting to a different occupation.
What happens to my benefits after two years with Canada Life or Manulife? Do I lose my benefits after two years? What is the change of definition, and why is it important?
In Canada, long-term disability (LTD) insurance policies typically include a “change of definition” provision that alters how disability is defined after a specified period, usually 24 months. This change significantly impacts a claimant’s eligibility for ongoing benefits.
During the initial period of an LTD claim, typically the first 24 months, the “own occupation” definition of disability applies. Under this definition, you are considered disabled if a physical or mental impairment prevents you from performing the essential duties of your own occupation—the job you held at the time you became disabled. If you can no longer work in your specific role due to a disability, you will likely qualify for LTD benefits during this time, even if you might be capable of working in a different occupation.
However, after the specified period (usually 24 months), the definition of disability changes to “any occupation.” Under this definition, you are considered disabled only if your physical or mental impairment prevents you from engaging in any occupation for which you are reasonably suited by education, training, or experience. This is a much more stringent definition of disability, as it means you must be unable to work in any job that you are qualified for, not just your previous role.
Under the “own occupation” definition, you are considered disabled only if your physical or mental impairment prevents you from engaging in any occupation for which you are reasonably suited by education, training, or experience.
Matt Lalande – Disability Lawyer
The shift from the “own occupation” to the “any occupation” definition often results in the termination of LTD benefits for many claimants. Insurance companies may determine that while a person is unable to perform their previous job, they are capable of working in another capacity. This can be particularly challenging for individuals who have worked in a specialized field or have limited transferable skills.
It is crucial for LTD claimants to understand the “change of definition” provision in their insurance policy and prepare accordingly. Gathering strong medical evidence that demonstrates the severity of the disability and its impact on the ability to work in any occupation is essential. Claimants may also benefit from vocational assessments that evaluate their skills, experience, and the labour market to determine if there are any suitable occupations they can reasonably perform.
In summary, the “change of definition” provision in Canadian LTD policies transitions the definition of disability from “own occupation” to “any occupation” after a specified period. This shift can lead to the termination of benefits for many claimants who may be unable to work in their previous roles but are deemed capable of working in other capacities. Understanding this provision and gathering comprehensive evidence is crucial for claimants seeking to maintain their LTD benefits.
If you’ve been denied long-term disability benefits in Canada, don’t lose hope. You have the right to appeal the decision, and hiring a skilled one of our disability lawyers can significantly improve your chances of success. Follow these recommendations to find the right disability lawyer for your case.
Look for experience: When searching for a disability lawyer, prioritize those with extensive experience in handling long-term disability cases. For example, our experienced lawyers have a deep understanding of the legal landscape and know how to navigate the complexities of the appeals process.
Check their track record: Research the lawyer’s success rate in disability cases. Look for client testimonials and case studies that demonstrate their ability to win appeals and secure benefits for their clients.
Consider their communication skills: Choose a lawyer who communicates clearly and empathetically. You want someone who listens to your concerns, explains the legal process in plain language, and keeps you informed at every stage of your case.
Evaluate their accessibility: Make sure the lawyer you choose is responsive and accessible. They should be available to answer your questions, address your concerns, and provide regular updates on the progress of your case.
Hire a local disability lawyer if you can: When you search for “hiring a disability lawyer near me,” you’ll find lawyers who are familiar with the local legal system and have established relationships with local medical professionals. A local lawyer can provide personalized attention and be more accessible for in-person meetings.
Discuss fees upfront: Most disability lawyers work on a contingency basis, meaning they only get paid if they win your case. However, it’s essential to discuss fees and payment structures upfront to avoid any surprises down the line.
Hire a lawyer that you like: Feeling comfortable with your disability lawyer is essential for building trust, fostering open communication, and reducing stress throughout the appeals process. A strong lawyer-client relationship is key to working together effectively and achieving a successful outcome in your long-term disability case.
Remember, the key to success in a long-term disability appeal is having a skilled and dedicated lawyer by your side. By following these recommendations and hiring a disability lawyer near you, you can increase your chances of securing the benefits you deserve.
At our firm, we have been passionately advocating for the rights of long-term disability claimants for nearly 40 years. We deeply empathize with the physical, emotional, and financial challenges you may face when your disability benefits are terminated, and we understand the pressure you may feel to return to work before you’re ready.
Our mission is to fight for the long-term disability benefits you are entitled to, allowing you to focus on your health and recovery without financial stress. If you or a loved one is dealing with colon cancer and has been denied or unfairly cut off from long-term disability insurance benefits, we are here to help. Our services aim to secure the benefits you need to support you financially as you recover.
Located in Hamilton, Ontario, our firm serves disability claimants throughout Canada.
We provide free consultations to individuals in Ontario and across the country. Contact us at 1-844-4-DISABILITY or reach out to us confidentially through our website for a complimentary discussion about your long-term disability rights and legal options.
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Short-term disability (STD) provides income replacement for a shorter period, usually while you recover from a temporary disability. Long-term disability (LTD) provides income protection for an extended period if you become disabled and unable to work due to illness or injury. LTD benefits usually begin after STD benefits are exhausted.
The “own occupation” period, typically the first 24 months of an LTD claim, is when you are considered disabled if your medical condition prevents you from performing the essential duties of your specific job. If you can’t work in your previous role due to disability during this time, you will likely qualify for LTD benefits.
After the initial “own occupation” period (usually 24 months), most LTD policies in Ontario change the definition of disability to “any occupation.” Under this definition, you are considered disabled only if your impairment prevents you from working in any job reasonably suited to your education, training, or experience, not just your previous role.
To apply for LTD benefits in Ontario, notify your employer, complete the required claim forms (including an attending physician’s statement), and submit the paperwork to your employer or their insurance provider along with supporting medical evidence. The insurer will then review your application and make a decision on your claim.
If your LTD claim is denied in Ontario, don’t lose hope. You have the right to appeal the decision. Consider hiring an experienced disability lawyer who can help you gather strong evidence, navigate the appeals process, and fight for the benefits you deserve.
“Matt Lalande halped get my long-term disability benefits back. It was a longer fight than expected, but he managed to help make things right again. Would recommend A+++++ Thank you Matt.”
Patricia Williamson
Long-Term Disability
“Matt Lalande helped me attain my long-term disability benefits. The denial of benefits caused me substantial stress on top of my existing condition. Matt Lalande and his team were very understanding and explained the whole process clearly. They were confident that we would be successful. Dealing ...
Cheryl Oddie
Long-Term Disability
My experience with Mr. Matt Lalande and his team was exceptional. Matt is a very impressive professional when involved in a long-term disability benefits denial. Matt and Heather responded to all my emails and phone calls in a prompt and efficient manner. Matt is a great and honest lawyer. I highly reco...
Payne Momich
Long-Term Disability
