Long-term Disability

Long-Term Disability Lawyers in Ontario

Many employers offer long-term disability benefits to employees as part of their group benefits packages. Long-term disability benefits provide income replacement to those who are unable to work for an indefinite period of time due to an illness or injury. 

More About LTD Claims

While every long-term disability policy is different, all policies require that an insured person satisfy a “qualifying period”(also known as an elimination period or waiting period), submit a complete application, provide updated medical application, participate in treatment/rehabilitation and be subject to a “change of definition” where the insurer’s definition of disability changes from “own” occupation to “any” occupation.

What type of benefits can I expect?

The amount of your long-term disability benefit will depend on your policy. Benefit amounts can be equivalent to 50%-85% of your monthly income. Depending on your policy, your benefit may or not be taxable.


Long-term disability policies are complex and contain many provisions. Letters from the insurance company may contain terms that are ambiguous or unclear. A lawyer can help you to understand your insurance policy and any letters from your insurer.

What if my LTD application was denied?

If your application for long- term disability benefits has been denied, or your benefits have been terminated, you should not hesitate to seek legal advice. It is always important to understand your rights and your options with respect to a denial of benefits and to know that you can pursue a court action against your insurer.

The lawyers at Aaron Waxman and Associates have handled many claims for long-term disability benefit denials and helped many clients achieve the settlements they deserve.

If you have a question about long-term disability benefits, call or e-mail Aaron Waxman and Associates - there is no charge to call us and there are no bad questions.

Answers to Commonly Asked Questions

  • Can I still apply for LTD benefits if I was fired?

    Yes. You can always submit an application if your employer’s benefits package included short-term or long-term disability benefits.

  • Can I make an LTD claim for workplace stress or employee burn out?

    If you have developed anxiety or depression as a result of workplace stress/burnout, to the point where you have a condition that renders you unable to work, you can make an application for long-term disability benefits.

  • What are the types of conditions that people make a long-term disability claim for?

    People make claims for disabilities such as:

    • Mental Illnesses including Depression, Anxiety and Bipolar Disorder
    • Chronic conditions such as Fibromyalgia and Chronic Fatigue Syndrome
    • Physical injuries such as fractures and spinal cord injuries
    • Cardiovascular Disease
    • Neurological conditions such as Parkinson’s Disease, Multiple Sclerosis, Stroke
    • Traumatic Brain Injuries
    • Arthritis Conditions such as Osteoarthritis, Lupus, Psoriatic Arthritis, Fibromyalgia, Gout, Rheumatoid Arthritis and Scleroderma
    • Gastrointestinal issues including Irritable Bowel Syndrome, Colitis, Crohn’s Disease, Diverticulitis and Diverticulosis
    • Gynecological issues including Endometriosis
    • Complications from Diabetes including Retinopathy, Peripheral Neuropathy, Charcot Fractures, Osteomyelitis
    • Cancers and cancer treatments
    • Complications related to cancer treatment including pain, fatigue, lymphedema, depression, anxiety
  • If you return to work after being on LTD benefits, and become disabled again, do you have to submit a new claim?

    Many long-term disability (LTD) policies have a “recurrence” clause, which means that if you return to work but are unable to continue working as a result of the same disability, you will not have to submit a new application. Instead, you can make a ‘recurrent’ claim. Under some policies, the time limit to make a claim for a recurrent disability is 6 months.

  • What happens to your extended health care benefits while on long-term disability benefits or during a lawsuit?

    During a claim for long-term disability benefits (or if your benefits have been denied during the lawsuit), if you have extended health care benefits that are usually paid for by your employer your benefits should still be available to you if you are still an employee.

  • What am I suing for if I start a lawsuit against my LTD insurer?

    If your claim for long-term disability benefits has been denied, by hiring a disability lawyer, you can start a court action against your insurance company.


    What you are suing for is a declaration of coverage (that you are entitled to benefits) and a reinstatement of benefits (also referred to as getting back on claim).


    When settlement of your case occurs, you have the option of receiving a lump-sum settlement or reinstatement of benefits. It is often the case that a lump-sum settlement occurs. If you have questions about the legal process or how a lawsuit works, contact a disability lawyer today.

  • What does "total disability" mean in a long-term disability claim?

    Each long-term disability policy may be different, but in order to qualify for benefits, a person must meet the definition of totally disabled.


    A total disability means that you are reasonably unable to carry out the normal functions of your job. It does not mean that you have to be completely physically unable to do any part of your job, but that your injury or illness is such that common sense requires you to stop working so you can focus on getting better. As a result of your injuries or illness, you are unable to perform the essential duties of your own occupation.


    This is the definition your insurer will go by during the “own occupation” period of your disability. When the own occupation is over, you are considered totally disabled if you are unable to perform any occupation for which you are reasonably suited for or could become suited for.


    You should review the definitions section of your policy, or have a lawyer review it, to find out what your LTD policy states.

  • Can I apply for LTD benefits if I didn't receive full STD benefits?

    If you have access to STD benefits and don't receive payments for the whole period, that doesn't necessarily mean that you are no longer disabled from working. STD benefits are paid for a specified period of time. It usually this covers the "qualifying period" for LTD benefits.


    In order to receive and qualify for LTD benefits, you need to meet the requirements for disability during the waiting period.


    Even if your insurance company did not pay you the full amount of short-term disability benefits, or does not feel you meet the qualifying period, you should still apply for long-term disability benefits if you are still unable to work and if your doctors continue to support that you are disabled.

  • What do "Own Occupation" and "Any Occupation" mean?

    In a long-term disability claim, you are assessed as to whether or not you can perform the essential duties of a) your own occupation and b) any occupation. In most policies, the own occupation period lasts for 2 years, but this depends on the policy.


    Own occupation refers to your pre-disability occupation; the job you held at the time your disability occurred.


    Any occupation refers to any occupation for which you are reasonably qualified, or could become qualified for by reason of education, training or experience.


    Own Occupation Test

    This test applies to the first 24 months of disability (or the period set out in your policy). Total disability during this period of time means that you are unable to work at your own occupation and perform the essential duties of your job.


    Any Occupation Test

    Total disability refers to the inability to work at any occupation. After the 24 month period, your continued eligibility for long-term disability benefits will be based on whether you are unable to perform the essential duties of any occupation for which you are reasonably qualified. This includes occupations you could become qualified for by reason of education, training or experience. 


    It is important to read your own policy to find out what tests are applicable and when they apply. 

  • Do I need to participate in a graduated return to work program? What if it makes my symptoms worse?

    Your insurer may try to coordinate what is known as a graduated return to work program with your employer. A graduated return to work is a schedule that gradually increases the number of hours and days you work until you reach full time hours and days at work. This may include modified duties if you are unable to resume your regular duties.


    Usually your insurer will write to your treating physician and treatment providers to get approval for the graduated return to work plan, and to determine your restrictions and limitations.


    If the graduated return to work plan and returning to work increases your symptoms, and you are unable to continue working, you must provide supportive medical evidence to your insurer. If you are unable to participate in the program entirely, you would also need to provide supportive medical evidence showing that your symptoms would be made worse if you participated.

  • Do I have to participate in a work hardening program? What if it makes my symptoms worse?

    Your insurer may arrange what is known as a “work hardening program” for you if they feel that you would benefit from a rehabilitation program that prepares you for a return to work. For example, if you have chronic pain, you may receive physiotherapy sessions, chronic pain education and cognitive behavioural therapy sessions in order to prepare you for a return to work.


    If the program makes your symptoms worse, or you are unable to participate, you must provide medical evidence to support your medical status and/or inability to participate in the program or are unable to complete it.

  • What is an independent medical examination, and do I have to attend it?

    An independent medical examination is an in-person assessment with a doctor chosen by the insurance company. Throughout your disability claim, or during a lawsuit against your insurer, it is important to attend scheduled appointments made by your insurance company to show that you are a willing participant in the legal process.


    During your disability claim, your insurance company may request that you be seen for an assessment so that they can obtain an opinion about your condition. It is important to attend this appointment, and to honestly answer all questions asked by the assessor.

  • What is a waiver of premium?

    If you are responsible for paying a premium for LTD benefits, if applicable, when your benefits are approved, the insurer typically will approve you for a waiver of premiums for long-term disability and optional life benefits. This means you do not need to pay premiums as long as you meet the test for total disability. If your claim is denied, you need to continue paying premiums in order to maintain your coverage.

  • What is a no evidence maximum?

    Some policies have what is called a "no evidence maximum”, which means there is a maximum benefit amount you can receive without providing proof of medical evidence. The policy may have a formula, but you can only be paid a benefit up to the no evidence maximum, which may be less than what you could be entitled to. For example, the policy may have a $1,000 limit, but your earnings are $5,000 monthly. The benefit formula is the lesser of 50% of monthly earnings or the no evidence maximum, so you would only receive $1,000.

  • What are "basic earnings"?

    Basic earnings refer to the regular salary you receive from your employer, not including any overtime, bonus pay or incentives.

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