If you can’t work due to illness or injury, long-term disability (LTD) benefits may replace part of your income. This page explains how to start an LTD claim in Ontario, what documents and medical evidence you typically need, common mistakes that lead to delays or denials, and what to do if the insurer refuses to pay.
Need help now? If your LTD claim was denied, delayed, or cut off, request a free 30-minute phone consultation or call (416) 907-9249.
Start Here: Long-Term Disability Resources
- Long-Term Disability in Ontario – Your Complete Guide
- LTD Denied – Common Reasons and What To Do
- Appealing an LTD Denial – Internal Appeal vs Lawsuit
- Limitation Periods & Deadlines – Don’t Miss Your Right to Sue
- CPP Disability + LTD – How They Work Together
- Long Term Disability Lawyer Toronto – Services
Step 1: Confirm You Have LTD Coverage
Most LTD coverage comes from:
- an employer group benefits plan, or
- a private disability insurance policy.
If you are unsure whether you have coverage, check:
- your benefits booklet or employee portal,
- any LTD policy documents you received, and
- HR/payroll deductions (some plans are employee-paid, employer-paid, or shared).
Step 2: See Your Doctor and Document Functional Limits
Insurers often focus less on the diagnosis and more on your functional restrictions (what you can and cannot do). Before you apply, it helps to ensure your medical records clearly describe:
- your symptoms and their frequency/severity,
- your work-related restrictions (physical, cognitive, psychological),
- treatment plan and medication effects, and
- why you cannot safely perform your job duties.
Step 3: Gather the Key Documents
Before submitting your LTD claim, collect (and keep copies of) the following:
- your LTD application package (employee statement + employer statement + attending physician statement),
- a copy of the LTD policy/benefits booklet,
- job description (or a clear list of your actual duties),
- medical records supporting restrictions and limitations,
- any correspondence from the insurer (emails, letters, claim notes), and
- if denied by phone, request the decision in writing.
If you are missing policy documents or the insurer’s file, a lawyer can help request your full claim file.
Step 4: Complete Forms Carefully
Common form mistakes that create delays or denials include:
- inconsistent dates (last day worked, first symptoms, first treatment),
- vague statements like “not well” instead of specific restrictions,
- downplaying symptoms (many people do this unintentionally),
- missing attachments (test results, clinical notes, specialist reports), and
- return-to-work language that conflicts with medical restrictions.
Step 5: Prepare for the Insurer Interview
Insurers may schedule a phone interview. This is not “just a formality.” Treat it like evidence gathering.
Before the call:
- review your forms so your answers match what you submitted,
- write down a short description of your typical day and key limitations,
- be ready to explain how symptoms affect work tasks (concentration, stamina, sitting/standing, driving, lifting, etc.).
During the call:
- be truthful and specific,
- avoid guessing—say you’ll confirm if you’re unsure,
- ask for clarification if a question is unclear, and
- make notes of what was asked and what you answered.
Step 6: Understand the Elimination Period
Most LTD plans have an elimination period (a waiting period) before LTD benefits begin (often after sick leave or short-term disability). The length varies by policy.
If you are unsure, check your policy or benefits booklet, or speak with HR/benefits.
What If Your LTD Claim Is Denied or Cut Off?
A denial is not necessarily the end of your claim, but it is a warning sign that deadlines may matter.
Common reasons insurers deny LTD claims include:
- “insufficient medical evidence” (often code for not enough functional detail),
- paperwork gaps or missed deadlines,
- insurer disagreement with your doctor,
- surveillance or selective interpretation of activities,
- insurer saying you can work in another job, especially after the “any occupation” change.
Next steps:
- Read: Long Term Disability Denied – Know Your Rights
- Read: Appealing Long Term Disability
- Read: LTD Limitation Periods & Deadlines
Limitation Periods and Deadlines
In many LTD disputes, lawsuits must be started within strict limitation periods. The start date is not always obvious, and insurers are not required to warn you.
For a plain-English explanation, see:
Older case law also addresses how limitation issues can arise in LTD matters, including the Ontario Court of Appeal decision in P. v. Sanmina-Sci Systems (Canada) Inc.
Deductions: What Can Reduce LTD Payments?
Many policies allow deductions from LTD benefits depending on your circumstances. Examples can include:
- CPP disability benefits,
- EI sickness benefits,
- WSIB benefits, and
- other income sources defined by the policy.
If you’re receiving (or applying for) CPP disability, see:
Bad Faith Conduct and Additional Damages
In exceptional cases, courts may award damages beyond basic benefits if the insurer acted in bad faith.
For example, in K. v. Sun Life Assurance Company of Canada, 2020 ONSC 3925, the court awarded damages for mental distress where the insurer’s approach to the claim was found not to be balanced or reasonable.
FAQ: Starting an LTD Claim in Ontario
How do I start a long-term disability claim?
Most plans require an application package with an employee statement, employer statement, and attending physician statement. Supporting medical evidence is critical, and you should keep copies of everything you submit.
What medical evidence do insurers usually want?
Insurers often look for functional restrictions and limitations tied to your job duties, treatment history, and ongoing medical support—not only a diagnosis.
Do I have to appeal internally if I’m denied?
Some policies allow or encourage internal appeals, but internal appeals are often unsuccessful. The safest approach is to get legal advice early so you do not miss a limitation period or weaken your claim.
How long do LTD benefits last?
It depends on the policy and whether you continue to meet the definition of disability. Many policies change from “own occupation” to “any occupation” after a period of time, which is a common point for denials or terminations.
Does CPP disability affect my LTD benefits?
Often yes. Many LTD policies require you to apply for CPP disability and allow the insurer to deduct CPP amounts from LTD payments. See: CPP Disability + LTD.
Talk to a Long-Term Disability Lawyer
If you are dealing with a long-term disability claim, getting legal advice early can help protect your rights and avoid costly mistakes. The long-term disability lawyers at Monkhouse Law assist employees across Ontario with denied, delayed, and terminated LTD benefits. Request a free 30-minute phone consultation or call (416) 907-9249.