If you can’t work due to illness or injury, long-term disability (LTD) benefits may replace part of your income. Unfortunately, many Ontario employees face LTD denials, delayed approvals, cancelled benefits, or accusations that they are “not totally disabled.”
Long-term disability insurance is an important financial safety net for employees across Ontario, but navigating an LTD claim can be complex, and insurers frequently challenge or terminate benefits.
This page explains how LTD benefits work in Ontario, what insurers look for, why claims are denied, and what you can do next — including how deadlines and limitation periods can affect your right to sue.
Need help now? If your claim was denied, cut off, or delayed, speak with a long term disability lawyer before you miss important deadlines. Request a free 30-minute phone consultation or call (416) 907-9249.
Start Here: Long-Term Disability Guides in Ontario
If you’re dealing with long-term disability benefits in Ontario, these guides may help:
- Long Term Disability Lawyer Toronto (Services)
- LTD Denied: Common Reasons & What to Do
- Appealing an LTD Denial (Internal Appeal vs Court Claim)
- Limitation Periods & Deadlines (Don’t Miss These)
- Starting a Long-Term Disability Claim
- Own Occupation vs Any Occupation (Why benefits are often cut off after 2 years)
- What Happens After Two Years on LTD?
- LTD After Termination
- CPP Disability + LTD (How benefits interact)
What Are Long-Term Disability (LTD) Benefits?
Long-term disability benefits are insurance benefits that provide income replacement when an employee cannot work due to a medical condition. LTD coverage is often provided through:
- an employer group benefits plan, or
- a private disability insurance policy.
Typically, LTD begins after a waiting period (often after short-term disability or sick leave ends). Coverage varies by insurer and policy, but LTD benefits commonly replace around 60–70% of pre-disability income (sometimes more or less depending on the policy and maximums).
How Does Long-Term Disability Work in Ontario?
Although every policy is different, LTD claims often follow this general path:
- You stop working because your doctor says you cannot safely perform your job.
- You submit an LTD claim with medical evidence.
- The insurer reviews your file and may request forms, tests, updates, and assessments.
- The insurer approves, denies, or delays the claim.
- If approved, benefits may be reviewed over time and can be reduced or terminated.
Many people are surprised to learn that even approved claims can later be terminated or “cut off” — especially when the definition of disability changes from “own occupation” to “any occupation.”
Learn more: What Happens After Two Years on LTD and Own Occupation vs Any Occupation
What Does “Totally Disabled” Mean in LTD Claims?
The insurance company’s definition of “total disability” is one of the most common reasons benefits are denied.
Ontario courts have considered what “total disability” means in many LTD cases. One commonly cited legal test is from S. v. Paul Revere Life Insurance Co. (SCC, 1983), which held that disability can exist even where a person is not physically incapable of all activity — if common care and prudence require the person to stop working to recover.
“There is total disability if the insured’s injuries are such that common care and prudence require him to desist from his business or occupation in order to effectuate a cure.”
S. v. Paul Revere Life Insurance Co. [1983] S.C.J. No. 86
In practical terms, insurers often deny claims by arguing that:
- you can still do some tasks, therefore you’re not disabled,
- the medical evidence is “insufficient,” or
- you could work in another job.
Common Reasons LTD Benefits Are Denied or Cut Off
LTD denials are extremely common. Even legitimate claims can be denied due to:
- alleged lack of objective medical evidence,
- paperwork gaps or inconsistencies,
- insurer disagreement with your treating doctor,
- surveillance (often misleading),
- failure to meet the “any occupation” test after 2 years.
For a full breakdown, see: Long Term Disability Denied: Common Reasons & What to Do
What to Do If Your LTD Claim Is Denied
If your LTD claim is denied, don’t assume the insurer is correct. A denial is not the end — but it is a warning sign that deadlines may now matter.
Options may include:
- internal appeal (often unsuccessful),
- court claim (suing the insurer for wrongful denial),
- strategy to build medical evidence and strengthen your case.
We explain this in detail here: Appealing Long-Term Disability
Deadlines & Limitation Periods: Don’t Miss Your Chance to Sue
Ontario has strict rules about limitation periods. In many LTD cases, the key deadline is the two-year limitation period under Ontario’s Limitations Act, 2002.
The start date is not always obvious — and insurers are not required to warn you about it.
Read next: Long-Term Disability Limitation Period Ontario
Case Examples: Courts Have Awarded LTD Benefits (and More)
Disability benefits disputes frequently go before Ontario courts. In appropriate cases, courts have awarded:
- payment of past-due LTD benefits,
- ongoing monthly benefits,
- mental distress damages,
- punitive damages (in rare cases).
D. v. Great West Life Assurance Co. (2014)
In D. v. Great West Life (2014), the plaintiff was denied short-term disability benefits. The court awarded disability benefits and ongoing monthly benefit continuation.
F. v. Penncorp Life Insurance Co. (2014)
In F. v. Penncorp (2014), the plaintiff was awarded significant damages after benefits were cut off following surveillance evidence the insurer relied on.
M. v. Sun Life (1997 / 1999)
In M. v. Sun Life, the plaintiff was awarded LTD payments that should have been paid, plus damages for mental distress due to improper denial.
Frequently Asked Questions About Long-Term Disability in Ontario
What is the elimination period for long-term disability?
The elimination period is the waiting period between the date you become disabled and the date you become eligible for LTD payments. Many policies use a 90-day elimination period, but this can vary. The elimination period is often covered by sick leave or short-term disability benefits (if available).
Can a pre-existing condition affect LTD eligibility?
Yes. Many LTD policies include pre-existing condition clauses that may exclude or restrict benefits if your disability relates to a condition you had before coverage began (for example, before you started a new job or before the plan’s eligibility date). These clauses are common, and the facts and policy language matter. To learn more about how these exclusions work, see our guide to pre-existing conditions and long-term disability insurance claims.
What exclusions can prevent LTD benefits?
Policies often contain exclusions and limitations. For example, some policies may exclude certain circumstances such as self-inflicted injuries or other listed exclusions. The wording of the policy and the evidence are key.
How much does long-term disability pay in Ontario?
Many LTD plans pay a percentage of income (often around 60–70%) up to a maximum monthly amount. Some plans coordinate benefits with other sources (such as CPP Disability). Your policy will determine the amount and how it is calculated.
How long can long-term disability last?
Depending on the policy and your medical condition, LTD benefits may continue until recovery, a change in disability definition (often after 2 years), or in some cases to a maximum benefit period such as age 65. Policy language and medical evidence are important.
Can you be terminated while on long-term disability?
Termination connected to disability may raise human rights issues. In Ontario, employers have duties under human rights legislation, including a duty to accommodate to the point of undue hardship. Each situation is fact-specific.
Can an employment agreement end due to frustration of contract?
In some cases, an employer may argue the employment contract has been frustrated due to a prolonged inability to return to work. If frustration is established, termination may occur with minimum statutory entitlements (depending on the circumstances). These cases are highly fact-specific.
Video: Basics of Long Term Disability Insurance
In this video, Employment Lawyer Andrew Monkhouse discusses what long term disability insurance is, how it helps employees, and key issues that arise when dealing with disability insurance claims.
Talk to a Long-Term Disability Lawyer
If you have been denied LTD benefits, your benefits were cut off, or your insurer is pressuring you to return to work, it is important to get legal advice. LTD claims often require strategic handling of medical evidence and strict deadlines. Please contact Monkhouse for a free 30 minute phone consultation.