If you’re unable to work due to illness or injury, you may qualify for long-term disability (LTD) benefits. Many employees assume they must be completely incapacitated to qualify. That is not true.
In Ontario, LTD eligibility depends on whether you meet the insurer’s definition of disability — which usually changes over time.
This page explains the difference between:
- “Own occupation” disability
- “Any occupation” disability
Understanding this distinction is critical, because it is one of the most common reasons LTD benefits are denied or cut off.
Need help now? If your LTD benefits were denied or terminated, 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
Government resources:
The “Own Occupation” Test
Most LTD policies start with an “own occupation” definition.
This means you are considered disabled if you cannot perform the essential duties of your specific job.
You do NOT have to be bedridden or unable to perform basic daily activities.
Courts have repeatedly confirmed that:
- You may still qualify even if you can perform some tasks
In plain English:
If your medical condition prevents you from safely and reliably doing your actual job, you may meet the “own occupation” test.
This phase typically lasts:
- 12 months, or
- 24 months
depending on your policy.
The “Any Occupation” Test (Where Many Claims Get Cut Off)
After the own-occupation period ends, insurers usually switch to the much stricter “any occupation” test.
At this stage, the insurer asks:
Can you work in ANY job you are reasonably suited for?
This does not mean literally any job on earth.
Courts look at:
- Your education
- Your work history
- Your skills and training
- Your age
- Your medical limitations
The question becomes:
Is there a realistic full-time job you could perform given your background and condition?
This is where many insurers deny or terminate benefits — often based on:
- paper reviews
- brief surveillance
- generic job lists
- selective medical interpretations
Being observed doing groceries or light chores does NOT automatically mean you can return to full-time employment.
Common Reasons LTD Benefits Are Denied After Two Years
- The insurer claims you can do “alternative work”
- Medical evidence is labelled “insufficient”
- Your doctor’s restrictions are minimized
- Surveillance is taken out of context
- The insurer disagrees with your treating specialists
If this has happened to you, see:
Important: Limitation Periods Apply
You do NOT have unlimited time to challenge a denied LTD claim.
In many cases, lawsuits must be started within two years — sometimes sooner depending on your policy.
Internal appeals do NOT pause this clock.
Learn more here: Ontario LTD Limitation Periods & Deadlines
FAQ
Can I qualify for LTD if I can still do some tasks?
Yes. The test is whether you can perform substantially all of your job duties — not whether you can function at home.
Do mental health conditions count?
Yes. Anxiety, depression, PTSD, burnout, and cognitive impairment can all qualify depending on severity and functional impact.
Do I have to appeal internally first?
Not always — and internal appeals are often unsuccessful. Speak to a lawyer before appealing so you don’t damage your case or miss deadlines.
Does CPP disability affect LTD?
Most policies require you to apply for CPP disability and allow insurers to deduct CPP amounts.
See: CPP Disability + LTD
Talk to a Long-Term Disability Lawyer
If your LTD claim has been denied, delayed, or terminated, legal advice early on can protect your rights and help avoid costly mistakes.
Monkhouse Law Employment Lawyers assists Ontario employees with LTD denials, appeals, and lawsuits. Request a free 30-minute phone consultation or call (416) 907-9249.
Note: Monkhouse Law focuses on LTD claims for non-union employees through private insurers. If your are involved in WSIB, it operates under a separate system from private long-term disability insurance.