Category: Toronto Medical Malpractice Lawyers

Long-term disability insurance replaces a portion of your income – typically 60% to 70% – if a medical condition prevents you from working for an extended period. Most people are covered one of two ways:

• Group LTD through an employer benefits plan, the most common source of coverage for employees in Toronto and across Ontario. Terms are negotiated between the employer (or plan administrator) and the insurer, and individual employees generally can’t customize them.
• Individual or private LTD policies, purchased directly from an insurer – common among self-employed professionals or as supplemental coverage on top of a group plan.

Benefits typically start after an elimination period – often 90 to 120 days of continuous disability – usually bridged by short-term disability benefits, sick leave, or EI sickness benefits. One detail that surprises many people: if you personally paid your LTD premiums, benefits are generally received tax-free; if your employer paid the premiums, benefits are usually taxable. Most group policies also require you to apply for CPP Disability benefits, with the insurer deducting whatever CPP-D pays from your LTD benefit – a standard offset provision, not a sign your claim is weak.

LTD insurers deny, or later terminate, a substantial share of claims, and the reasons tend to fall into a few recurring categories:

• Insufficient or subjective medical evidence. Conditions like chronic pain, fibromyalgia, and mental health conditions are harder to document with objective testing, and insurers often argue the file doesn’t prove disability.
• Surveillance. Insurers sometimes hire investigators to film claimants; footage of routine errands or short outings is frequently used to argue someone is more capable than claimed, even when it doesn’t reflect what a full workday would actually require.
• Missed deadlines or incomplete forms. LTD applications and ongoing “proof of claim” forms carry their own deadlines, separate from any legal limitation period, and missing them can trigger a denial on procedural grounds alone.
• “Not disabled enough” determinations, often based on an insurer-arranged medical assessment that reaches a different conclusion than your own treating doctors.
• Pre-existing condition exclusions, where the insurer argues your condition existed before your coverage began.

A denial is the insurer taking a position – not a final legal determination that your claim lacks merit.