Denied Long-Term Disability Benefits in Ontario? What to Do Next
If your long-term disability claim has been denied in Ontario, you are not alone. Many employees rely on disability insurance for income protection, only to discover that insurers sometimes deny claims after reviewing the medical evidence.
A denial letter can feel final. In many cases, however, a denial is simply the beginning of a legal dispute about whether the policy requirements have been met.
Disability Claim Denied?
If your long-term disability benefits have been denied or cut off, it may be worth having the decision reviewed before accepting the insurer’s position.
Lecker & Associates regularly represents Ontario employees in long-term disability disputes.
Call 416-223-5391 or email intake@leckerslaw.com to request a confidential consultation.
Why Do Long-Term Disability Claims Get Denied?
Several common issues often lead to disability claim denials.
| Reason for Denial | Explanation |
| Insufficient medical evidence | Insurer claims medical documentation does not meet the policy definition of disability |
| Policy definition change | Disability test changes from “own occupation” to “any occupation” |
| Surveillance | Insurer claims observed activity contradicts reported limitations |
| Independent medical exams | Insurer relies on doctors hired by the insurer |
What Happens After an LTD Claim Is Denied?
After a denial, insurers sometimes invite claimants to submit an internal appeal. However, the insurer still controls that process.
Some claimants choose instead to start a lawsuit for disability benefits. Many LTD disputes resolve through negotiation or mediation before trial.
Limitation Period for LTD Lawsuits
In Ontario, lawsuits for denied long-term disability benefits must generally be started within two years of the denial decision.
For that reason, employees should consider obtaining legal advice soon after receiving a denial letter.
The “Any Occupation” Disability Test
Most long-term disability policies apply two stages of disability.
First 24 months
The test usually asks whether the claimant can perform the duties of their own occupation.
After 24 months
The test usually shifts to whether the claimant can perform any occupation that reasonably exists in the labour market.
This change in definition is one of the most common reasons insurers terminate disability benefits.
Employment Protection During Illness
Ontario employees may be entitled to Long-Term Illness Leave under the Employment Standards Act, which provides up to 27 weeks of job-protected leave for serious medical conditions.
This leave protects employment but does not replace income.
How Lecker & Associates Can Help
Lecker & Associates represents Ontario employees whose disability claims have been denied or terminated.
If your long-term disability claim has been denied, legal advice can help determine whether the insurer’s decision can be challenged.
Call 416-223-5391 or email intake@leckerslaw.com to request a confidential consultation.
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