Canadians can protect themselves from long-term loss of income after an injury, accident, or if they are diagnosed with a debilitating condition through long-term disability insurance. Ontario residents can access long-term disability benefits a few ways; through their employer, independently, or through the Canada Pension Plan.

Read on to learn more about long-term disability claims in Ontario, including what long-term disability insurance covers, how to apply, and what to do if your claim is denied.

What is Long-Term Disability in Ontario?

The term “disability” varies between long-term disability insurance plans in Ontario, but, according to the Government of Canada, coverage under these policies generally includes health conditions that leave policy holders unable to work for an extended period of time.

How Does Long-Term Disability Work?

If you are applying for long-term disability, an important question is “when does long-term disability start?”, along with how to file a claim, and how long-term disability payments work.

Long-term disability generally starts after a period of short-term disability and after possible support under the Employment Insurance (EI) program has been exhausted, according to the Government of Canada.  

Workers Compensation can cover injuries or illnesses that an employee develops on the job, along with short term disability plans for conditions that keep workers off the job temporarily. Long-term disability usually kicks in after these benefits have ended.

Ideally, long-term disability claims would work by policyholders paying their premiums and then making a claim if and when they are injured or develop a condition that leaves them unable to work for a long period. Unfortunately, insurance companies are notorious for denying claims. In situations where a claim is accepted, insurance companies may try to reduce the payments that a policy holder is entitled to under their agreement. Further, insurance companies may attempt to delay claims, making life very difficult for a disabled person without an income and facing serious health and living expenses.

Due to these denial and delaying tactics, experts recommend filing long-term disability claims as soon as possible. Policy holders making a claim need to factor in the very real possibility their claim will be denied or that they will be required to obtain additional medical evidence to back up their claim.

Further, policy holders making a long-term disability insurance claim should consider whether their condition will worsen over time. In Ontario, those making a long-term disability claim have a duty to make sure that they do what they can to keep their condition from getting worse or more expensive.

Workers with a private long-term disability insurance policy should be aware that support provided through the Canadian Pension Plan will affect their claim. According to experts, insurance companies receive a credit from the government if they accept a long-term disability claim. This reduces the amount of money that an insurance company will have to pay each month.

Some may also wonder, is long-term disability income taxable in Canada? According to the Government of Canada, for policyholders who pay their entire premium, long-term disability payments are not taxable; however, if all or a portion of the premiums were paid by the policyholder’s employer, any long-term disability payments through that policy may be taxable. Additionally, benefits through the Canada Pension Plan are taxable; however, benefits through the Ontario Disability Support Program are not taxable.

What are the Ontario Long-Term Disability Benefits?

If you plan to apply, you may wonder, what does long-term disability cover? Long-term disability coverage generally provides benefits for injuries or health conditions that render the policy holder unable to work.

How to Apply for Long-Term Disability in Ontario

Those in Ontario planning to apply for long-term disability should start by carefully reading and understanding their insurance policy. Potential claimants should understand what the term “total disability” requires under their insurance policy. Even at this early stage, it may be helpful to consult with a long-term disability insurance lawyer to help understand how to best support a claim.

The specific procedures for each claim will depend on the policy, but all long-term disability insurance policies in Ontario require documentation supporting the “total disability” claim.

The term “total disability” is used by many policies to describe conditions that leave workers making a claim unable to work; however, the term “total disability” usually does not require complete debilitation of the worker before the insurance kicks in. Alternatively, workers making a long-term disability claim are only required to establish that they are unable to reasonably complete or participate in their job functions in order to effect a cure of the condition or prolong life as a result of the disabling condition.

In Ontario, long-term disability qualifications depend on the following factors:

• Occupation, whether it is regular or your own
• Offsetting benefits, such as other insurance plans
• Your medical condition

Long-term disability insurance covers both physical and mental health conditions. Claims can be for a myriad of physical conditions, from arthritis and diabetes, to brain injuries, chronic pain, and infection.

Covered long-term disability Ontario mental health conditions include medical diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders. Covered conditions include depression, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobias, and post traumatic stress disorder.

Obtaining long-term disability coverage for a mental health condition is notoriously difficult, experts say. Experts recommend thoroughly documenting your condition by potentially meeting with a specialist, as well as ensuring your medical evidence describes your condition in terms of your job description and provides a medical diagnosis.

What Can You Do if Your Claim Was Denied?

Unfortunately, many long-term disability claims start with a denial from the insurance company. After a claim is denied, the policyholder can appeal this denial. The specific procedure will depend on the policy, but generally start with an internal appeals process. While many policies give claimants up to two years to appeal a denial, experts recommend getting the appeals process started as soon as possible after the denial.

After the internal appeals process is exhausted, and if the policy holder is still facing a denial of their claim, they can begin an external appeals process within the court system. Generally, disability claim denials are heard by an adjudicator, rather than in a formal court of law. Even though both the internal and external appeals process can sound intimidating, claimants should know that these processes are actually extremely common.

While initiating an appeal through the internal system can make sense, some legal experts say  it can turn out to be a waste of time. The internal appeals process can take a long time and often it does not result in a reversal of the original decision. Going through this process could result in you missing other important deadlines concerning a possible external appeals process like a lawsuit.  

Do You Need Lawyers for Long-Term Disability Insurance Ontario?

It is important to consider obtaining legal assistance early in the process of making your long-term disability claim. An experienced disability lawyer can help you understand the terms of your policy and make your claim as strong as possible when you apply, potentially saving time and expense later on in the process.

A long-term disability insurance lawyer could also help you evaluate whether the insurance company is offering a fair payment to your claim, or if you are entitled to more under the terms of your long-term disability policy.

Have you applied for long-term disability insurance in Ontario? Tell us what happened in the comment section below!