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Rob Konduros

About Rob Konduros

https://hilbornandkonduros.ca

I've dedicated over three decades to fighting for individuals who have been injured, wrongfully dismissed, or denied the benefits they deserve. Since graduating from Osgoode Hall Law School in 1986, I've built my practice on a simple principle: ensuring my clients receive the justice and compensation they need to rebuild their lives. My Expertise: - Personal injury and motor vehicle accident litigation - Long-term and short-term disability benefits claims - Employment law and wrongful dismissal cases - Insurance litigation and dispute resolution - Extensive trial experience across all levels of Ontario courts I've successfully represented clients before the Superior Court of Justice, Divisional Court, and Court of Appeal for Ontario. My experience as former chairperson of the Canada Pension Plan Disability Benefits Tribunal provides me with unique insights into disability law that benefit my clients every day. My clients don't pay unless they win. I understand that dealing with injury, disability, or job loss creates financial stress, which is why I offer contingency fee arrangements and make home and hospital visits when needed. Whether you're dealing with a serious injury, fighting for disability benefits, or facing wrongful dismissal, I'm here to help you navigate the legal system and secure the outcome you deserve. Serving Cambridge, Kitchener, Waterloo Region, and across Ontario. đź“ž Ready to discuss your case? Let's connect.

Posts by Rob Konduros:

Can I Qualify for Long-Term Disability in Ontario?

Can I Qualify for Long-Term Disability in Ontario?

Undeniably, you’re in no shape to be able to return to work; you are fearful for the future… In addition to (or perhaps as a result of) your physical health challenges, your mental health has taken a strong turn for the worse, you realize. Your doctors have admitted that significant improvement in your condition is not likely, at least not in the foreseeable future.  

Through your former employer, you have been awarded short-term disability benefits to replace a portion of the wages you were earning prior to the time this nightmare of pain began. Before those short-term benefits expire, you’ve been warned, it is crucial for you, as a resident of Ontario, Canada, to file for long-term disability benefits. Meanwhile, despite the fact that your live-in partner has some income to contribute to the household,  without the pay you were used to bringing in, your bills have been piling up.

You’ve been given forms to fill out, questions to answer, and steps to follow in order to apply for long-term disability benefits. Both you and your partner find the language quite confusing; it’s not at all clear if you will be able to qualify for long-term disability benefits in Ontario.  

If you haven’t applied yet, this complete LTD claim preparation guide for Ontario workers walks you through what to do before you file.

You have so many questions:  if you get to feeling well enough to work some kind of part-term job, will that be allowed if you’re on disability?  (One of your doctors referred to you having an “anxiety disorder” — Does depression qualify as a disability?).

Where do long-term disability benefits come from in Ontario, Canada?

  1. From a long term disability policy issued through an employer. While some employers in Ontario offer their employees the opportunity to enroll in long-term disability coverage through an insurance company, often that insurer requires the employee to apply for CPP before claiming benefits through that long-term disability policy.
  2. From the Canada Disability Benefit, a program administered by Service Canada, meant to provide direct financial support to people with disabilities who are between 18 and 64 years old. In order to qualify for long-term disability benefits through this program, you must either be a Canadian citizen or permanent resident (or at least have lived in Canada for the past 18 months). You and your spouse or live-in partner must have filed your 2024 federal income tax return.
  3. From the Ontario Disability Support Program (ODSP), which is designed to help people with a severe and prolonged physical or mental disability that limits their ability to work or manage daily activities.

Your rights depend on the kind of coverage you have. Learn the difference between group and individual LTD policies in Ontario

What kinds of illnesses and physical conditions qualify for long-term disability benefits in Ontario, Canada?

It is important to understand that qualifying for long-term disability benefits depends less on having any specific physical or mental condition, but on whether that condition not only currently prevents you — but is likely to continue preventing you, for the foreseeable future — from performing duties at any job for which you are reasonably suited.

Illnesses and physical and mental conditions possibly qualifying as disabilities include:

  • Injuries – accidents, falls, trauma, fractures
  • Musculoskeletal – arthritis, fibromyalgia, spinal stenosis, carpal tunnel, degenerative disc
  • Cardiovascular – heart disease, stroke, coronary artery disease
  • Neurological – stroke, Parkinson’s MS, ALS, epilepsy
  • Respiratory – COPD, asthma
  • Cancer
  • Diabetes
  • Depression, anxiety or bipolar disorder, schizophrenia, PTSD

Remember, qualifying for long-term disability benefits involves providing comprehensive documentation — from medical doctors, pharmacies, physical therapists, and psychiatrists.

Your doctor’s input can make or break your claim. Learn how to build strong medical evidence with your doctor’s help.

My doctors say I might be capable of working “light duties”. Can I still qualify for LTD benefits, since I will still be not be earning enough to support myself?

Some insurance company LTD policies restrict any form of work, while others allow for limited work, while reducing your benefits accordingly. Remember, though, the Canada Pension Plan approves benefits only for those who “have a disability that is long-term and of indefinite duration, or is likely to result in death”.

“Word to the wise”…While gathering all the information needed to file your long-term disability claim, it will be helpful to focus on financial survival, narrowing your budget down to the essentials, and dipping into emergency savings only to the extent. It would be wise to contact your mortgage lender and credit card companies, explaining the situation and asking them for concessions…

Rob Konduros Disability, Employment & Personal Injury Lawyer
If your long-term disability benefits from an insurer have been cut off or denied to you, you have rights and we have the experience to defend those rights, Rob Konduros explains.
The Hilborn and Konduros Lawyers has been providing legal advice across Ontario since 1979.
“We don’t get paid until you get paid.”

Dealing with the reality of long-term disability claim denials 

While no official statistics have been published showing the precise percentage of long-term disability income claims that are denied, truth is that more than half of applicants receive denial letters every year.

When disability benefits have been denied, you need experienced legal help from a professional well-versed in the laws and regulations that govern long-term disability claims. An Ontario disability lawyer can perform crucial tasks that an individual claimant cannot, including:

  • understanding the complex clauses in long-term disability insurance policies
  • requesting a hearing with an administrative law judge.
  • dealing with the benefits “tribunal” for the ODSP (Ontario Disability Support Program)
  • dealing with the administrators of the Canada Pension Plan disability program (CPP) 

The earlier in the process you get professional legal advice, the better…

 A denial letter will need to be reviewed thoroughly by someone who understands the legal “language”, someone who can gather the additional documentation needed to appeal your claim. You’ve already begun to struggle financially; rather than waiting for benefits to be denied, you can begin proactive measures now.

 

FAQs: Can I Qualify for Long-Term Disability in Ontario?

 

Do you have more questions?

Call Rob
Sun Life LTD Claims -- What You Need to Know About Their Policies and Practices

Sun Life LTD Claims: What You Need to Know About Their Policies and Practices

Your Sun Life long-term disability policy was there, you believed, to provide a potential financial safety net. Before your health took such a dramatic turn for the worse, you hadn’t paid too much attention to the details of how that safety net would work in Ontario, Canada. To you, your long-term disability was very much like your homeowner’s or rental or even auto insurance — until and unless something happened, there was no point delving into all the small print.

Now something has, indeed, happened — your condition has deteriorated to the point that, not only have you been unable to support yourself, your doctors are saying that your condition is not likely to improve, at least not for many years into the future. Following months of working with your medical professionals to fill out paperwork, after months of interviews, of lengthy conversations with your Sun Life case manager, months of suffering the indignity of surveillance  — you’ve received a letter informing you that your Sun Life Long-Term Disability Claim has been denied.

The language in the denial letter is not only upsetting – It’s confusing.  You’ve spend all those hours and hours filling out paperwork, hours and hours sending emails and making phone calls, making sure every single form had been completed by every medical professional who ever treated you or prescribed medication for you. Now, you’re being told that there is “insufficient evidence” and that you meet the policy’s definition of total disability”.

While the letter includes instructions on how to request a copy of your claim file, no specific steps are being recommended for you to take in order to get your case re-evaluated.

Sun Life’s practices — some uncomfortable truths:

  • All long-term disability insurance providers are in business to make a profit. Yes, they are obligated by contract to pay all legitimate claims. But they are in business, and, like all business owners, their goal is to minimize payouts, thereby increasing their profit. Learn more about The Hidden Traps in Long-Term Disability Applications: What Insurance Companies Don’t Want You to Know.
  • Although this remains an allegation rather than a “truth”, some attorneys have accused Sun Life and other insurers of purposely denying legitimate claims — or threatening to deny claims —  in order to pressure claimants into accepting low settlements.
  • The long-term disability claims forms you submitted were completed by the doctors and therapists who actually saw you in person. When Sun Life has its own medical consultants review the paperwork; (people who never examined you or processed your test results), they may disagree with the conclusions reached by your own medical providers.
  • Sun Life consultants will have examined your social media posts, purposely interpreting things you’ve shared with friends to mean you are not as “disabled” as you have claimed.
  • Sun Life’s definition of disability changes after two years, going from “own occupation to “any occupation”, The company will often claim that, because (they believe) you are able to work, even if that work is not in the field in which you specialized training and experience, they are not obligated to honor your claim of being  totally disabled.

Your claim file includes all medical treatments since the onset of your condition, but Sun Life investigators may have uncovered some long-past medical appointment or recommendation that was inadvertently not included in the paperwork you submitted.

It’s scant comfort to realize you’re not alone. Perhaps the most uncomfortable truth of all is represented by the following statistic published in Globe Newswire: 

In Ontario, Canada, about 60% of legitimate disability claims are rejected by insurance companies every year.

Uh-oh! After a denial of a long-term disability claim, things are likely to become even more uncomfortable than before…

Once an insurance company has determined (rightly or wrongly) that your case does not qualify you to receive benefits, the odds of them reversing that decision are slim to none. That means that, without being presented with new, irrefutable evidence, Sun Life is highly unlikely to reverse its decision.  In fact, for all the “uncomfortable truth” reasons mentioned above, they hope you will become discouraged and “go away”.

3 things to try to turn around the denial of your LTD claim and file for reconsideration:

  • Go back to each of your medical providers to get additional details about your limitations. Have them clarify any areas of misunderstanding about your condition.
  • Arrange for an examination from a new specialist.
  • Consult a vocational advisor, asking for a letter explaining why you are unable to work at, not only your former occupation, but any

This information should be included in your reconsideration appeal, which must be filed within 60 days of your having received the disability denial. 

Managing in the meanwhile…

Before you received that claim denial letter from Sun Life, you’d been focusing on financial survival, narrowing your budget down to the essentials, dipping into emergency savings only where absolutely necessary. You contacted your mortgage lender and credit card companies, explaining the situation and asking them for concessions to help you survive until your long-term benefits were set to begin.

Where to go from here?

Rob Konduros Disability, Employment & Personal Injury Lawyer
Yes, you can!

You’re already struggling financially. The denial letter from Sun Life has been a crushing setback. The last thing you need is another financial burden.

 “My clients don’t pay unless they win,” Rob Konduros explains.

Is it time to get professional legal advice from an Ontario disability lawyer?

When disability benefits have been denied, you need experienced legal help to standing up to the level of “uncomfortable truth” tactics you fear Sun Life may be using to avoid paying you the benefits you deserve. Large insurers have teams of legal advisors; it’s only fair for you to have one on your side.

An experienced Ontario disability lawyer who is well-versed in the laws and regulations that govern long-term disability claims can review the denial letter you’ve received from Sun Life, comparing each point the insurer is making in that letter with the evidence of treatments and evaluations from your own medical providers.  

Most important, if Sun Life refuses to reconsider your case, your disability lawyer can request a hearing with an administrative law judge.

Taking your Sun Life disability claim “to court”

Denials can be overcome in a court of law, Ontario disability Rob Konduros explains. Managing complex legal procedures requires specialized experience and expertise:

  • The language in Sun Life long-term disability policies is complex, often even purposefully obscure. In denying your claim, the company may have relied on a technicality that only an experienced legal advisor can understand.

  • Sun Life may be expecting clients who have received a denial letter to appeal, allowing the company to further delay the process and persuade them to accept an unfairly low settlement. An experienced disability lawyer will judge whether or not you’d be better off proceeding to litigation.

  • Those months spent gathering “evidence” for your claim have been exhausting. An experienced disability attorney can take over the management of the process.

FAQs: Sun Life LTD Denials in Ontario

 

  • 1. Should I file an internal appeal or start a lawsuit?

    An internal appeal keeps the decision with Sun Life and usually relies on what’s already in your file. A lawsuit moves the dispute into the Ontario court process, where timelines are enforceable and most cases resolve through negotiation or mediation. The right path depends on timing, policy language, and the strength of your updated medical and vocational evidence.

Do you have more questions?

Call Rob
Understanding LTD Elimination Periods in Ontario: When Can You Actually File Your Long-Term Disability Claim?

Understanding LTD Elimination Periods in Ontario: When Can You Actually File Your Long-Term Disability Claim?

Coping with an injury or lingering illness, you’ve been unable to work. Initially determined to get back on your feet and back to work quickly, you’re beginning to realize it’s not happening. Whether  you’re still on unpaid sick leave, or have begun receiving Canadian Employment Insurance Sickness Benefits, you are now to the point of needing to file long-term disability claim.

 It’s all so overwhelming…you’ve never dealt with a severe disability before, certainly not with applying for long term disability insurance benefits.. Anxious about missing deadlines, filing too early — or too late –you need clear, practical answers. How does the elimination period work on long-term disability insurance? When is the optimum point to actually file your claim? What are the procedures? What rights do you have when it comes to claiming benefits?

Understanding the purpose of long-term disability insurance

When short term benefits end, including: 

  • short-[term disability insurance
  • sick leave from an employer
  • Canadian EI (Employment Insurance Sickness Benefits),

that is when long-term disability insurance can begin.

Long-term disability insurance is meant to replace between 60% and 85% of the income you were earning before the onset of your illness or injury.

 

From what sources might you be claiming long-term disability benefits?

  1. Your employer’s group disability insurance plan

Your employer may offer long-term group disability insurance intended to replace a percentage of the monthly income of an employee who has become unable to work due to a major illness, accident, or injury. (Depending on the plan, benefits may be guaranteed to last for a prescribed period of time or even up to an employee’s age 65.

  1. The Canada Pension Plan Disability Benefits Plan (CPP)

If you are under age 65, have been contributing for years to CPP, and have a mental or physical disability that now is preventing you from doing any kind of substantially gainful work, you can claim benefits through this plan. 

  1. The Ontario Disability Support Program (ODSP)

The Ontario Provisional Government provides money to help disabled employees with living expenses, health benefits, and employment support.


What is this thing called the “elimination period”?

Even if the insurance company (or government plan administration)   agrees that, due to the severity of your illness or injury, you are unable to work and therefore qualify to receive long-term disability benefits, there will be a waiting period, or “elimination period”, before regular benefit payments actually begin.

  • CPP – The plan has a waiting period for benefits to become payable; you must have been totally disabled and have used up all sick leave credits before qualifying for CPP benefits.

  • ODSP – The waiting period is usually 90 – 120 days, beginning when you become unable to work and ending before long term benefits begin.

  • Employer group long-term disability plan (or self-employed long-term disability plan – the elimination period usually lasts 90 to 180 days.

Must I wait until the elimination period has expired before filing a long-term disability income claim?

It is natural, even healthy, to continue to hold out hopes for recovery from your condition.  On the other hand, you realize that your inability to work is going to last for an extended period of time. Since no long-term disability benefits will be paid until the elimination period has expired, why is it important to begin the claims process now? 

  • The administrative review process for your claim can take weeks or even longer. You may receive requests for more documentation and will need time to gather the needed information.

  • Failing to file in a timely manner can give an insurer reason to deny your claim.

  • You do not want to face a gap in income between any short-term disability benefits for which you may qualify and the start of long-term benefits.

Financial survival during the long-term Ontario disability elimination period

 If ever there was a time to get pro-active about your finances, the elimination period is that time…

  • Narrow your budget down to the essentials – housing, utilities, food, and medicine. Cut out all non-essentials.
  • Take stock of your resources, including: emergency savings and short-term disability benefits.
    Contact your credit card company(ies) and mortgage lender to see if they can adjust your payments until you have qualified for long-term disability benefits.

Remember, you must be able to demonstrate that you are disabled throughout the elimination period. That means doing no work at all – of any kind – to help cover expenses.

Rob Konduros Disability, Employment & Personal Injury Lawyer
With decades of experience dealing with all these authorities, Rob Konduros knows that the elimination period is a crucial phase in the disability benefits application process. Every detail has to be “done right”; any denials can be appealed — providing the information was properly submitted and in timely fashion.
Far from imposing yet another financial burden on individuals already struggling through the disability elimination period, “My clients don’t pay unless they win“, Rob Konduros explains.

Should I consult an Ontario disability lawyer during the disability elimination period?

Given your reduced ability to handle the daily challenges — both physical and financial — of your life, navigating the complex disability claims process can be a daunting prospect. An experienced Ontario disability lawyer can provide reassurance, helping you avoid pitfalls and mistakes as you’re preparing to qualify for long-term disability benefits.

Fact is, a high percentage of long-term disability claims are rejected on the first try; many of those benefit denials happen because of mistakes on the paperwork and the documentation.

An Ontario disability lawyer can help you navigate your complex new world, which may well end up including:

  • your employer’s Human Resource department
  • multiple medical providers and therapists
  • one or more long-term disability companies
  • the Superior Court of Justice
  • the Court of Appeals for Ontario

When filing for long-term disability benefits in Ontario, Canada, it’s important to understand the way the elimination period works, and how to successfully “work through” that period in making your claim.

FAQs: LTD Elimination Periods in Ontario

 

Do you have more questions?

Call Rob
Ontario Long-Term Disability Claims: Understanding Your Rights Before You Need Them

Ontario Long-Term Disability Claims: Understanding Your Rights Before You Need Them

Over the past few months, it’s become more and more difficult to ignore the muscle spasms, tiredness, and increased pain levels you’ve been experiencing while on the job. With at least ten years to go to qualify for retirement benefits, you can’t imagine being able to support yourself if you were to request a cut-back on hours or if you were unable to work at all. You’ve heard of others going on disability status, but you’re hardly prepared to file any sort of claim right now. Still, you’d like to know more about how long-term-disability works and what rights you have… 

If you’re thinking ahead, start with our complete LTD claim preparation guide for Ontario workersto learn what to do before applying.

If and when I decide to file a long-term disability claim, what’s my first step?

The process of filing a disability claim in Ontario, Canada generally begins with you reporting your condition to your employer, asking for an “accommodation” (a change in hours or in the tasks you perform at work) or a temporary leave of absence. Human Resources will require a note from your doctor explaining the need for the leave and an estimate of a return-to-work date.

During that visit with Human Resources, you should verify the basic terms of your employee disability insurance plan, specifically inquiring about:

  1. The elimination period (or waiting period)
  2. The definition of disability (cannot perform in “any occupation” or in the occupation for which you’ve been trained and in which you’re experienced)?

Who Pays Long-Term Disability Benefits in Ontario?

  1. Your employer’s group disability insurance plan

Your employer may offer short-term and/or long-term group disability insurance. intended to replace a percentage of the monthly income of an employee who is unable to work due to a major illness, accident, or injury.

(Depending on the plan in which you are enrolled, these benefits may continue until:

  • The plan’s maximum period ends, or
  • You reach age 65, depending on the policy terms.

Your eligibility and benefit amount depend on your coverage type. Learn the difference between group and individual LTD policies in Ontario.

  1. The Canada Pension Plan Disability Benefits Plan (CPP)

If you are under age 65, have been contributing for years to CPP, and have a mental or physical disability that prevents you from doing any kind of substantially gainful work, you can claim benefits through this plan. 

  1. The Ontario Disability Support Program (ODSP)

The Ontario Provisional Government provides money to help disabled employees with living expenses, health benefits, and employment support.

Important to note:

If you receive the federal government’s Canada Disability Benefit, that will not affect your eligibility for the Ontario Disability Support Program — or change the amount of your payment.

ODSP and CPP – You can have one with the other! 

Remember: Your Employer Is Going to Be Part of the Process

As you contemplate filing for disability benefits, it’s important to understand that, in addition to all the paperwork and medical documentation that you and your medical providers will need to provide, your employer is also going to be submitting statements, providing details about your work history and commenting on your present inability to continue doing your job.  

Before you start gathering paperwork, review these 8 critical documents you need before applying for LTD in Ontario.

What Are My Disability Rights in Ontario?

As you prepare to file a disability claim, it’s important to realize that, as stated on the website of the Government of Canada, “Our nation has a strong legislative framework that guarantees the equal rights of people with disabilities.”

There are two main federal laws protecting people with disabilities:  

  1. The Canadian Charter of Rights and Freedoms
  2. The Canadian Human Rights Act

In addition, Canada is bound by the United Nations Convention on the Rights of Persons with Disabilities.

The Ontario Human Rights Code

Five fundamental rights for persons with disability are outlined in the Ontario Human Rights Code:

  1. Non-discrimination – the right to equal treatment

  2. Accessibility – to services in restaurants, shops, business offices, hotels, movie theatres, and transportation.

  3. Independence – The right to live independently and not be forced into an institution

  4. Equal recognition under the law, – with the right to exercise legal rights, own property, and control one’s own finances

  5. Protection from abuse, violence and exploitation

 

Rob Konduros Disability, Employment & Personal Injury Lawyer
With decades of experience dealing with:
  • employers’ Human Resource departments
  • medical providers and therapists
  • long-term disability insurance companies
  • the new disability tax credit
  • the Superior Court of Justice
  • the Court of Appeals for Ontario,
Rob Konduros wants clients to get ready, but helps them start the process only when they feel ready.
“My clients don’t pay unless they win“, Rob Konduros explains.
 

Should I consult an Ontario disability lawyer even before I’ve made up my mind to file a claim?

Already dealing with your own reduced ability to keep up with the demands of your work, you no doubt dread the prospect of navigating the complex process of applying for disability benefits. Used to being in charge of your own life, you’re finding it very unsettling to contemplate having to depend on any insurance company or any government program for financial support. Yet, the last thing you want is to be pressured into filing a claim before you feel ready…

Meeting with an experienced Ontario disability lawyer should provide reassurance, not pressure. When and if the moment is right to begin the process, you’ll be ready with a file of paperwork, prepared to as to avoid the common mistakes that lead to delays and rejections of claims later on.

 

FAQs: Long-Term Disability Rights in Ontario

 

  • 1. What mistakes should I avoid when applying for long-term disability in Ontario?

    Common mistakes include waiting too long to apply, providing incomplete medical documentation, or failing to follow your doctor’s treatment plan. Insurers may use these gaps as grounds to deny your claim. Speaking with a disability lawyer early can help you avoid costly delays.

    To avoid common errors, read about the hidden traps in LTD applications that insurers don’t want you to know.

     

Do you have more questions?

Call Rob
Group vs. Individual Long-Term Disability Policies: Understanding Your Coverage in Ontario

Group vs. Individual Long-Term Disability Policies: Understanding Your Coverage in Ontario

You recently became unable to work. Unsure whether you have group or individual disability coverage, you want to understand the legal and practical differences between the two before taking any action or filing any claim for benefits…

In Canada, don’t government health plans cover medical services?

Canada does have a universal health care system, and all Canadian citizens and permanent residents may apply for coverage. As is true of all provinces and territories, Ontario has its own health plan, which covers medical services, including doctor visits and hospital care. 

Disability insurance, in contrast, is not provided by the government, but is purchased from insurance companies, either privately (by individuals) or by their employers. The main purpose of all disability insurance is not to cover medical expenses, but to replace a portion of monthly income needed to cover a disabled individual’s basic expenses such as housing and groceries. 

What’s the Difference Between Group and Individual LTD Policies?

The key difference is portability: whether your coverage follows you when your employment changes.

Group disability insurance

In Ontario, Canada, many companies and professional associations offer short-term and/or long-term group disability insurance or long-term disability to their employees or association members. Group policies provide a benefit intended to replace a percentage of an employee’s monthly income, when that employee is not unable to work due to a major illness, accident, or injury.  Depending on the plan, benefits may be guaranteed to last for a prescribed period of time, or even be designed to replace income up to an employee’s age 65. Sometimes the premiums for group disability insurance are paid by the employer; sometimes the premium is deducted from each employee’s paycheck.

Group long-term disability insurance coverage is not “portable”. That means that, if you lose your job or move to a different employer, you’re no longer part of the “group”, and your insurance coverage will end.

Individual long-term disability insurance

Individual policies are purchased by individuals from a long-term disability insurance company. These individual policies are often purchased by the self-employed. Individual long-term disability policies are “portable” and do not automatically terminate when an employee leaves his place of employment.

 Feature

 Group LTD Insurance

 Individual LTD Insurance

 Who provides   it

 Employer or professional association

 Purchased directly by you

 Cost

 Lower cost (sometimes employer-paid)

 Higher premiums

 Portability

 Ends if you leave job or change  employers

 Portable – coverage continues regardless of  employment

 Custom Options

 Limited benefits, one-size-fits-all

 Customizable coverage & features

 Who uses it

 Employees and association members

 Self-employed, or workers wanting extra protection

 

Can workers in Canada buy individual disability insurance if they already have group coverage?

Yes, even while covered under a group policy at work, you may have wanted more benefits and features than were available through the group, and decided to add those addition benefits and features by purchasing individual insurance.

Your focus moving forward

 Now that you’ve become unable to do your job, you are no longer eligible to purchase new individual long-term disability insurance. Your focus now must be dealing, directly or indirectly, with one or more insurance companies in order to claim the benefits needed to replace at least some the income you’ve lost.

Psst….Before you start the process of filing a long-term disability claim, there’s one thing you need to realize about long-term disability insurance companies in Canada:

Long term disability insurance providers are in business to make a profit. While they must honor the policy contracts they’ve issued by paying legitimate claims, they are in business, and, as is true of all business owners, their goal is to minimize payouts and increase their own bottom line. As you prepare to file for benefits, you’ll need to navigate your way around certain “traps” designed to invalidate your claim. 

Your first stop in filing a long-term disability claim under a group policy – your employer’s human resource department.

To file a claim under a group policy, the first step is contacting your employer’s human resources department, notifying them of your intention to file a claim  (Understand that, in addition to your own statement about how your condition is affecting your ability to work, plus all the medical documentation your doctors will be providing, your employer will be submitting to the insurance company its own statement about your work history and your present inability to continue doing the job.)

3 things to verify during your visit with human resources:

During the visit (call, or online conversation) with your employer’s human resource department, be sure to verify three basic clauses or terms contained in your long-term disability insurance plan:

  • The elimination period (or waiting period) – the number of days you must have been disabled before benefits begin. Typical elimination periods range from 90 to 180 days.
  • Definition of disability – Does the policy define disability as meaning you cannot perform the duties of your own occupation (the work you had been doing and in which you are trained) OR that you cannot perform in “any occupation”? In many group Long-Term Disability policies, “own occupation” defines disability for the first two years; beginning in Year 3, the “any occupation” definition applies.
  • Reduction due to “other income sources – Under the policy terms, will your benefits be reduced if you have other income sources (Canada Pension Plan, rental income, spouse’s income)? Does your employer policy require you to apply for CPP benefits?

 

Rob Konduros Disability, Employment & Personal Injury Lawyer
As your Ontario disability lawyer Rob Konduros expresses his mission, it’s “Getting to Yes – and Staying there.”

 

Do you need to have a legal advisor involved? At what point in the process can it be important to seek help from an Ontario disability lawyer?

Unfortunately, as we know at Hilborn and Konduros, at every step of the process of filing a disability claim in Ontario, denials are all too common. But, putting into use our many years’ experience in dealing with

  • employers’ Human Resource departments
  • medical providers and therapists
  • long-term disability insurance companies,

we are able to help complete all the forms and avoid the “traps”. Our goal – helping you generate a flow of income to cover your everyday living costs.

FAQs: Group vs. Individual LTD Coverage in Ontario

 

Do you have more questions?

Call Rob
The Hidden Traps in Long-Term Disability Applications: What Insurance Companies Don't Want You to Know

The Hidden Traps in Long-Term Disability Applications: What Insurance Companies Don’t Want You to Know

The first step in applying for long-term disability benefits in Ontario, Canada involves contacting your insurer to get the forms you need for filing a claim. There will be a Claimant’s Statement and an Attending Physician’s Statement, both of which will need to be submitted along with copies of your medical records and information about your employment.

Your Long Term Disability insurance coverage may have been provided through:

  • your employer
  • a professional association to which you belong
  • an individual policy you purchased directly

Whichever is the case, you’re going to be dealing, directly or indirectly, with an insurance company.

Uncomfortable truths about long-term disability insurance companies:

 While your disability insurance company is going to be asking you to help them by filling out mountains of detailed paperwork, it is important for you to understand one thing: it is generally not in the insurance company’s best interest to help you. 

Facing two realities:

  • Long term disability insurance providers are in business to make a profit. While they must honor the policy contracts they’ve issued by paying legitimate claims, they are in business. Like all business owners, their goal is to minimize payouts and increase their own bottom line.

  • Your involvement with the insurance company is just beginning. The need to submit information is not going to be over just because you’ve completed and turned in all the forms. Even after you have been approved to receive certain long-term disability benefits, you will continue to have a duty to keep the insurance company informed of any and all changes in your situation – any new treatments, any travel, any change in family situation, any improvement in your abilities or any worsening of your symptoms.

What Are the Hidden Traps in LTD Applications?

In filing a long-term disability claim in Ontario, it’s important to “navigate” your way around certain “traps” set by your insurance company. Beware of any of these tactics:

Trap #1: The Form That Doesn’t Give You Enough Space

“Crowding” – An insurance claim form may pose a question, about your disability or about your former job duties, yet provide only a line or two on the form – hardly enough to accommodate a complete answer. The company then claims you haven’t “proved” that your disability qualifies you to receive benefits!

How to avoid it: Attach pages to the file, (either on paper or online) giving a thorough answer to each question about your symptoms and the effect those symptoms are having on your day-to-day life.

Trap #2: Monitoring Your Social Media

“Friending” and “connecting” – You may not have invited them to connect or “friend”, but your insurance company is sure to be monitoring your presence on LinkedIn, Facebook, TikTok, Instagram, X, etc. looking for any pic, video, or post portraying you as a lot more “abled” (less disabled) than you had described on your claim form.

How to avoid it: Be cautious with social media. Assume anything you post could be used against you.

Trap #3: Missing Deadlines or Appointments 

“Watching the clock” – To have any chance at getting the disability benefits you need, pay attention to every deadline, because the insurance company is keeping track. It is important for you to keep every doctor or therapy appointment and to be on time. Take every medication your doctors prescribe. Never forget – your insurance company will be “watching the clock”, looking for any reason to deny your claim for benefits.

How to avoid it: Keep a calendar of every deadline, appointment, and medication. Document everything.

Trap #4: Playing With Definitions

“Definition chiseling” – Insurance policies tend to be very, very specific when it comes to precisely what is covered — and what is excluded — from coverage.

For example, many policies exclude conditions that existed before you were even enrolled in the company’s plan. It could be that, before your symptoms worsened, you were able to work full-time.

Even though you may now be unable to perform your job, your application may be rejected on the grounds that your condition is “pre-existing”. What’s more, the contract may have one definition of “unable to work” for the first year or two (meaning you cannot do the type of work for which you’ve been trained) — and then require that you be unable to work at any job in order to be considered eligible for benefits going forward.

How to avoid it: Review your policy carefully, or have a lawyer explain it to you before filing.

 

Surviving surveillance while applying for disability benefits in Canada

While, as a disabled Canadian citizen, your equality and human rights are guaranteed by law, you need to be aware that, in their efforts to avoid paying fraudulent claims, companies are allowed to conduct ongoing, legitimate “surveillance” activities of those who’ve filed claims. In Ontario, disability surveillance is governed by Canada’s Personal Information Protection and Electronic Documents Act, stipulating that insurance companies can collect only personal information that is necessary for their stated purpose.

Problem is, far too often, insurers carry that practice too deep and too far, performing intrusive surveillance on all claimants, in an effort to raise doubt about your credibility and find reasons for denying benefits.

On the original Activities of Daily Living questionnaire, you are asked about how your condition affects you on a typical day in your life. Do you need help with personal care? Standing? Sitting? Getting dressed? Going to the bathroom? Are you able to do household chores such as cleaning and cooking? Are you able to drive? Shop for necessities? Manage your own finances? What are your sleep patterns? Are you able to pursue any hobbies? Periodically, you will be sent update requests.

(The purpose of surveillance is showing that the answers you’ve provided overstate the reality of your situation.)

While your insurance company cannot record you inside your home, their representatives (or even a private investigator they’ve hired) might be tailing your car, compiling video or photos of you, even talking to:

  • your neighbors
  • your friends
  • your co-workers past or present
  • your doctors or therapists
  • owners of businesses you visit – hairdresser/barber, dry cleaner, laundromat, etc.
Rob Konduros Disability, Employment & Personal Injury Lawyer
As Ontario disability lawyer Rob Konduros expresses his mission, it’s “Getting to Yes – and Staying there.” At your side every step of the way, helping you complete all application and update forms accurately and thoroughly, we work to help you avoid the “traps”.

 

Do you need to have a legal advisor involved? When is it time to seek help from an Ontario disability lawyer?

Unfortunately, as we’ve learned over many years at Hilborn and Konduros, denial of disability claims  is all too common. As experienced disability lawyers in Ontario, Canada, we’ve helped many clients overcome, not only those original denials, but the ongoing attempts by their insurance company to stop providing the benefits they need and deserve.

When dealing with a Long-term disability insurance company in Ontario, Canada, the keys are:

  • facing up to unpleasant truths
  • getting the professional help you need
  • navigating your way around the “traps”  

Key Traps to Avoid in LTD Applications (Checklist)

✔️ Don’t rely on tiny spaces on forms, attach detailed answers
✔️ Be careful on social media
✔️ Never miss a deadline, appointment, or medication
✔️ Understand how your policy defines “disability”
✔️ Keep records of everything you send or receive from your insurer
✔️ Get legal advice early to avoid mistakes that cost you benefits

FAQs: LTD Applications in Ontario

Do you have more questions?

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Working With Your Doctor: How to Build Medical Evidence That Supports Your Long-Term Disability Claim

Working With Your Doctor: How to Build Medical Evidence That Supports Your Long-Term Disability Claim

Perhaps you’re preparing, for the first time, to file a Long-Term Disability claim in Ontario, Canada. Or, perhaps you’re concerned that disability benefits you are now receiving are in danger of being cut off. Dealing with mountains of paperwork while coping with a mental and physical health condition can be overwhelming, to say the least. What, exactly, does your doctor need to say? How much “evidence” is going to be “sufficient”? Do you need to have a legal advisor involved in the process?

All your life, you’ve taken pride in being self-sufficient. It’s incredibly frustrating to depend on others for support and help. Now, it’s important to focus on restoring some measure of financial stability to your life by claiming – and keeping – all the benefits you deserve. Working with your doctor is going to be the key to success….

What is a doctor’s proof of disability letter?

In filing a disability claim, you will need a detailed report from a medical professional who knows you well enough to provide details about your medical condition, your treatment history, and the extent to which your condition prevents you from doing the kind of work in which you’re trained.

This paperwork is also referred to as an Attending Physician Statement. 

The specific form need will depend on where you were employed prior to the disability. The “proof of disability letter” might involve the doctor’s completing one or more of these forms: 

  1. Medical Review Package

The Ontario Disability Support Program (ODSP) – benefits come from the Ontario provincial government, and the Medical Review Package is what must be completed and submitted. 

  1. Form ISP-2519

The Canada Pension Plan Disability Benefits come from the Federal government of Canada; Form ISP-2519 is the proof of disability report needed. Service Canada reimburses up to $85 to a healthcare professional for filling out the medical form; patient may need to pay any additional charge. The CPP disability benefits application may be submitted on paper or online.

  1. Claim form from a private Long-Term Disability Insurance company

Each company will have its own claim form, which you may request directly. If a group policy through an employer is involved, the Human Resources Department should be able to provide the form.

A Proof of Disability letter in Canada is much than just a “note from your doctor”…

While the Proof of Disability letter represents a statement from your main physician (a qualified medical professional who has known you and been involved in your care for the longest period of time), the report will include:

  • Records from any medical professionals who’ve treated you, including specialists and psychiatrists
  • Records of lab tests (blood tests, biopsies, and imaging studies)
  • Records of medications prescribed
  • Records of surgeries
  • Recommended treatment plans – and whether you’ve followed those plans

Notes from you to your doctor:

Even the most caring and careful doctor cannot know what you are experiencing as a result of your condition.  Think about how your symptoms are affecting your day-to-day activities. Sharing this information allows your doctor to better describe the scope of your disability in the Proof of Disability Letter:

  • Are there things you are able to do, only it now takes you much longer to do them?
  • Are you having the most trouble functioning in the morning or at night?
  • What new symptoms have you been noticing? 
  • Household details – Who resides with you? Is anyone dependent on your for financial support? Are you receiving help and support from anyone in your household?

Make sure “enough is enough”; remember the 3 reasons for a “no”:

In the formal letters insurance companies issue denying a claim for disability benefits, one or more of these reasons is typically offered:

  1. The definition of disability was not met
  2. The medical evidence was insufficient
  3. There was documentation missing

Is the “no” ever coming from the doctor?

Yes, doctors in Ontario, Canada have the right to refuse your request to fill out your disability claim forms, for any of the following reasons:

  • The doctor may have no experience or expertise in the particular condition that is causing your disability. (For example, a mental illness is what is causing your inability to function at work; this doctor is not trained to treat mental disorders)
  • The doctor has not been treating you for long enough to have sufficient knowledge about your disability.
  • The doctor does not believe you meet the criteria needed to qualify for disability benefits.
Rob Konduros Disability, Employment & Personal Injury Lawyer
As Ontario disability lawyer Rob Konduros expresses his mission, “To get to ‘yes’, we are at your side every step of the way, helping you complete all application forms accurately and thoroughly, working with your healthcare providers, guiding you through the appeals process, all to ensure you receive fair treatment and that your rights are upheld.”

Do you need to have a legal advisor involved? When is it time to seek help from a disability lawyer?

Unfortunately, as we’ve learned over many years at Hilborn and Konduros, even with carefully prepared Proof of Disability letters -“no” answers to initial disability claims are all too common. As experienced disability lawyers in Ontario, Canada, we’ve helped many clients fight disability claims denials and get the benefits they need and deserve.

At any stage in the process of filing a claim for disability benefits, having expert can make a difference:

  • Preparing your filing. Your disability lawyer helps gather the detailed medical records and expert opinions for your Proof of Disability letter.
  • Navigating your appeal after a denial. Your lawyer represents you in hearings and fights for your rights – with government agencies or insurance companies.
  • Protecting you from unjust reduction of termination of benefits

In “getting to yes” when filing for Long-Term Disability benefits, the key is working with your doctor to build medical evidence in support of your claim.

FAQs: Working With Your Doctor on LTD Claims

  • 1. Can my family doctor fill out my LTD forms?

    Yes. Your family doctor can usually complete your disability forms if they have treated you long enough to understand your condition. However, in some cases, insurers may require input from a specialist (such as a psychiatrist, rheumatologist, or neurologist) to confirm the severity of your disability.

     

Do you have more questions?

Call Rob
8 Critical Documents You Need Before Applying for Long-Term Disability in Ontario

8 Critical Documents You Need Before Applying for Long-Term Disability in Ontario

When applications for Long-Term Disability benefits in Ontario are being considered, the difference between success and failure can often be found “on paper.” Were all eight critical documents submitted in timely fashion? Were there any important details inadvertently omitted?

As a recently disabled worker in Ontario, Canada, you’ve got a lot on your plate. Frustrated by the prospect of needing to depend on others for support and help, you’re determined to restore some measure of financial stability to your life by claiming all the benefits you deserve. Here are some steps to follow in the process of applying for Long-Term Disability benefits:

Step One: Determine the source(s) from which you might qualify to receive Long-Term Disability benefits.

Depending on where you were employed prior to the disability, you may be claiming benefits through one or more of these three programs:

  1. the Ontario Disability Support Program (ODSP) – benefits come from the Ontario provincial government
  2. the Canada Pension Plan Disability Benefits (CPP) – benefits come from the Federal government of Canada
  3. a private Long-Term Disability Insurance company – benefits come through a policy issued to you or to your employer

Important to understand:

  • Each program has its own paperwork that needs to be completed;
  • Each plan has different criteria for eligibility.
  • Qualifying for benefits under one of these programs can impact the amount for which you qualify under one program may be reduced if you are receiving benefits from a second program.

 

Step Two: Begin the process of gathering information to support your claim. The “what” and the “then + when”:  

Your Long-Term Disability “evidence package” is going to include documentation that essentially addresses two aspects of your disability: the “what” and the “when”.

The “what”:

These are documents and forms that explain what your reality is now, providing details about your medical condition and about how your ability to do the kind of work for which you have been trained is now limited.

Included in the “what” portion of your evidence package will be:

  1. Records of treatments you are now undergoing, and of what medications you are taking.
  2. Household details – Who resides with you? Is anyone dependent on your for financial support? Are you receiving help and support from anyone in your household?
  3. Income verification and financial records (what assets do you own? What sources of income do you have now?)
  4. Daily living impact evidence (What daily activities can you no longer perform?)

The “then + when”:

These are documents that show the details of your “past”, including your education and training history, and what jobs you’ve held from the beginning of your career and up to the present.

Included in the “then and when” portion of your evidence package will be:

  • Record of Employment from the Canada Revenue Agency
  • Detailed job descriptions of all prior jobs, along with performance reviews from employers
    Treatment and medication history
  • financial records – pay stubs, tax returns, bank statements
  • Record of all prior disability claims and benefits

 

Step Three: Take a breath; ask the questions; dismiss the myths; deal with the realities.

So much to think about… so many steps and details. It’s difficult to concentrate at a time when your life is undergoing such dramatic change. It’s understandable to experience sorrow and even anger, possibly facing a future very different from what you’d been expecting. For that very reason, before proceeding, it’s important to separate fiction from fact about the process of filing a Long-Term Disability claim.

Twin myths to dismiss:   

  • Myth: You can qualify for disability benefits only if you cannot do any work at all. Reality: Your education, skills, experience, and age will all be considered in addition to your medical diagnosis and prognosis, along with your overall ability to function and participate in your own care.
  • Myth: Only those with visible and physical disabilities qualify for benefits. Reality: Mental illnesses (bipolar disorder, depression, or PTSD, for example) can cause an inability to function at work.

Timeline in real time

  • Under the Canada Disability Benefit program, if you qualify, you will begin receiving payments the month after your application is approved.
  • Realistically, though, the approval rate for first-time disability claims in Ontario, Canada is not high, and more than half are initially denied.
Rob Konduros Disability, Employment & Personal Injury Lawyer
As Robert Konduros of Hilborn & Konduros, Disability, Employment and Personal Injury Lawyers, expresses his mission: “We help our clients navigate the complexities of the legal landscape.”

 

Step Four: Decide whether to enlist expert legal help in navigating the disability claims system.

The process of applying for disability benefits in Ontario involves navigating complex systems, regulations, and deadlines, all at a time when you’re already struggling to cope with all the unwelcome changes that seem to be “upending” your lifestyle.

How can having expert legal help improve your chances for a successful disability claim?  

  • An Ontario disability lawyer can help you understand your rights and options.
  • Your lawyer can ensure that your medical evidence is presented completely and effectively.
  • Should your claim be initially denied, your lawyer will negotiate with the insurance company or help gather whatever information is requested.
  • If needed, your disability lawyer will advocate for your rights in court.

Navigate the Long-Term Disability system in Ontario, Canada using the 4 steps and the 8 Critical Documents.

 

Checklist of Critical Documents:

Document 1: Complete Medical History & Current Treatment Records 

Document 2: Detailed Employment and Job Description Records

Document 3: Income Verification and Financial Records

Document 4: Functional Capacity and Daily Living Impact Evidence

Document 5: Previous Disability Claims and Benefits History

Document 6: Pharmacy Records and Medication History

Document 7: Educational and Training Background 

Document 8: Legal and Administrative Records

FAQs: Preparing an LTD Claim in Ontario

Do you have more questions?

Call Rob
Before You File: The Long-Term Disability Claim Preparation Guide for Ontario Workers

Before You File: The Long-Term Disability Claim Preparation Guide for Ontario Workers

Learn how to prepare your Long-Term Disability (LTD) claim before filing: essential timelines and expert tips for Ontario workers.

As a recently disabled Ontario worker, you’ve (very understandably) been wrestling with feelings of uncertainty and helplessness. Used to being in charge of your own life, you find it difficult to contemplate depending on others for support – financial or otherwise.  Despite those frustrations, you’re a person of action, prepared to take the next step – which is filing a Long-Term Disability Claim.

From what source or sources can you expect benefits?

Depending on where you were employed prior to the disability, you may be claiming benefits through one or more of these three programs:

  1. the Ontario Disability Support Program (OOSP)
  2. the Canada Pension Plan Disability Benefits (CPP)
  3. a private Long-Term Disability Insurance

First, though, you have many questions about the process of LTD claim preparation itself: 

  • How do I prepare myself for the process of filing a claim?
  • What medical records do I need before filing a Long-Term Disability claim?
  • How do I gather evidence before I apply?
  • How long it is likely to take to file a Long-Term Disability claim here in Ontario?
  • Do I need legal help? Can I prepare a LTD disability claim without a disability lawyer?
  • How do I find a Long-Term Disability lawyer in Ontario?

It’s difficult to concentrate on all these details. So much to think about…Your whole life is undergoing change, and if you’re like others adjusting to a disability, you’re experiencing sorrow, loneliness, and even anger as you contemplate a future very different from what you’d been expecting. Still, you know it’s crucial to proceed with care in order to qualify for the financial benefits you know you’re going to need.

What’s true and what’s not – dismissing disability myths and misinformation

  • It is not true that you can qualify for disability benefits only if you cannot do any work at all. Your education, skills, experience, and age will all be considered in addition to your medical diagnosis and prognosis, along with your overall ability to function and participate in your own care.
  • It is not true that only those with visible and physical disabilities qualify for benefits; mental illnesses (bipolar disorder, depression, or PTSD, for example) can cause an inability to function at work.
  • It is not true that one source of Long-Term Disability benefits is intended to provide the full amount of pre-disability income. The Canada Disability Benefit is designed to supplement the income from other sources of help, such as the Ontario Disability Support Program and/or private or employer-provided LTC benefits.
  • It is not true that once you’ve qualified for LTD benefits, they can never be stopped; you can expect regular reassessments of your situation.
Rob Konduros Disability, Employment & Personal Injury Lawyer
As Robert Konduros of Hilborn & Konduros, Disability, Employment and Personal Injury Lawyers, expresses his mission: “We navigate the complexities of the legal landscape.”

 

What medical records do you need before filing an LTD claim in Ontario?

In order for your application for LTD benefits to get the consideration it deserves, it is up to you to clearly demonstrate that it is your physical or mental medical condition preventing you from doing the kind job you were trained and educated to do (or, later, any job for which you’re reasonably suited based on your experience and education). What’s more, any medical conditions that were present before the disability must be fully disclosed.

Medical support is critical in applying for disability benefits. You’re going to need records of:

  • notes from family doctor visits
  • imaging results (X-rays, MRIs, CT scans, EMGs, EKGs)
  • lab test results
  • medications
  • documentation of therapy sessions (chiropractic, massage, aquatic, occupational, speech or language therapy)
  • notes from any specialists or mental health professionals who have been consulted about your condition
  • hospital records
  • rehab session records

The more organized your file, the easier it will be for the insurance company to review the information and “rule” on it.

Getting approved for Long-Term Disability benefits in Ontario, Canada – a reality check

Under the Canada Disability Benefit program, if you qualify, you will begin receiving payments the month after your application is approved. Realistically, though, the approval rate for first-time disability claims in Ontario, Canada is not high, and more than half are initially denied.

The process of navigating the disability claims system, with all its deadlines and legal procedures, can be daunting, particularly while you’re coping with so many unexpected life changes. Having expert legal help; can significantly improve your chances for a successful disability claim in Ontario.

 A disability lawyer can act as your advocate

Your disability lawyer:

  • understands the regulations
  • ensures that your medical evidence is presented completely and effectively.
  • helps you understand your rights and options
  • makes sure your paperwork is complete and filed on time
  • negotiates with your insurance company
  • if needed, advocates for your rights in court

LTD Claim Preparation Checklist for Ontario Workers: 

  • Review your Long-Term Disability insurance policy or your employer’s group benefits plan. Notice the definition of disability and the waiting (elimination) period before benefits start. Check to be sure your policy was in force at the time your disability began.
  • Ask your employer (Human Resources Department?) and/or the insurance provider for the application forms (there will be parts of the application for the employer to complete).
  • Gather the medical evidence from your doctors, including each specialist or therapist who treated you or who is now treating you.
  • Keep detailed records of every meeting, letter, email, and text message that related to your case.
  • Be prepared for an insurance adjuster to contact you via telephone or email to confirm the information on your claim.

“Know before you go” – filing a disability claim is no easy process

Despite your feelings of frustration and uncertainty, you’re prepared to face the future by taking the necessary actions to get financial support. You realize you’re going to need help navigating all the complexities of filing a claim, and it makes sense, as you begin the process, to meet with an experienced Ontario disability lawyer to plan the most effective way to successfully present your Long-Term Disability claim.

FAQs: LTD Claim Preparation in Ontario

Do you have more questions?

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