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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. 📞 Ready to discuss your case? Let's connect.

Posts by Rob Konduros:

Warning Signs Your Long-Term Disability Insurer Is Preparing to Cut Your Benefits (Ontario)

Warning Signs Your Long-Term Disability Insurer Is Preparing to Cut Your Benefits (Ontario)

For the past year and a half, you have been just barely able to manage your finances and pay the bills on time. Having heard stories about long-term disability benefits being cut off at the two-year mark, you are determined to remain calm and be proactive to protect the income stream on which you depend.

Are you just being paranoid? No. You have begun to sense a change in tone from your insurer. You are getting more frequent review visits and more forms to complete. There have also been several requests that you schedule an IME with a doctor of their choosing at a facility other than the one you are used to visiting. Even though you have filled out form after form over the past year or so, new forms are being sent to you requesting “updates.”

In the most recent correspondence, there has been mention, for the first time, of your “return-to-work” plan. Once known to be highly motivated and strongly committed to excellence at your job, you now realize that both your physical stamina and concentration have been so diminished that getting through a full day of any kind of work is just not yet possible.

If your LTD insurer is preparing to cut your benefits, there are usually early warning signs first. These often include more forms, broader medical record requests, an IME, vocational testing, payment delays, or new return-to-work language. In Ontario, these signs often appear before the 24-month change from own occupation to any occupation.

 

The biggest trigger in Ontario Long-Term Disability Claims: the 24-month change (own job to any job)

Every Long-Term Disability (LTD) policy has a definition of disability, meaning what conditions must exist for the insured to collect the benefit. In most Canadian LTD policies, that definition changes after the insured has collected benefits for two years.

Own occupation definition of disability

During the first two years from the month benefits begin, you qualify to receive benefits if it has been verified that you are unable to perform the duties of your own occupation.

Any occupation definition of disability

Starting from the change of definition date (COD), you are entitled to benefits only if it is proven that you are unable to work at any occupation for which you qualify based on:

  • your level of education
  • your training
  • your work experience

Why do insurers “build a file” before cutting benefits?

In an effort to maximize business profits and reduce the payout of benefits, the insurance company:

  1. conducts cost-control reviews
  2. exerts pressure on the insured to return to work as soon as possible
  3. often claims there is insufficient evidence that an insured cannot work, at least at a sedentary job
  4. uses an insured’s part-time ability as an argument for denying benefits

Remember, your insurer is testing whether you can work reliably, not whether you look unwell on any single day.

A simple timeline of what insurers often do leading up to and at the 24-month mark

3-4 months before: send requests for evidence of disability, including new questionnaires and updated demands showing that the insured is trying to get back to work

1-3 months before: demand that the insured take an IME, undergo vocational training, and/or participate in rehab planning

At the 24th month mark: reduce benefits or send a termination of benefits letter

12 warning signs your insurer is preparing to cut your LTD benefits

  1. You see: a sudden spike in forms and “function” questionnaires, such as ADLs, pain scales, mental health checklists, or “typical day” forms.

Do next: Answer accurately, stay consistent, and keep a copy of every form.

  1. You see: broader requests for medical records or new authorizations, asking you to complete a chart, list all providers, or update records every 30 days.

Do next: Track what was requested and what was sent. Confirm that your doctor’s notes match the limits you are claiming.

  1. You see: a request for an IME or “independent assessment.”

Do next: Prepare a one-page baseline summary covering symptoms, limits, bad-day frequency, medications, and how you feel after the exam.

  1. You see: a file review by an insurer doctor, with no exam, using terms such as “paper review,” “medical consultant,” or “internal review.”

Do next: Ask your treating clinician to address the specific work-capacity claims being implied.

  1. You see: a Functional Capacity Evaluation (FCE) or similar capacity testing used to argue that you can do sedentary or light work.

Do next: Make sure your treating team understands what the test is being used for, and document symptom flare-ups afterward.

  1. You see: a vocational assessment, transferable skills analysis, or job matching.

Do next: Gather your real work demands, education limits, cognitive limits, and reliability issues, including attendance, pace, and focus.

  1. You see: pressure to quickly join a rehab plan or return-to-work program, framed as rehabilitation, work hardening, or job search.

Do next: Request the plan in writing and confirm that your doctor supports the timing and restrictions.

  1. You see: the adjuster’s tone changes and becomes more formal, colder, and more focused on “entitlement” language.

Do next: Move communication into writing where possible, and keep calls short and documented.

  1. You see: payment delays, partial payments, or “reservation of rights” letters, signaling that the insurer is creating space to terminate.

Do next: Calendar the dates, ask what is missing, and respond with organized documentation.

  1. You see: more questions about your daily life, hobbies, travel, or routines, often tied to credibility and surveillance planning.

Do next: Answer honestly, avoid guessing, and keep your own daily log so you can stay consistent.

  1. You see: increased employer contact, such as updated job descriptions, attendance questions, or performance references.

Do next: Request a copy of the current job description and collect accommodation history and failed return-to-work attempts.

  1. You see: pressure to apply for CPP-D or other benefits in a way that feels strategic, with offsets and cost-shifting appearing alongside reassessment.

Do next: Track deadlines and keep your LTD narrative consistent across applications.

Notice any or all of the 12 signs? Five things to do:

  1. Keep a communications folder with letters, emails, forms, and dates.
  2. Start a reliability log covering symptoms, limits, missed tasks, recovery time, and bad-day frequency.
  3. Book a doctor visit focused on function, including work capacity, pace, attendance, focus, and pain or fatigue tolerance.
  4. Gather employer proof, including accommodations tried, attendance issues, and failed attempts.
  5. Save prescription and treatment history to show consistency.
Rob Konduros Disability, Employment & Personal Injury Lawyer
When your long-term disability benefits stop, it is your income, your treatment, and your stability.
You need a lawyer who can see you as a person, not an insurance file, and who is experienced in navigating insurance company bureaucracy.
And remember, I don’t get paid until you do.

Call me to find out more: 519 658 6341

Mistakes to avoid

(These things make termination easier for insurers.)

  1. Downplaying symptoms in appointments by saying you are “doing well” without explaining function limits.
  2. Making inconsistent statements across forms, doctors, and calls.
  3. Missing treatments or skipping recommended follow-up without a clear reason.
  4. Treating surveillance like a movie scene instead of a documentation problem.
  5. Waiting until after the termination letter to organize evidence.

You’re facing a decision: should you file an appeal or a legal claim?

If:

  • you have received an IME, FCE, or vocational notice
  • you are within months of the 24-month change in benefits
  • you see payment delays or entitlement review language
  • your doctor’s notes are vague or inconsistent with your real limits

It may be time to consult an Ontario Long-Term Disability lawyer.

FAQ: Warning Signs Your LTD Benefits May Be Cut (Ontario)

 

  • 1. What are the most common signs an LTD termination is coming?

    The most common signs are a sudden increase in forms, new requests for medical records, an IME, a paper review by the insurer’s doctor, vocational testing, payment delays, and a noticeable change in the adjuster’s tone. These often mean the insurer is reassessing whether it can argue you are able to work.

Get Your LTD Benefits Back

Start with a Free, No-Pressure Case Review
Call Rob
No-Fault Insurance in Ontario: What It Really Means for Injured Drivers and Passengers

No-Fault Insurance in Ontario: What It Really Means for Injured Drivers and Passengers

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It seems like just a moment ago that your daily drive turned into a nightmare.

Actually, it has been two days since the accident.

Going back to Friday, your co-worker had asked for a favor. His car was in the shop, and you had agreed to drop him off at his dentist’s office on your way home. He had arranged for his wife to pick him up from there. A light rain had begun to fall, and, at the end of the work week, traffic out of the city seemed even heavier than usual.

Suddenly, just as you were turning onto the highway off-ramp, you felt a tremendous impact from behind, forcing your car to hit the one in front of you.

The next few hours seemed like a blur of activity, with police asking questions, taking down information, and shooting pictures. An ambulance was summoned, but none of the four of you needed to be taken to the hospital. Both the rear and front ends of your car sustained significant scraping and denting, but you were actually able to drive it home.

While enormously relieved to have survived the accident with all four limbs intact, you have had time over the weekend to worry about many aspects of the accident. Will all the damage to your automobile be covered by your insurance? Although you were hit from behind, will you be held at fault for rear-ending the car in front of you?

As a freak side effect of the accident, your passenger’s mouth brace was dislodged, and he is concerned about the resulting dental costs. Should he claim under your insurance or his?

Meanwhile, perhaps due to the tension after such a “shake-up,” you have been having a hard time sleeping and are experiencing some neck pain.

 In Ontario, “no-fault” insurance means you can claim certain accident benefits through your own auto insurer no matter who caused the crash. But fault can still matter for vehicle damage, some parts of the claims process, and any lawsuit for losses not fully covered by accident benefits.

 

What does no-fault mean in Ontario?

The Ontario Motorist Protection Plan is meant to simplify the process for drivers  involved in a collision. The term ‘no-fault’ means that, regardless of whose fault the accident was, each driver will be covered by his or her own insurance policy, under the Statutory Accident Benefits regulation that has been in effect since 2010.

What is covered under no-fault insurance?

Dealing directly will your own insurer for coverage claims, you may be eligible to receive three basic types of compensation:

  1. health care and rehabilitation
  2. compensation for property damage to your vehicle and for lost or damaged contents
  3. protection from uninsured drivers

 

What does no-fault insurance in Ontario not mean?

The term “no-fault auto insurance” is often misunderstood. While certain benefits may be available regardless of fault, the term “no-fault”:

  • does not mean that nobody is held responsible for the accident
  • does not mean you have no rights
  • does not mean you cannot sue
  • does not mean the insurer will automatically cover all damages.

In order to receive benefits, you must still show evidence of injuries, treatment costs, and loss of income.

Are passengers injured in a car accident in Ontario covered under no-fault insurance?

Yes, passengers inured in car accidents in Ontario have rights to accident benefits for medical treatment and rehabilitation, regardless of fault.

Insured passenger compensation may be claimed:

  • against the passenger’s own insurance
  • against the driver’s insurance policy
  • against the Ontario Motor Vehicle Accident Claims Fund.

Passengers involved in a car accident often feel insecure: “

I wasn’t driving, so what do I do?”  

“I don’t want to create problems for the driver” (the driver is likely  a relative or friend)…

What can accident benefits help pay for?

  • medical and rehabilitation support
  • attendant care support
  • income-elated support
  • other support (depending on circumstances and coverage)

Important reminder: for both drivers and passengers who’ve been injured in an accident, not all insurance coverage is the same.

  • Optional insurance coverage choices will affect what levels of financial support are available to the insured.
  • Direct Compensation Property Damage covers vehicle repairs and damage to contents if you are not at fault ; optional collision coverage pays for repairs if you are at fault.
  • That means that, even in a “no-fault” system, actual fault can affect the claim process.

What to do in the first 7 days after a crash?

(a practical 3-point checklist):

  1. Get medical help. Document your symptoms.

  2. Report the accident promptly.

  3. Start a simple claim file, including dates, names of all people

Involved (passengers, bystanders, other driver/passengers), license plates,  receipts, photos, notes from medical appointments).

 

False thinking (myths) about no-fault insurance:

Myth 1: No-fault means fault does not matter at all.

The term “no-fault” describes how benefits begin. The term is not intended to cover every situation or every legal question.

Myth 2: If I cooperate, everything will be approved.

Optional coverage choices may have ruled out coverage for certain claims.

Myth 3: Passengers don’t have real rights.

Insured passenger compensation may be claimed.

Myth 4: If I feel OK today, I’m fine.

Symptoms often first appear days or even weeks after an accident.

Rob Konduros Disability, Employment & Personal Injury Lawyer
I’ll explain your options, protect deadlines for submitting paperwork, build the evidence needed to protect your right to treatment, and help you get the level of compensation you need and deserve.
Remember, we don’t get paid until you do.
Call 519 658 6341

If Ontario is no-fault, can I still sue? 

Lawsuits are usually considered only when:

  1. there have been serious injuries
  2. the accident has resulted in long-term impairment of a driver or a passenger
  3. there have been losses no fully covered by accident benefits

When a lawsuit is filed, it is in an attempt to cover:

  • pain and suffering
  • costs of future care 

Do you need legal help? Whether you’re thinking of suing or not, be on the alert for any of these scenarios:

When it makes sense to consult a lawyer:

  • Your insurance benefits have been delayed, reduced, or denied.
  • You’re being pushed into quick decisions.
  • You are unable to work.
  • Your condition does not seem to be improving.
  • You’re feeling dismissed, blamed, or just overwhelmed.

FAQs: No-Fault Insurance in Ontario

 

  • 1. What does “no-fault” mean in Ontario auto insurance?

    It means injured drivers and passengers can usually apply for certain accident benefits through an insurance policy connected to them, regardless of who caused the crash. It does not mean fault disappears or that every loss will be covered automatically. 

Get Clarity Without Pressure

Worried about going to court? Ask Rob how cases like yours are usually resolved.
Call Rob

The 6 Car Accident Checklists: Evidence That Protects Your Future Claim

The 6 Car Accident Checklists: Evidence That Protects Your Future Claim

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You’d always taken pride in being a careful driver,  but an accident was bound to happen sooner or later, you told yourself after your car was sideswiped in late afternoon Kitchener traffic. Your car was quite badly damaged; you , of course, were quite shaken up. Thankfully, no ambulance needed to be summoned. 

Now, days later, headachy and experiencing considerable stiffness, you’re second-guessing yourself, worried about saying the wrong things on what seems like a “mountain” of claim forms.  You certainly don’t view yourself as the litigious sort , but  (just in case things later appear to be “going downhill”, you could use a clear, practical checklist of what to record and what to save. 

You did report the accident to the police along with the insurer, and you did take photos at the scene. However, amidst the late afternoon rush, there was little opportunity to gather  any information from witnesses. You’ve had the same insurance company for years, and although somewhat concerned that your premiums might rise, you nonetheless feel fairly confident that your claim will be fairly treated.  

Meanwhile, you’ll work on keeping calm, but the truth is, the sooner your car is repaired and you’re able to put this behind  you and get back to a regular  routine, the happier you’re going to be…

What evidence should you keep after a car accident in Ontario?
After a car accident in Ontario, keep photos of the scene and vehicle damage, contact and insurance details for everyone involved, police or Collision Reporting Centre reports, medical records, a symptom diary, work and income records, receipts for accident-related expenses, and copies of all insurer communications. This evidence can quietly protect your future insurance or injury claim.

 

After an Ontario car accident – even a no-fault accident – evidence matters.

Insurance adjusters rely on what’s written down, not on what you say later.

Documents to gather and organize include: 

  • photos
  • medical records
  • police reports
  • Collision Reporting Centre reports
  • financial records

 

No-fault accidents

You can get Statutory Accident Benefits regardless of fault, but you still must show evidence of injuries, treatment costs, and income loss.

 

Serious injury claims

Courts look for medical evident and documentation of the effect injuries have on your work and on your daily life.

(keep this list on your phone)

Checklist set #1 – at the scene

Scene and vehicle photos

  • all damages to vehicles
  • license plates
  • road and weather conditions
  • skid marks, debris at the scene
  • visible injuries (bruises, cuts, seatbelt marks) 

 Exchanged information

  • names, phone numbers, addresses
  • driver’s licenses, license plates
  • insurance providers and policy numbers
  • make, model, year of vehicles

Witness checklist

  • names and contact details for anyone who saw the crash
  • short note or text message from each witness tellling what they saw
     

Checklist set #2 – official reports

  • police report (request incident number, officer’s name and number)
  • Collision Reporting Centre report (request report number and copies)

Insurers and courts often treat these reports as a starting point for understanding the incident.

Checklist set #3 – medical evidence

Medical visit and treatment reports

See a doctor, go to a walk-in clinic or ER and keep:

  • consultation notes/visit summary
  • imaging reports
  • specialist reports
  • physiotherapy/rehab/chiropractor records
  • hospital discharge papers

Symptoms and function diary (this diary is evidence not just a complaint list.)

Prepare weekly notes on:

  • pain levels and location
  • sleep problems
  • headaches, dizziness, “brain fog”
  • tasks you now have difficulty doing at home or at work
  • emotional impact (fear of driving, anxiety, low mood)

Checklist set #4 – work, income, daily life impact

(Ontario pain-and-suffering claims focus on credible evidence that important functions were affected by the accident)

Income and employment records 

  • pay stubs and T-4s
  • employment contract/job description
  • timesheets showing reduced hours
  • employer letters confirming time off and modified duties

Impact on real life

  • notes on missed work days or lost contracts
  • extra help needed with childcare housework, shopping
  • hobbies or activities that needed to be given up

Checklist set #5 – receipts and out-of-pocket expenses

Start a file of receipts for:

  • medications
  • over-the-counter aids (braces, bandage wraps, etc)
  • treatment expenses not fully covered (physiotherapy, massage, counseling)
  • parking and travel expense going to medical appointment
  • home help (assistance with chores, childcare)

 Checklist set #6 – insurance and communication file

(A  tidy “claim binder”, either physical or digital, will make it easier for your lawyer or claims adjuster to review the full picture and also make it harder for anyone to claim there is “no proof”.)

Keep copies of:

  1. insurer communications
  • letters and emails from insurers
  • text messages relating to the accident
  • notes of phone calls (dates, times, what was said and by whom)
  1. forms and applications
  • accident benefits forms (OCFs)
  • proof-of-loss forms
  • questionnaires
Rob Konduros Disability, Employment & Personal Injury Lawyer
As a personal injury lawyer in Ontario, I’m there to help with your motor vehicle accident claim. You may be entitled to compensation for pain and suffering, lost income, or medical expenses.  I put my team to work helping protect your rights to get the compensation you need and deserve.
Remember, we don’t get paid until you do.
Call 519 658 6341

How long do you need to keep car accident evidence?

Insurance timelines

  • Notify your insurer of injuries and of your intention to claim benefits within 7 days.
  • Complete and return benefits forms within set deadlines.

Lawsuit and limitation periods

  • Many Ontario motor vehicle claims must be started within two years of the accident (subject to exceptions.)

Common documentation mistakes that hurt Ontario auto accident claims:

  • not taking photos (“it’s just a minor accident…”)
  • delaying or skipping medical visits
  • throwing out receipts and letters
  • relying on memory instead of written notes

 

The “quiet 6” checklists that “speak loudly” to protect your claim:

  1. At-the-Scene
  2. Official Reports
  3. Medical Evidence
  4. Work, Income, Daily Life Impact
  5. Receipts and Expenses
  6. Insurance and Communication

FAQ: Car Accident Checklists

 

  • 1. What evidence is most important after a car accident in Ontario?

    The most important evidence includes scene photos, vehicle damage photos, witness details, police or Collision Reporting Centre reports, medical records, a symptom diary, work and income records, receipts, and all communication with your insurer. The goal is to create a clear record of what happened, how you were affected, and what the accident has cost you. 

Get Clarity Without Pressure

Worried about going to court? Ask Rob how cases like yours are usually resolved.
Call Rob

Empire Life LTD Claims: What to Watch For (Ontario)

Empire Life Long-Term Disability Claims: What Ontario Residents Should Watch For

The monthly long-term disability benefit check you’ve come to rely on is likely to be cut off just weeks from now, you’ve been informed in a letter from Empire Life. Struggling to remain calm, you reread the letter several times, realizing you’ve been given the option to appeal the company’s decision.

However, that would need to be done very quickly and you’re feeling totally lost as to how to begin.  What’s so absolutely frightening is that, even if you appeal, before a decision is likely reached, your financial support will have been cut off. 

Empire Life is claiming that your latest medical reports, in addition to their “surveillance” (of your social media and interviews with neighbors) show that your condition has improved to the extent that you could work, even if not at your former occupation. The letter highlights the paragraph in your policy that talks about the “24-month change of definition”.

It’s very difficult to focus on what next steps to take. You only wish that what they are saying were true, but it remains a daily challenge to overcome your own physical and emotional challenges.  Yes, you try to put on a good front in social media posts, trying to be cheerful in brief encounters with other people. But you know you’re far from being able to return to the workforce, putting in an entire day outside of your own space.

You feel paralyzed, yet you know some kind of decision must be made — and quickly.

If Empire Life denies or cuts your LTD benefits in Ontario, act quickly. Review the denial letter, note every deadline, gather your policy and medical records, and build evidence that shows how your condition limits reliable work. Depending on timing and evidence, an internal appeal or a lawsuit may be the stronger option.

What is the 24-month change in long-term disability coverage with Empire Life in Ontario, Canada?

Most Canadian LTD policies, including Empire Life, use two different definitions of disability,

  • During the first two years (starting from the month benefit payments have begun, you qualify to receive benefits if it has been verified that you have been unable to perform the duties of your own occupation..
  • Beginning in the 25th month, the insurance company usually changes the standard to any occupation, meaning that you are entitled to benefits only if it is proven that you are unable to work at any occupation for which you qualify based on your level of education and training, and your work experience.

What this all means is that the key to receiving benefits from  Empire Life is proving, not what your condition is or what the symptoms are, but proving that your condition impacts your ability to perform the duties of a job.

Responding to insurance company surveillance findings

Private investigators are often employed by insurance companies, both to uncover fraud and to deny claims. This might include social media monitoring and interviews with neighbors or vendors who interact with the insured person.

Honesty is key in claiming Long-Term Disability insurance benefits. It is also important to be mindful of your activities — and how you present yourself and those activities on social media. While you may be trying to “put on a good face” despite your struggles, your postscan be misinterpreted.  It might be wise to limit, or even totally avoid, social media use.

In responding to the Empire Life 24-month letter, “think functional”

Precisely because the insurance company is concerned with the impact your condition has on your ability to perform job duties, you, too, should think in terms of functional limitations. In gathering medical evidence from your medical providers, insist that the report show the impact your condition might have on your ability to function in a work environment.

  • Organize a file of all the medical appointments you’ve had.
  • In reading over each report, see whether there is mention of how your condition prevents you from maintaining regular attendance at work and from concentrating on tasks. 
  • Particularly in more recent reports, request from that provider a comment on specific functional effects of your condition.
  • Organize a log of medications prescribed and taken and their side effects you’ve experienced (complete with dates).
  • Prepare a description of a “typical day in your life”. (What activities did you do? How often did you need to rest? Did you “crash” after a certain kind of activity?

 

Get ready for the in-between time

It’s important not to allow your fear of supporting yourself  to paralyze you.  While working to restore your Long Term Disability insurance benefits, you can explore alternative financial resources:

 

Other can-do actions to consider

  • arrange for an examination or consultation from a new specialist.
  • consult a vocational advisor, asking for a letter explaining why you are (as of right now) unable to work at any occupation.
  • follow up on any Independent Medical Examinations mentioned in the denial letter.  

Should I appeal to Empire Life or sue in Ontario? That is the question…

Internal appeal:  

An appeal is faster, less formal and confrontational than turning  to the courts, but you are leaving the decision up to Empire Life’s employees and hired consultants. (Remember, it is not in the company’s best interests to help you.) You might also risk the deadline for filing a lawsuit.

Lawsuit:

You are turning to a third party, letting the court system decide whether or not you qualify for continued benefits.  There will be both court costs and increased lawyer’s fees involved.

Read more: Should You File a Legal Claim or Internal Appeal for Long-Term Disability in Ontario?

 

Rob Konduros Disability, Employment & Personal Injury Lawyer
As a lawyer focusing on Ontario disability claims, I have experience navigating denied Long-Term Disability cases against major insurers, including Empire Life.
You’re already struggling financially. The denial letter from Empire has been a crushing setback. The last thing you need is another financial burden.  What you do need is experienced legal help on your side.
Remember my clients don’t pay unless they win.

Call me to find out more: 519 658 6341

Can an Ontario disability lawyer be of help in reversing an Empire Life LTD denial?

Whether your decision is to file an internal appeal or a lawsuit, an experienced Ontario disability lawyer can be of enormous help in:

  1. reviewing both the policy itself and the 24-month letter (the lawyer understands the terminology and the options).
  2. gathering the comprehensive medical information (the lawyer understands how to solicit the functional diagnoses and opinions as third-party evidence).
  3. negotiating settlements and handling communications (the lawyer has experience with many different situations).

FAQ: Empire Life denied my Long-Term Disability 

 

  • 1. Empire Life denied my LTD. What should I do first?

    Start by reading the denial or termination letter carefully. Note the deadline to respond, the reason Empire Life gave, and any request for extra documents, an IME, or updated medical evidence. Then gather your policy, recent medical records, job description, and any prior approval letters so you can assess your next step clearly.

Get Your LTD Benefits Back

Start with a Free, No-Pressure Case Review
Call Rob
Chronic Pain & Fatigue Long-Term Disability Claims

Chronic Pain & Fatigue Long-Term Disability Claims (Fibromyalgia, ME/CFS): Evidence That Works in Ontario

Unable to work for the past twenty months, you’ve been struggling to keep your spirits up, trying desperately to maintain control over your own mind and body. There has been comfort in knowing the regular monthly disability benefit check has been sufficient to cover at least your basic living expenses.

However, you’ve now been informed that, in just a few months’ time, those checks will no longer be arriving. Unless you are able to prove that you’re unable to  perform the duties of “any occupation for which you’re suited based on your education, training, and experience”, your benefits are going to be cancelled.

It all seems insurmountable… there have been months and months of tests and interviews, but how do you explain, even to a medical professional, how it feels to “crash”, being totally helpless after any prolonged physical or even mental activity?  How do you “prove” those blinding headaches when even a  tiny ray of light or a slight noise –or even a slight movement — causes such terrific pain?

You’ve been over and over the letter from the insurer. They obviously believe you are capable of working at a more sedentary job than the one you once had. So long as no heavy physical exertion is required, their idea is, you should be able to keep up a regular work schedule. (How you wish that were really the case!).  

The reality is that, even after you’ve competed a simple task: reading a paper, paying bills, mental effort you require a recovery period; you become “flattened” by  what  your  doctor calls “malaise”…

Can fibromyalgia or ME/CFS qualify for LTD in Ontario?
Yes. In Ontario, fibromyalgia and ME/CFS can support an LTD claim if the evidence shows that your symptoms limit your ability to work reliably. Insurers look beyond the diagnosis itself and focus on functional limits, post-exertional malaise, attendance problems, reduced pace, impaired focus, and whether you can sustain work on a predictable basis. 

What is ME/CFS?

Myalgic encephalomyelitis/chronic fatigue syndrome is a complex disease that limits the health and productivity of patients. 

Two other names for the condition are:

  • SEID – systemic exertion intolerance disease
  • CFIDS – chronic fatigue immunity deficiency syndrome

The cause is not fully understood, but the condition often develops after an infection such as SARS, COVID2, or mononucleosis.

There is no diagnostic test for ME/CFS, and no approved drugs.

Treatment focuses on easing symptoms.

Symptoms of MC/CFS:

  • extreme, persistent fatigue
  • PEM (post-exertional malaise) – symptoms worsen after physical or mental effort
  • Headaches (including migraines), sore throat, tender lymph nodes in neck or armpits

What is fibromyalgia?

Fibromyalgia is frequently confused with ME/CFS due to similar symptoms such as fatigue, brain fog, and sleep issues. However, fibromyalgia is defined by widespread musculoskeletal pain. 

Remember, LTD decisions turn on functional limits and reliability, not labels.

Your disability insurance company is viewing your illness from the point of view of a potential employer. Employers are concerned with whether an employee can perform the essential functions of their job safely and reliably. What tasks can – or can’t – their employee be relied upon to do?

  • Will the employee’s health condition cause a lot of absenteeism?
  • Can the employee maintain a predictable work schedule?
  • Can the employee be relied on to keep up the “pace”?
  • Will the employee’s medical condition cause him or her to make dangerous mistakes, possibly resulting in injury to self or co-workers?
  • What scheduling accommodations or ergonomic equipment will be needed in the workplace for this employee?

What is an IME?

In the letter notifying you that your benefits are in danger of being terminated at the 24-month mark, you were told that you can agree to undergo an IME.  This is an Independent Medical Examination, designed to evaluate two things:

  1. whether the treatments recommended by your own doctors are necessary and appropriate
  1. whether you would be able to handle the duties of a regular job.

While the results of an Independent Medical Examination can be used to provide a “neutral” assessment of medical facts, those results may be used  by the insurer to justify denying you benefits, using doctors  and investigators hired by and representing the interests of the insurance company.

Preparing for an IME: 7-Day Evidence Plan

Day 1: Gather your documents: the insurance policy, letters from the insurer, medical reports from doctors and therapists.

Day 2: Start a log showing incidents of pain, fatigue, PEMs (post-exertional malaise occurrences).

Day 3: Book the doctor visit (request they use functional language).

Day 4: Compile all records from your last employment and any RTW (Return to Work) attempts

Day 5: Gather objective proxies (specific examination results, diagnostic studies such as EKGs or ECGs that were done, blood tests results, CT scans, X-rays).

Day 6: Draft a 250-300 word description of a “typical day in your life”.

Day 7: Consider the “decision tree” – appeal vs. claim.

What is a CPET? If this has not been suggested by your insurer, should you request one?

Cardiopulmonary Exercise Testing is a two-day testing protocol using a stationary bicycle with resistance added incrementally for 8-12 minute cycles.

CPETS can be helpful in documenting PEMs (which are otherwise difficult to prove), reinforcing your claim of being unable to work.

Appeal vs. Legal Claim — Choosing Your Path:

As you reread the letter issued by your LTD insurer, take careful note of the two specific deadlines the company is giving you for taking action.

  1. Deadline for filing an “internal appeal” (usually 60-180 days)
  2. Deadline for filing suit against the company (usually two years)

The differences:

An internal appeal challenges the insurance company’s decision to terminate your benefits.  You are responding to the insurer, offering new evidence of both your disability and your efforts to comply.

When you choose to start a lawsuit, you are turning to a third party, letting the court system decide whether you qualify for continued benefits. The insurance company will be forced to obey whatever the court’s decision is, or agree to a settlement.

Rob Konduros Disability, Employment & Personal Injury Lawyer
Your insurance company wants to discontinue your benefits, insisting you are ready to get back to work (perhaps not in your former position, but at “any occupation.” But, while the chronic pain and fatigue symptoms may be hard to “prove”, they are affecting your life in ways all too real.’
For decades, I’ve devoted my work to protecting your rights and getting you the compensation you need and deserve.

For a no-obligation chat, call 519 658 6341

How can an Ontario LTD lawyer help chronic pain and fatigue sufferers?

  • Managing the process

 Understanding the terminology, the lawyer manages all the letters, emails, and phone calls from the insurance company, along with all requests to and correspondence  from medical providers.

  • Building the case

Gathering medical evidence, including functional capacity evaluations  and vocational analyses, and  documenting conditions to prove the severity of your condition.

  • Providing legal support

Overcoming denials and guiding you through the legal process, helping  you decide whether to appeal or file a claim.

FAQ: Chronic Pain & Fatigue LTD Evidence (Ontario)

 

  • 1. What functional limits matter most for pain and fatigue LTD claims?

    The most important limits are the ones that affect your ability to work consistently. That includes reduced stamina, pain with sitting or standing, the need for unscheduled breaks, brain fog, slower processing speed, missed days, and delayed recovery after physical or mental effort. Insurers often focus on whether you can show up reliably, stay on task, and repeat that effort day after day.

Get Your LTD Benefits Back

Start with a Free, No-Pressure Case Review
Call Rob
Should You Call the Police and Your Insurer After a Minor Crash? A Plain-Language Guide for Ontario Drivers

Should You Call the Police and Your Insurer After a Minor Crash? A Plain-Language Guide for Ontario Drivers

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Hard to believe a car accident can happen in a parking lot, but that’s exactly what effectively spoiled your day.

Although shaken up, you feel you managed the situation quite well, exchanging information with the other driver, even taking pictures on your phone of the damage done to your car (and to the front of the other driver’s car). You notified your insurance agent. You called the police, and after answering a few questions, were directed to the CRC. Albeit damaged, the car was driveable, and you were able to get home to share the details with your family. 

Still a bit shaky , you’re feeling foolish.  After years and years of safe driving, you get hit in a parking lot! Can a situation be more ironic? Even your insurance agent, taking down the report, consoled you by mentioning your previously unblemished record. (Still, you thought he sounded a bit ‘cagey’ when you asked whether your premium would be going up…)

In Ontario, report a collision to police or a Collision Reporting Centre if anyone is injured, combined damage appears over $5,000, public property is damaged, or a crime is suspected. If the cars are drivable and it’s non-emergency, start the report and attend the Centre within 24 hours. Tell your insurer within 7 days if you plan to claim.

 

Things to know and where to find answers after a minor crash in Kitchener or Waterloo:

OntarioHighwayTrafficAct.com  is an online community in which members  share their knowledge to  help people make informed decisions about driving and about traffic tickets.

The Ontario Highway Traffic Act requires that all collisions in which a) persons were injured or b) where property damage is valued at more than $5,000  be reported to police as soon as possible.

The minor injury guideline is a framework used by insurance Companies  in Ontario to classify certain injuries and limit the medical benefits  available to accident victims. When your injury is classified under the MIG,  it restricts your access to treatment and puts a cap on the benefits  you can claim.

The Financial Services Regulatory Authority of Ontario supervises the auto insurance sector, and SABS, the Statutory Accident Benefits Schedule is included in all automobile insurance as standard coverage.

No-fault insurance streamlines the claims process because your claim is handled solely by your own insurer.

A ‘fender bender’ can cause serious injury

The body can absorb force even when the damage to the car appears small. Stiff seats and head restraints are designed to protect drivers and passengers in high-speed crashes, but  are less helpful in low-speed impacts in preventing strain and soft tissue damage.            

When must you call police?

Under Ontario rules and police guidance, you must file a police report if:

  • anyone has been injured or killed
  • the combined damage (to vehicle or property) exceeds $5,000
  • highway or public property has been damaged (signs, guardrails, lighting)
  • a criminal offense in suspected (leaving the scene, impaired driving)

What are the possible legal consequences of failing to report an accident to the police?

If any of those factors listed under the police guidance rules are present and you fail to file a police report, you may suffer legal consequences, including:

  • a fine of up to $1,000
  • statutory victim surcharges
  • court costs
  • demerit points
  • increase in insurance rates

Is it illegal to call police for a “very small” accident?

It’s never illegal to seek guidance. The police will direct you to CRC if that is the most appropriate course of action.

Note: If in doubt, call non-emergency police, they will advise whether to attend a CRC or just exchange information with the other driver.

Collision reporting centres for non-emergency situations:

If two things are true: (your vehicle is drivable and there appear to be no serious injuries), you: 

  1. start an online or phone report
  2. attend a Collision Reporting Centre within 24 hours.

Do you have to call your insurer after a minor crash?

According to FSRA, you are to file a report with your insurer (or the agent or broker for that company) as soon as possible after the accident,  but within seven days if you want to claim benefits.

Any time you:

  • want repairs paid by the insurance company
  • think you might in fact have an injury
  • think the other driver might report the accident
  • you’re unsure who is at fault

Think twice –

Your policy might allow you to “pay out of pocket” and avoid filing a claim, but…

  • the other driver might report damages (and your insurer could  then deny paying on the grounds that you failed to properly  notify them.
  • you could later develop pain or concussion symptoms, and it would be easier for your insurer to deny benefits, saying your problems are unrelated to the accident.

The importance of keeping records

  • At the scene, exchange phone numbers, addresses, driver’s licenses, insurance details, license plate numbers. If there are bystanders, take notes on their comments.
  • Keep notes on every telephone call with the insurer or agent, and with the police.
  • If you visit a doctor or clinic to check on possible physical effects of the accident, keep all notes on those visits.
Rob Konduros Disability, Employment & Personal Injury Lawyer
Over my nearly 40 years’ experience dealing with clients, I’ve seen how, more often than you might think, so-called ‘minor’ car accidents result in not-so-minor injuries, and with extended battles with insurance companies.
If you feel the need to speak with someone who knows what all the insurance terminology means and precisely what your options are, I’m willing to offer a no-obligation, no pressure-to-sue chat.
Call 519 658 6341

Is there any reason to talk to a car accident lawyer after a minor car crash?

At the scene of the accident, there appeared to be no injuries — either to you or to the other driver, and with the damages under $5,000, you were told no police report was needed. You think you’ve handled everything in the proper way. On the other hand, you would like to speak with someone who knows all the laws and who can represent your interests in the event your insurance company refuses to pay for treating any health problems that might appear later on.

If you have no intention of suing anyone or being sued, you wonder, would a car accident lawyer in Ontario be willing to offer a free consultation or would that be wasting their time?

 

FAQ: Minor Crash in Ontario: Should You Call Police & Insurance?

 

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Worried about going to court? Ask Rob how cases like yours are usually resolved.
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When “It Was Just a Fender Bender” Isn’t Simple: Why Minor Crashes Can Lead to Serious Injuries

When “It Was Just a Fender Bender” Isn’t Simple: Why Minor Crashes Can Lead to Serious Injuries

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Can it be more ironic? After more than a decade of careful driving with no accidents, your car gets hit as you’re backing out of your parking spot.

Your insurance agent was quick to comfort you by calling the incident a ‘fender bender,’ complimenting you on your own previously unblemished safe driving record.

Although relieved that your car had sustained only relatively small damages, needing only two days in the shop, you’re not so sure about your own ‘damages.” Although nothing serious showed up on the scans, your neck pain hasn’t gone away, and neither have the headaches. Perhaps it’s psychological, because you find yourself mentally ‘freezing up’ every time you get behind the wheel, particularly in that very same parking lot at your workplace. 

When you reported your continuing discomfort to your doctor, he suggested some physical therapy, which you’ve begun. But when you went back to your insurance company with those reports, they dismissed  your symptoms as ‘psychological.’ The agent was told you were simply ‘overreacting.’ You were directed to the Minor Injury Guideline (MIG), and told that you could fill out a request for an exception, but they doubted you would qualify.

Whereas your earlier conversation with the agent had you feeling comforted — after all, it was just a ‘fender bender’ now you’re feeling very isolated, viewed as an enemy rather than as a client. Should you seek legal help, you wonder?

Even a “minor” fender bender can cause real injuries like whiplash, soft-tissue strain, concussion symptoms, chronic pain, and driving anxiety. Symptoms often show up hours or days later. In Ontario, insurers may label these injuries “minor” under the Minor Injury Guideline (MIG), capping treatment at $3,500, unless strong medical evidence supports an exception.

 

What is whiplash, and can you get it in a ‘fender-bender’?

Whiplash is a neck injury caused by a rapid back-and-forth movement neck. The condition might result from a sports accident or even from physical abuse, but it is commonly caused by a rear end car crashed.

When the car is “jolted” from behind, the neck of the person sitting in the driver’s seat can be sprained, the Mayo Clinic’s website explains.  

Symptoms may include headaches, loss of range of motion in the neck, tiredness, dizziness, and headaches. Most get better within a few weeks, but some end up with long-lasting complications.

Rear-end collisions account for nearly 30% of all car accidents, Alexander Orthopaedics.com notes, making them one of the most common causes of whiplash injuries. Sometimes symptoms don’t appear at all until weeks after the initial Incident, orthopedic spine surgeon Dr. Joshua Abrams explains. Adrenaline  released right after the injury can mask the initial effects, even when micro-tears have occurred. Possible delayed symptoms include:

  • neck pain and stiffness
  • headaches
  • sleep disturbances
  • ringing in the ears
  • depression
  • difficulty concentrating

Can a ‘fender bender’ really cause serious injury?

A low-speed impact can cause serious harm to the human body for two basic reasons:

Anatomical physics: When you’re in the driver’s seat and your car is hit from the rear, your neck snaps forward and back in just milliseconds.                 

Car construction: Stiff seats and head restraints are designed to protect drivers and passengers in high-speed crashes, but in low-speed impact situations, they are less helpful in preventing strain and soft tissue damage Modern bumpers are built to remain rigid at low speed, so that when an automobile is rammed from behind, energy transfers to the body rather than to the car.           

The benefit spectrum – MIG to SABS

 What is the Ontario Minor Injury Guideline (MIG)?

The minor injury guideline is a framework used by insurance companies in Ontario to classify certain injuries and limit the medical benefits available to accident victims..When your injury is classified under the MIG, it restricts your access to treatment and puts a cap on the benefits you can claim.

Insurance companies typically apply the minor injury guideline​ when they believe your injuries will heal within a few weeks or months with minimal treatment. The MIG puts a $3,500 limit on medical and rehabilitation benefits, meaning that once you’ve used up this amount, you will be  need to pay out of pocket for any further treatment.

The only way a claimant can get out of the Minor Injury Guideline in Ontario is to provide medical evidence showing that the injuries are not minor and that they deserve to be viewed as ‘major’ under SABS.

What is SABS (Statutory Accident Benefits Schedule)?

SABS is an Ontario regulation that mandates no-fault insurance coverage for individuals injured in motor vehicle accidents.  That means that, regardless whose fault the accident was, essential benefits are provided  by the insurer to injured parties, (which might include drivers, passengers, pedestrians, or cyclists.

The Financial Services Regulatory Authority of Ontario supervises the auto insurance sector, and SABS, the Statutory Accident Benefits Schedule is included in all automobile insurance as standard coverage.

Potential benefits under SABS include:

  • medical treatment
  • rehabilitation
  • income replacement
  • caregiver support.
Rob Konduros Disability, Employment & Personal Injury Lawyer
While you’ve never been the type of person who’s always threatening to sue, you need to speak with someone who knows what all the insurance terminology means and precisely what your options are, someone who explains your options without any pressure to sue.
I have nearly 40 years of experience dealing with physical injuries after so-called ‘minor’ car accidents that result in not-so-minor injuries.
For a no-obligation chat, call 519 658 6341

Should you talk to a car accident lawyer about a ‘minor’ crash?

Yes. Successfully proving, through medical evidence, that your accident has caused major damage can increase your potential benefit limit from $3,500 (under MIG) to as much as $65,000 (under SABS).

There may be no need to file a lawsuit against the driver who rear-ended your car. But an experienced  Canada personal injury lawyer can gather evidence, and fight for your rights against the insurer that is denying

you the benefits you need. Through the dispute resolution process of the Ontario Licence Appeal Tribunal, the lawyer can push for reclassification of your injuries from MIG to SABS.

An experienced, knowledgeable auto accident lawyer is used to dealing with insurance companies and understands the intricate language of any offer, helping you decide whether to accept or reject it.

 

FAQ: When a ‘Fender Bender’ Isn’t Minor in Ontario 

 

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Worried about going to court? Ask Rob how cases like yours are usually resolved.
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First 72 Hours After an Ontario Car Accident

What to Do in the First 72 Hours After a Car Accident in Ontario (Even If You Feel ‘Mostly Fine’)

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It was bound to happen to you sooner or later, you realize.  While you’ve always prided yourself on being a responsible driver, not everyone is.

Heaven knows, you’d driven by plenty of car accident scenes on your way to and from your job. You’d shake your head in sympathy as you viewed the mangled fenders and frightened drivers exchanging  contact information.

Now, it’s happened to you. A driver – miscalculating the time needed to change lanes – collided with the side of your vehicle, inflicting some rather serious-looking dents and scratches. Thankfully, no one’s airbag deployed; and although each obviously shaken up, you were able to  exit your cars.

Mostly fine, you’re hoping the stiffness in your neck and arms will pass in a few days. With several important projects afoot at your job, and the kids depending on you to chauffeur them to school and activities, the rental car will have to do for now. 

You’ve reported the accident to your insurance company, and, although concerned that your premiums might go  up, you trust them to treat you fairly. As a person who hates unnecessary conflict, even the thought of filing suit against the other driver is unappealing. The sooner your car can be repaired and you can get back to your regular routine, the happier you’re going to be.

In the first 72 hours after a car accident in Ontario, focus on your health and your paper trail. Get checked by a doctor, report the collision to police or a Collision Reporting Centre within 24 hours when required (often when combined damage appears over $5,000), take photos and gather witness info, start a symptom diary, and notify your insurer promptly (SABS notice is commonly referenced as 7 days).

 

An 6-Point, 72-hour post-accident checklist: 

#1 Your own safety must be first on your after-accident to-do list. See a doctor ASAP (go to a walk-in clinic or ER)

Many people feel just fine right after a car crash, wanting nothing more than to get home (or back to work) anxious to get on with their lives. The problem is that many soft-tissue injuries, concussions, and psychological symptoms don’t show up right after the accident.

In fact, it’s quite common for serious effects to make themselves known hours, days, even weeks later.

  • “Adrenaline and shock often mask pain receptors immediately after impact,” Dr. Adam Rosoff of the Total Vitality Medical practice explains.
  • “Psychiatric symptoms and disorder are frequent after major and less severe road accident injury,” according to the National Library of Medicine.

Therefore, you should start a symptom-and-impact diary, which helps both doctors and. Insurers understand functional limits caused by the crash, not just labels. Record all incidents of:

  • pain
  • stiffness
  • headaches
  • nausea
  • brain fog
  • fear of driving
  • whiplash neck pain
  • things you have difficulty doing at home or at work since the injury
#2 Deadlines start the moment a crash happens. 
  • 24-hour deadline: “Drivers involved in property damage collisions MUST report  within twenty-four hours to a Collision Reporting Centre,”

The government collision report form is then checked by a police officer.

#3  Information to collect at the accident scene:

(All drivers are advised to screenshot this list on their phone)

From the other driver:

  • name
  • contact information
  • driver’s license
  • insurance information
  • license plate

From witnesses:

  • name
  • contact information

Take photos – or videos – showing:

  • damage to both cars
  • road conditions
  • weather conditions
  • skid marks
  • debris
  • airbag deployment
  • seat belt marks
  • bruises to drivers or passengers
#4  What to say (and what not to say) when reporting the accident to your insurance company: 
  • Notify your insurer of the accident as soon as possible (don’t  wait 7 days)  
  • Stick to facts, not fault

Report the date, tie, location of the accident, the basic facts of what happened, and any injuries you know of to either party or to passengers. Avoid assigning blame to the other driver or to yourself.

  • Ask about accident benefits

Verify SABS (Statutory Accident Benefits Schedule) of coverage for treatments, income replacement, rehabilitation support.

Request  that an Accident Benefits package be sent to you, noting the 30-day form deadline. 

#5  Document now – it will make a big difference later!

Start an Accident Folder (or Accident App) to keep all records, photos, and information  pertaining to the accident.

  1. Claim number
  2. Adjustor’s name and contact information
  3. Log of calls – time, date, who said what
  4. Photos and videos
  5. Accident effects log (documenting

                 – days you needed to take off from work

                 – help you needed to hire for childcare or household management

                 – tasks you now have difficulty performing at work

#6  Avoid mistakes commonly made in the first 72 hours following a car accident
  • Minimizing your injuries (you’re embarrassed or busy)
  • Not reporting the accident (failing to notify the Collision Reporting Center or the police)
  • Giving detailed recorded statements before you understand your rights (You feel pressured to make early statements or to sign authorizations before you’ve had a chance to speak with a lawyer)
  • Posting about the accident on social media (saying you’re “safe” or “fine” can be used against you later if you file a claim) 
Rob Konduros Disability, Employment & Personal Injury Lawyer
As a veteran litigator who has dealt with car accidents many, many times before, my role is protecting your rights whether you end up filing a lawsuit or not.

I will personally handle your case with no surprises, and no upfront costs.

For a no-obligation chat, call 519 658 6341

Should you talk to a car accident lawyer in the first 72 hours following a crash? 

  • You don’t have to wait for things to go wrong.

Talking with a lawyer allows you to ask questions about benefits, deadlines, and next steps.  (Many lawyers offer free, no-obligation consults).

  • A good Ontario car accident lawyer will:

Explain your rights, helping you avoid mistakes in filling out forms and in making statements. The lawyer becomes a buffer between you and the insurer.

  • Red flags that mean “talk to a lawyer NOW!”
  1. You’ve had serious symptoms, perhaps even requiring a hospital visit.
  2. Your insurer suggests you “don’t need a lawyer”.
  3. You’ve been pressured to settle quickly or to sign broad releases.
  4. You feel overwhelmed by all the forms and calls.

          

Know this: You do not need to be confrontational in order to protect your interests following a car crash. And, no, you do not ‘have to’ go to court after a car accident in Ontario. But you do need to move forward and make sure your rights are protected.

 

FAQ: First 72 Hours After an Ontario Car Accident

 

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Worried about going to court? Ask Rob how cases like yours are usually resolved.
Call Rob

Desjardins LTD Claims: What to Do if Your Benefits are Cut or Denied (Ontario)

Desjardins LTD Claims: What to Do if Your Benefits are Cut or Denied (Ontario)

You’ve just received notice from your Long-Term Disability insurance company, Desjardins, that in just a few weeks, the benefit checks you’ve been receiving are going to be cut off. You’ve been given an option to file an appeal with the company, but that would need to be done very quickly, and meanwhile, the financial support on which you’ve been relying will have stopped. Beyond disheartened, you feel trapped, not knowing how to respond.

You’ve read the letter over and over. It seems the reasoning for Desjardins’ decision are that “surveillance footage” suggests that, while your condition has improved sufficiently to allow you to work, you’ve not taken any steps to find a job.  What’s more, the implication is that there is insufficient medical documentation proving you are still totally disabled. While no specifics are given in the letter, the company is implying that you’ve not faithfully followed all the prescribed medical treatments. 

You’re finding it very difficult to focus on next steps to take; despite what the letter implies — and your own efforts to overcome your physical and emotional challenges, , you know you are far from being able to return to the work force. Frightened about how you’ll support yourself without those monthly checks, your thoughts go round and round, even as you realize you must embark – and quickly – on some course of action…

If Desjardins denies or stops your Ontario long-term disability benefits, act fast. Save the denial letter, write down every deadline, and get your policy and job description. Ask your doctor for notes that link your condition to work limits. Then choose a path: an internal appeal or a lawsuit, based on timing and evidence.

 

What is the 20-month change in long-term disability coverage with Desjardins LTD Insurance Company in Ontario, Canada?

  • First two years:

Covered: any state of continuous disability resulting from an accident, illness, complication of pregnancy or organ donation that prevents the member from performing the main duties of their regular occupation (own occupation) during  the long-term disability insurance waiting period and the 20 months following this same period of disability.

  • Years following the first two:

If this condition lasts for more than 20 months, in order to be covered by insurance, the disability must prevent the plan member from performing any paid occupation or from doing any work that  might provide them with wages or profit of any kind (occupation or work they are reasonably prepared for by education, training or experience (regardless of the availability of employment). 

Take comfort while taking steps to restore benefits

It’s important not to allow your fear of supporting yourself to paralyze you. While working to restore your Long-Term Disability insurance benefits, you can explore alternative financial resources:

Where to start after receiving a denial letter

5 steps to take:

  1. Get a grip on timelines and medical records

When dealing with a long term disability denial letter, having comprehensive and organized records is critical.  Match up all correspondence recommending  treatments with records of your having received those very treatments:

  • Proof of each visit to specialists and therapists (Go back to each Provider, asking them to provide additional details about your limitations).
  • Gather and organize receipts showing that you filled every prescription for medication.
  • Test results from doctors, therapists, or hospitals.
  • Records of your correspondence with the insurer.

2. Arrange for an examination or consultation from a new specialist.

3. Consult a vocational advisor, asking for a letter explaining why you are (as of right now) unable to work at any occupation.

4. Follow up on any Independent Medical Examinations mentioned in the denial letter.  

5. Create a “typical day” description (telling how you spend your time now, including what portion of your day involves medical visits or self-treatment).

 

Think “work-related limits” not symptoms.

Remember, in deciding whether to continue paying you disability benefits, the Desjardins people are not weighing your symptoms. What they are measuring is your mental and  physical ability to perform job duties, including your likely:

  • reliability
  • stamina
  • pace
  • concentration
  • absenteeism

Explain why, even though you have a history of good  work performance prior to your disability, pain and inability to maintain concentration do not now allow to perform consistently even in a less demanding job.

Rob Konduros Disability, Employment & Personal Injury Lawyer
Your lawyer’s experience makes a big difference when helping you choose between filing an appeal of a lawsuit.  We work quickly and efficiently, and, remember — we don’t get paid until you do.

For a no-obligation chat, call 519 658 6341

The 500-Pound Gorilla question: Should you file an internal appeal or start a legal claim?

Internal appeal – pros and cons:

+   On the positive side, the appeal process is faster, less formal, and less confrontational than turning to the courts.

+   There are no court fees involved.

 – On the negative side, by filing an internal appeal, you are challenging the Desjardins Insurance Company’s decision to terminate your benefits, leaving the decision up to Desjardins’ employees and hired consultants.

– The uncomfortable truth — it is generally not in any insurance company’s best Interest to help you. Desjardins is in business to make a profit. While they must comply with the policy terms, their goal is to minimize payouts so as to increase their own bottom line.

– By relying on an internal appeal, you risk missing the deadline for filing a lawsuit. 

Lawsuit – pros and cons

+ When you choose to start a lawsuit, you are turning to a third party, letting the court system decide whether you qualify for continued benefits, and the insurance company will be forced to obey whatever the court’s decision is, or offer a settlement. 

– The process of filing a lawsuit typically takes much longer than an appeal.

– Court costs and attorney’s fees are higher.

An experienced Ontario LTD lawyer can help you choose, based on your specific needs, the proper steps to take in order to make sure the disability benefits under your Desjardins LTD policy are properly respected.

Take comfort while taking careful steps to protect your LTD benefits in Ontario, Canada!

FAQ: Desjardins LTD Denials in Ontario

 

  • 1. Desjardins denied my LTD. What are my first three steps?

    First, read the denial or termination letter and calendar every deadline. Second, gather your policy, job description, medical records, and all letters or emails with Desjardins. Third, book a doctor visit focused on work limits (reliability, stamina, concentration) and ask for notes that match those limits to your job duties.

Get Your LTD Benefits Back

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Mental Health LTD: Documentation Strategy (Ontario)

Mental Health and LTD Claims: a Complete Documentation Strategy for Ontario Workers

Ever since the letter arrived from your Long Term Disability company notifying you that, in a few short weeks, the financial support you had been receiving is going to be cut off, you’ve felt paralyzed by panic.

The only hope being offered involves doing the impossible –‘proving’ what can’t be ‘proved.’ Sure, there are plenty of physical symptoms to be described — the chronic fatigue, heart palpitations, the weight gain (your doctors have mentioned tan early onset of diabetes), the breathing problems and the almost-constant upset stomach.

Still, you know there’s no blood test to demonstrate the extent of the almost-daily bouts of depression and anxiety, yet those have become an all-too-real part of your life. The therapists you’ve visited have used the term OCD and even prescribed medications related to bipolar disorder.

But there’s no x-ray to provide visual proof of why you came to find the work environment so terrorizing.  

Related to the 24-month termination of benefits notice you received from your Ontario long term disability insurance company, you’re scheduled for some Independent Medical Examinations.  Just the thought of all new tests and interviews causes you fear and anxiety.

While many of your problems are invisible from the outside, your regular therapists have come to understand your fears and sometimes strange behaviors. 

Outwardly, you’re looking better, your neighbors and one or two of your remaining friends tell you, but you realize that getting ‘better’ is not really happening for you.

LTD decisions focus on functional limits, not labels. For anxiety, depression, PTSD and similar conditions, document how symptoms affect reliability, attendance, pace, focus, and stress tolerance. Use consistent clinical notes, treatment adherence, standardized scales, a ‘typical day’ narrative, and employer evidence. Close gaps early to reduce denials and protect benefits at 24 months.

 

Can mental health conditions qualify for LTD benefits in Ontario, Canada?  

First, know that you’re not alone. In fact, as Benefits Canada points out, more than a third of disability claims under Canadian employer-sponsored benefits plans in 2022 were due to mental health reasons. Long term Disability policies in Ontario do cover these conditions if they prevent an insured from performing the essential duties of the job.

Yet, as you suspected, many individuals who rely on disability benefit coverage are unfairly denied by their insurers precisely because mental illness is more difficult to prove.

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.

In judging whether you are, in fact, capable of performing job duties, the considerations include:

  • Reliability – will an employer be able to count on you to get the job done?
  • Attendance – will an employer be able to count on you to show up, ready for work, on a regular basis?
  • Pace – will you be able to keep up with the work flow as part of a team?
  • Stress tolerance – when inevitable frustrations, delays, and problems arise, will you be able to handle the situation calmly and responsibly?   
  • Memory – will you be able to remember procedures needed to needed to complete job-related tasks?
  • Interaction with other employees – are you going to get along with co-workers and supervisors?

Yet many individuals who rely on disability benefit coverage are unfairly denied by their insurers precisely because mental illness is more difficult to prove.

How will those Independent Medical Examinations come into play?

An IME (Independent Medical Examination) is conducted by doctors and therapists chosen by the insurance company to evaluate your condition and decide if the treatments recommended by your own doctors are necessary and appropriate.

Up until now, you have been eligible for benefits because you have been unable to perform the duties of your own occupation. But starting from the 24-month mark, you will be entitled to receive benefits only if it is proven that you are unable to work at any occupation for which you qualify based on your level of education, training, and work experience.

The stated purpose of an IME is to provide ‘neutral’ answers to all the questions listed above. In reality, the insurance company may use the IME results as justification for denying or reducing benefits to an insured.

Building your case to keep your benefits: a step-by-step documentation strategy

Being asked to ‘prove what can’t be prove’ has you overwhelmed. You’re exhausted before you even begin the fight — between managing your own health, the endless paperwork, and the overwhelming financial concerns, you feel you’re at a breaking point. But know this:

You’re not going to let this challenge break you. You can build your case in five steps:

  • Step One: Assemble medical evidence

Contact each doctor, psychiatrist, and therapist you’ve seen for an Updated report.  Don’t accept vague generalities, such as “doing well” or “stable”. Ask each respondent to give an opinion about how ready you are — or are not — to handle the duties of a full-time job.

  • Step Two: Assemble a report on your medications

What medications have been prescribed? What have been the side effects of each?  Have there been barriers (needing to get on a waiting list or excessive cost)?

  • Step Three: Create a ” typical day” description

Starting with mornings, describe your everyday “mood life” — what helps you get going?  What seems to over-stimulate you? What things trigger a “meltdown” or “crash”? How long does it take to you to recover? What tasks are sometimes forgotten?

  • Step Four: Reconstruct the six months before you were forced to quit working

Organize the paperwork from the last few months on the job, including warnings from your supervisor, performance reviews, modifications to your job responsibilities, and recommendations for treatment.

  • Step Five: Study the denial letter and decide between filing an internal appeal or proceeding directly to a lawsuit

Internal appeal windows vary by insurer, often around 180 days from the decision letter date. Litigation timelines are different. Get case-specific advice from a disability rights attorney before choosing your next step.

Rob Konduros Disability, Employment & Personal Injury Lawyer
Invisible illness is a very real disability.
With nearly 40 years experience documenting anxiety and depression for LTD claims, I help Ontario claimants with mental disabilities push back and move forward with dignity.

For a no-obligation chat, call 519 658 6341

An experienced Ontario LTD lawyer can help you take the proper steps to make sure your disability claims rights are properly respected:

  • by understanding complex policy clauses and the language in the denial letter
  • by gathering the strong medical evidence you need for either an appeal or a lawsuit
  • by knowing how to counter denial reasons
  • by negotiating settlements

FAQ: Mental Health and LTD Claims in Ontario

 

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