Long-Term Disability

You followed the many, many steps needed to gather the information required for filing a Long-Term Disability claim, taking extra care to meet every deadline. Throughout the process, you’ve been struggling to survive financially — the short-term disability benefits you’ve been receiving are so far below the level of income to which you were accustomed before your work life began to fall apart…

Now, following weeks of filling out paperwork, of seemingly endless visits and correspondence with different medical professionals, of telephone interviews and unwelcome visits to your home by strangers — you’ve received a letter informing you that your claim has been denied.

Accustomed for all your adult life being independent, facing up to every challenge and even helping others face theirs, you had honestly believed you could manage the claims process on your own. The denial letter, explaining that you have a very limited time to file an appeal, has made one thing undeniably clear — you are going to need professional help.

How does the process of finding and working with a long-term disability lawyer in Ontario actually work?

The word “with” is key:

Building evidence to successfully dispute a long-term disability claim is going to require a joint effort between you and your LTD lawyer in Ontario. Just as you are going to want a lawyer who can communicate clearly and understandably with you throughout the process of proving your eligibility for LTD benefits, you are going to need to remain in communication with your lawyer. The work – and the hassle – aren’t over. Now, though, you’ll be guided by a professional who knows how to navigate the system.

Selecting an Ontario long-term disability lawyer –

Look for a professional who:

• has years of experience in fighting denials of long term disability claims
  
  
• is familiar with the Canada Disability Benefit, the Ontario Disability Support Program(ODSP), and with the major long-term disability insurance companies
  
  
• has a network of medical experts
  
  
• has received positive testimonials from former clients

Working with an LTD Lawyer in Ontario: What to Expect

Working with an Ontario LTD lawyer usually includes an intake call, a review of your policy and medical records, a strategy decision (internal appeal or legal claim), an evidence plan with your doctors, and your lawyer handling insurer communications, negotiations, and, if needed, litigation. Fees are commonly contingency-based, timelines vary by strategy, and your main role is to document and communicate clearly.

Step 1: Your Intake Call

It all starts with an intake call or visit.

What happens:

• You speak with the lawyer, not just staff. We listen to your story, review timelines, and screen for deadlines
• We explain your options in plain language and outline next steps for the first 30 days

Once you’ve selected a professional to represent you in appealing the denial of benefits, the next step will consist of an intake call or visit to check if there’s a good fit between the two of you:

1. you are comfortable communicating with each other
2. the details of your case suggest that you have a provable claim for long-term disability benefits

What to have ready for the intake call or visit:

• identification documents (Ontario Health Card, Social Insurance Number (SIN), monthly ODSP statement of assistance
• your insurance policy
• claim forms
• medical notes from all providers
• calendar “log” of all the medical appointments you’ve had
• all communications from your former employer
• the denial letter itself

Sharing the “what” on the intake call –

What, exactly, did the denial letter say was the reason for the decision to deny you benefits?

• You are not “totally disabled”
• You haven’t provided a sufficient amount of medical evidence
• Your doctors haven’t responded to their request for clarification
• Your income from sources other than your job is too high
• You own property or other assets that should be used towards your support before you request assistance
• You don’t have enough recent work history
• You were not forthright with examiners
• Your social media posts show you are capable of more activity than your claim implies

Step 2: Policy & Medical Review 

Once we agree to work together, the next step is to understand what your policy actually says and what your medical records actually show.

This is where we move from “I know I cannot work” to “Here is how your condition fits the policy definition of disability.”

Decoding your LTD policy

LTD denial letters usually quote parts of your policy. I go back to the source.

I review:

• How your policy defines disability

• Whether you are in the “own occupation” period or the “any occupation” period

• How pre-existing conditions are treated

• Requirements for ongoing treatment, rehabilitation, or return-to-work programs

• The insurer’s internal appeal process and deadlines

• The applicable limitation period for starting a lawsuit in Ontario

In simple terms:

• In the own occupation period, the question is whether you can do the important duties of your job.

• In the any occupation period, the question becomes whether you can do any job you are reasonably suited for by your education, training, and experience.

My role is to explain these definitions in clear terms and to identify where the insurer’s interpretation can be challenged.

Medical evidence your lawyer needs (functional limits > labels)

Diagnoses matter. But in LTD claims, functional limits matter more.

I focus on:

• How long you can sit, stand, or walk before you need to rest

• How long you can focus, read, or work on a computer before symptoms spike

• Whether you can reliably attend work on a regular schedule

• What happens if you push yourself (pain, fatigue, anxiety, cognitive crashes)

• How medications help — and what side effects they cause

To understand this, I review:

• Clinic notes from your family doctor and specialists

• Consultation reports (for example, rheumatology, neurology, psychiatry, psychology)

• Test results and imaging

• Physiotherapy, occupational therapy, and pain clinic records

• Any prior insurer forms (LTD, STD, WSIB, EI sickness, etc.)

If you want to learn more about how doctors can translate your symptoms into work-related limits, see “Working with Your Doctor: How to Build Medical Evidence That Supports Your LTD Claim.” 

Gaps that cause denials, and how we address them

Many denials are based on gaps, not a total lack of disability:

• Clinic notes that say “stable” or “doing well” with no detail

• Short visits where fatigue or cognitive issues were never explored

• Reports that list diagnoses but say little about work impact

• Paper reviews by insurer-hired doctors who have never met you

Once I see these gaps, I work with you to decide what is needed:

• Clarifying letters from your treating doctors

• Updated assessments, where appropriate

• A more detailed description of your typical day and how it differs from before you stopped working

You are not expected to fix these issues alone. My job is to identify what is missing and help you and your healthcare team address it in a focused way.

Step 3: Strategy: Internal Appeal or Legal Claim?

After your policy and medical evidence are reviewed, we reach a key decision:

Do we pursue an internal appeal with the insurer, or do we start a legal claim (lawsuit)?

In general: An internal appeal may make sense if there is a clear, fixable evidence gap and enough time to address it. A legal claim may be better when delays or insurer conduct put your rights at risk, or when experience shows that appeals are unlikely to be effective. The right choice depends on your denial, your evidence, and your timelines.

Factors I weigh before recommending a path

When advising you, I look carefully at:

• Deadlines and limitation periods

  • How close you are to the two-year limitation period

  • Any internal appeal deadlines in the denial letter

• Evidence strength and maturity

  • Whether we can realistically fix the insurer’s concerns with targeted medical evidence

  • How supportive and available your doctors are

• Insurer posture and history

  • Whether your insurer has a pattern of maintaining denials

  • Whether they have already ignored strong evidence you provided

• Your health and financial situation

  • Whether you can tolerate the delay an appeal may add

  • How urgently you need clarity on long-term income

You are part of this decision. I will explain the pros and cons of each path and give you a clear recommendation.

For a deeper dive into this choice, you can also read “Should You File a Legal Claim or Internal Appeal After an LTD Denial in Ontario?”  It explores appeal vs. lawsuit: which path and when.

When an internal appeal may make sense

We may lean toward an internal appeal when:

• The denial is based on a specific, narrow gap (for example, a missing test result or a form your doctor can complete).

• You have time to appeal without risking the limitation period.

• Your doctors are willing and able to provide better documentation quickly.

If we choose this path, I will:

• Build an evidence plan (which doctors to contact and what questions to ask)

• Draft a detailed appeal letter responding to each point in the denial

• Ensure the appeal and supporting documents are submitted on time

When a legal claim is the better option

Internal appeals are not sent to a neutral third party. They go back to the same insurer that denied your claim.

We may lean toward a lawsuit when:

• The insurer has already rejected strong evidence or appears to be stalling

• You are approaching the limitation period

• Your case involves complex issues that are better resolved in court or through formal negotiations

Starting a lawsuit does not mean you are guaranteed to go to trial. Many cases resolve through negotiation or mediationafter legal action is started. But a lawsuit protects your rights and signals to the insurer that you are serious about enforcing the policy.

I have successfully appealed LTD decisions in the Superior Court of Justice, the Divisional Court, and the Court of Appeal for Ontario. That experience guides the advice I give you at this stage.

Step 4: Evidence Plan & Doctor Collaboration

Once we have a strategy, we focus on building the right evidence, not just more paper.

This is where we turn a stack of reports into a coordinated plan.

Aligning clinic notes with your work limits

Clinic notes are written for medical care, not for legal disputes. They can be brief and miss key details.

I look at your records with questions like:

• Do they clearly describe your work-related limits (sitting, standing, lifting, concentration, attendance)?

• Do they explain what happens if you try to push yourself?

• Do they recognise good days and bad days, and the fallout after activity?

If important details are missing, I help you prepare for appointments so you can:

• Explain your day-to-day limits concretely

• Bring a simple symptom or activity diary, if helpful

• Ask your doctor to record specific information related to work capacity

The aim is not to “coach” anyone, but to make sure your real limitations are visible in your records, not just in your own words.

Support letters and forms that matter

Insurers rely heavily on forms and short answers. A rushed or incomplete form can harm a strong claim.

Where appropriate, I may:

• Provide your doctor with targeted questions that match the language of your policy

• Request a short narrative letter that addresses:

  • Your diagnosis and treatment

  • Your functional limits

  • Why you cannot safely or reliably perform your previous job (and, in some cases, any suitable job)

Depending on your case, we may also consider:

• Functional capacity evaluations

• Psychological or neuropsychological assessments

• Specialist consultations

Again, you are not sent to chase these things alone. I help you decide which pieces of evidence are worth the time, cost, and effort.

Your simple evidence checklist

Three habits I often recommend:

• Appointment log: Keep a basic record of visits and tests (date, provider, main issue discussed).

• Symptoms diary (short): Occasional notes about severe days, failed attempts at activity, and flare-ups after exertion.

• Treatment adherence: Follow reasonable treatment recommendations where you can, or communicate clearly why something is not suitable.

If you would like more detail on the documents that often matter most, see “8 Critical Documents You Need Before Applying for LTD.” It covers the documents your lawyer will ask for at different stages.

Step 5: Communications with the Insurer

For many clients, one of the biggest reliefs after hiring a lawyer is simple:

You no longer have to deal directly with the insurer on your own.

Who talks to whom

Once I am on record as your lawyer:

• The insurer is instructed to communicate through my office

• I handle letters, emails, and phone calls from the insurer and their lawyers

• You communicate with me, and I keep you updated on what is happening

Your main responsibilities are to:

• Provide information and documents when requested

• Let me know about changes in your health, work status, or other benefits

• Attend agreed medical and legal appointments

This structure is designed to protect your health and peace of mind while ensuring nothing important slips through the cracks.

Responding to IMEs, surveillance, and forms

Insurers may use:

• Independent Medical Examinations (IMEs)

• Functional assessments

• Surveillance (including video or social media reviews)

• Ongoing questionnaires and forms

My role is to:

• Assess IME requests and object where they are inappropriate or duplicative

• Prepare you for any required assessments so you know what to expect

• Review surveillance material in context

• Ensure forms you complete are accurate, consistent with your evidence, and submitted on time

If the insurer contacts you directly, you let us know, and we respond.

For more on insurer behaviour at this stage, see “The Hidden Traps in Long-Term Disability Applications.” It outlines insurer tactics to anticipate.

Negotiation cadence and update rhythm

You should never feel left in the dark.

From early on, I aim to set a clear update rhythm (for example, monthly updates or at key milestones). I explain:

• What we are waiting for

• What the insurer is doing and why

• When realistic opportunities for negotiation or settlement are likely to arise

Sometimes progress is very visible (an offer, a decision). Sometimes it is quieter (waiting on reports or court dates). Either way, you should always know where your case stands.

Step 6: If Litigation Is Needed. What Happens Next

Not every LTD file requires a lawsuit. Many resolve before or during early negotiations.

But if litigation is needed, you should know what that looks like in Ontario.

Pleadings, discovery, mediation, settlement, trial (rare)

A typical LTD lawsuit includes:

1. Pleadings

   • We file a Statement of Claim setting out your case.

   • The insurer files a Statement of Defence explaining its position.

2. Discovery

   • You may attend an examination for discovery (a formal question-and-answer session under oath).

   • I prepare you carefully for this.

   • We may also examine a representative of the insurer.

3. Mediation / Settlement Discussions

   • Many LTD cases involve a mediation with a neutral mediator.

   • I present your case, negotiate on your behalf, and advise on any offers.

4. Pre-trial / Trial (uncommon)

   • Only a small percentage of LTD cases go to trial.

   • If yours does, I guide you through each step.

At every stage, you will know what is coming, what is expected of you, and how we are positioning your case.

Expected timelines & key inflection points

Litigation timelines are usually measured in months and often years, not weeks. While every case is different, important movement often happens:

• Shortly after the claim is filed (as the insurer reassesses its risk)

• Around discoveries, when both sides see the evidence more clearly

• At or after mediation, when settlement options are tested

From the outset, I will give you a realistic sense of timing, based on your case, the court schedule, and the insurer involved.

To understand why acting early matters, see “Ontario Long-Term Disability Claims: Understanding Your Rights Before You Need Them.” It helps you know your rights early.

Settlement types & tax considerations (high-level)

Possible outcomes include:

• Reinstatement of benefits (your monthly LTD payments resume, sometimes with arrears)

• Lump-sum settlement (a one-time payment to resolve past and future LTD claims)

• Structured outcomes (for example, partial lump sum plus future benefits for a period)

Tax treatment depends on your specific policy and settlement structure. I provide general information, but I always recommend that you obtain independent tax advice before accepting a settlement.

Fees, Costs & How Payment Works

Money is a real concern when you are off work and fighting an insurer. You should not have to guess how legal fees work.

Contingency basics & transparency

In most LTD cases, I work on a contingency-fee basis. That means:

• You do not pay hourly fees as the case progresses

• My fee is a percentage of the recovery if your case is successful

• We sign a written agreement that clearly explains the fee structure

If there is no recovery, you do not owe a legal fee for my time. I will walk you through the agreement so you understand it before deciding.

For more context on how different types of LTD policies can affect recovery, see “Group vs. Individual LTD Policies: What Ontario Workers Should Know.”  It explains how policy type can affect recovery.

Disbursements, experts, and recoverable costs

In addition to legal fees, there are disbursements, out-of-pocket expenses such as:

• Court filing fees

• Medical report costs

• Expert assessments

• Mediation fees

In many cases, these are paid out of the settlement at the end. In some situations, part of these costs can be recovered from the insurer as well. We discuss this at the outset so you know what to expect.

When fees are charged and why

My legal fee is paid at the end of the case, from settlement funds or arrears recovered, not from your ongoing monthly benefits as they are paid. The goal is to:

• Give you clarity and predictability

• Align my interests with yours. If you do not recover, I do not get paid a legal fee

Timelines: From First Call to Resolution

Every LTD case is different, but it helps to understand typical patterns.

Appeal timelines vs. lawsuit timelines

Very broadly:

• Internal appeals may range from a few months to close to a year, depending on evidence needs and insurer response times.

• Lawsuits are often longer, sometimes taking a year or more from filing to resolution, depending on court schedules and negotiation timing.

These are not guarantees. They are general ranges. From the beginning, we set expectations based on your case, and adjust as needed.

Insurer response windows & court milestones

Typical timing points include:

• Deadlines for appeals in your denial letter

• Insurer response windows after we provide new evidence

• Court deadlines for pleadings, discoveries, and mediation

To avoid missing key dates before you even think about hiring a lawyer, see “Understanding Elimination Periods: When Can You Actually File Your LTD Claim?” It focuses on not missing your filing window.

Your Role 

You are not a passive passenger in this process. You are also not expected to carry it all alone.

Here is what usually helps most:

• Keep documents in one place. Letters from the insurer, your employer, and your doctors.

• Tell your doctors the truth about your limits. Even on “good days”.

• Respect deadlines. If we ask for information or forms, respond as promptly as you can.

• Update us. Let us know about any new diagnoses, tests, work attempts, or benefit changes.

• Protect your health. Over-exerting yourself to “prove” you are trying can backfire medically and legally.

How to prepare for each lawyer update:

A simple routine before each scheduled update call:

1. Make a short list of major changes since the last update (medical, financial, insurer contact).

2. Note any questions or worries you want answered.

3. Have your calendar handy in case we need to plan around deadlines or appointments.

This small habit can reduce stress and make each update more useful.

Case Outcomes: What ‘Success’ Can Look Like

Success in an LTD case can take different forms, depending on your condition, your policy, and your goals.

Reinstatement, lump-sum, and structured outcomes

Common outcomes include:

• Reinstatement of benefits:
  Your LTD payments resume, often with back pay to cover the period you were wrongly denied.

• Lump-sum settlement:
  A one-time payment to resolve past and sometimes future LTD claims.

• Structured outcomes:
  A combination — for example, partial lump sum and future payments for a defined period.

Each option has pros and cons, including tax and long-term planning implications. We discuss these in detail before you make any decision.

Protecting against premature ‘any occupation’ cut-offs

Many claims are approved at first, then cut off when the policy moves from own occupation to any occupation.

One key goal of our work is to:

• Anticipate that change in definition

• Build evidence that addresses both stages

• Reduce the risk of a sudden, unjustified cut-off when the definition tightens