You were counting on your long-term disability (LTD) insurance to protect your income when illness or injury prevented you from working.
Now Desjardins has denied your claim, stopped your payments, or told you that you should be able to return to work.
Your medical condition may not have improved. The bills keep coming, and you are left wondering how you will support yourself and your family.
At Hilborn and Konduros Lawyers, Robert Konduros helps Ontario residents challenge denied and terminated long-term disability claims, including claims involving Desjardins Insurance.
With nearly 40 years of litigation experience, Rob provides direct, personal legal representation to clients throughout Ontario.
Whether you have just received a denial letter, are approaching a change in your policy’s disability definition, or have already lost your benefits, you can get legal advice before deciding what to do next.
Desjardins Denied Your Long-Term Disability Claim. What Can You Do?
If Desjardins denies or terminates your long-term disability benefits in Ontario, you may be able to challenge the decision through an internal appeal or legal proceedings. Your options depend on your insurance policy, the reasons for the denial, your medical evidence, and applicable deadlines. An Ontario long-term disability lawyer can review your claim, assess whether the decision can be challenged, and help you determine your next steps.
A Desjardins denial letter does not necessarily mean you are no longer entitled to disability benefits.
It means the insurer has concluded that you do not meet the requirements of your policy. That conclusion may be disputed.
Before submitting an appeal, agreeing to return to work, or accepting a settlement, it is important to understand how Desjardins reached its decision and what your insurance contract requires.
When Desjardins denies your long-term disability claim or stops paying your benefits, the financial pressure can be overwhelming. You may still be unable to work, but suddenly you’re left wondering how you’ll pay your bills and support your family.
I understand how frustrating it can be to rely on disability insurance for financial protection, only to face a denial when you need that support most.
With decades of experience handling disability and insurance disputes in Ontario, I help people challenge unfair decisions and pursue the benefits they’re entitled to receive under their policies.
You deserve clear answers about your rights and your options.
For a no-obligation chat, call 519 658 6341
– Rob Konduros, Personal Injury & Long-Term Disability Lawyer
Understanding Desjardins Long-Term Disability Coverage in Ontario
Desjardins offers disability insurance through employer-sponsored group benefit plans and individual insurance products.
If your coverage comes through your employer, your benefits may be administered through Desjardins group insurance. If you purchased disability insurance independently, different policy provisions may apply.
The insurer’s group insurance products are issued by Desjardins Financial Security Life Assurance Company.
The terms of your particular insurance contract determine whether you qualify for benefits and how long payments may continue.
What Does Your Desjardins Disability Insurance Policy Cover?
Your policy may contain provisions dealing with:
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Definition of disability: The requirements used to determine whether your illness or injury prevents you from working.
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Waiting or elimination period: The period you must remain disabled before benefits become payable.
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Monthly disability benefit: The amount payable if you qualify, subject to policy conditions and limits.
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Change of definition: Whether the disability test changes after an initial benefit period.
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Benefit offsets: Income from other sources that may be deducted from your LTD payments under the contract.
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Exclusions and limitations: Conditions or circumstances that may restrict coverage.
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Rehabilitation and return-to-work provisions: Rules governing participation in rehabilitation programs or attempts to resume employment.
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Recurrent disability provisions: How your policy treats a disability that returns after you attempt to go back to work.
These details matter.
Two Ontario workers insured through Desjardins may have different coverage, even if they work in similar jobs and have the same medical condition.
How Are Desjardins Group Disability Claims Filed?
For group disability claims, Desjardins provides forms for the insured employee, employer, and treating healthcare professional.
These include:
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Disability or Waiver of Premium Claim, completed with the insured person’s information.
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Employer’s Statement, providing employment and coverage information.
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Initial Attending Physician’s Statement, describing the medical condition and related limitations.
Desjardins also provides an online claims process for eligible plan members.
The forms help establish your claim, but the information must also show how your condition satisfies the disability requirements of your coverage.
In particular, the medical evidence should explain how your symptoms affect your ability to perform the duties of your occupation.
Why Are Desjardins Long-Term Disability Claims Denied or Terminated?
Disputes may arise when Desjardins concludes that the medical information, employment evidence, or other claim documents do not establish entitlement under the policy.
The reasons for denial can vary. Common issues in LTD disputes include the following.
1. Desjardins Says There Is Insufficient Medical Evidence
Your doctor may have diagnosed a serious medical condition and advised you to stop working.
However, the insurer may argue that your records do not adequately explain why you cannot perform the duties of your occupation.
For example, a medical report may confirm chronic pain without describing how that pain limits your ability to sit, stand, concentrate, or maintain regular attendance.
A diagnosis is important. So is evidence of the resulting functional restrictions.
2. Desjardins Believes You Can Return to Work
The insurer may conclude that your condition has improved sufficiently for you to return to your previous occupation.
That conclusion may conflict with your doctor’s recommendations or your actual ability to function.
If the insurer believes you can work, the evidence should be examined in light of your medical condition, occupational duties, and applicable disability definition.
3. Your Policy’s Definition of Disability Has Changed
Some Desjardins group disability policies initially assess whether you can perform your regular occupation.
After a specified period, the policy may apply a more demanding definition involving your ability to perform other suitable work.
This change may result in a reassessment or termination of benefits.
Whether the decision is justified depends on the specific policy wording and medical and occupational evidence.
4. Disagreements About Mental Health or Invisible Disabilities
Conditions such as depression, anxiety, PTSD, fibromyalgia, chronic pain, and chronic fatigue can substantially affect a person’s ability to work.
These conditions may require detailed documentation because their effects are not always apparent through imaging, laboratory testing, or a brief medical appointment.
Your claim may need evidence explaining how symptoms affect your concentration, stamina, reliability, and ability to perform work consistently.
5. Questions About Treatment or Rehabilitation
Desjardins may review your medical treatment, rehabilitation activities, or participation in recommended programs.
An insurer may raise concerns if appointments were missed or a recommended treatment was not followed.
However, a particular treatment may be unsuitable, unavailable, ineffective, or medically inappropriate.
The policy requirements and reasons for treatment decisions should be considered before concluding that a claimant has failed to comply.
6. Insurer-Arranged Medical Assessments
Desjardins may request additional medical assessments where permitted by the policy.
An assessment arranged by the insurer may reach different conclusions from those of your treating healthcare providers.
A lawyer can examine the assessment, its findings, and whether it properly addresses the limitations relevant to your occupation.
7. Surveillance or Questions About Your Activities
An insurer may consider information about a claimant’s activities when assessing disability.
For example, Desjardins may raise questions about an activity it believes is inconsistent with the restrictions reported in your claim.
However, completing a short activity does not necessarily mean someone can perform a job reliably for an entire workday.
The circumstances of the activity, its duration, and its effect on your symptoms may all be relevant.
If Desjardins has denied or terminated your benefits for one of these reasons, Rob can review the insurer’s conclusions and assess whether they can be challenged.
Can Desjardins Cut Off Your LTD Benefits After 24 Months?
Many Ontario LTD claimants are concerned about what happens when their initial period of disability coverage ends.
Some Desjardins group policies change the definition of disability after an initial period, often around two years.
The precise timing varies. Certain policies measure the change using the waiting period plus a specified number of months.
This means your actual change-of-definition date may not be exactly 24 months after your first LTD payment.
How Rob Konduros Can Help With Your Desjardins Disability Claim
Disputing a disability insurance decision requires careful attention to your policy, medical evidence, and the insurer’s reasons for denial.
Rob provides personal legal representation throughout the process.
Review Your Desjardins Policy
He examines the provisions governing your disability benefits, including eligibility requirements, exclusions, definitions, and relevant deadlines.
Examine the Denial or Termination Decision
Rob reviews Desjardins’ stated reasons for denying or terminating benefits and assesses whether they are supported by the evidence and policy wording.
Assess Medical and Occupational Evidence
Your claim may require a detailed examination of the relationship between your medical restrictions and the duties of your occupation.
Rob can help identify relevant evidence and determine whether further medical or vocational information may be appropriate.
Explain Your Legal Options
You will receive advice about the possible benefits, risks, costs, and timelines associated with an internal appeal, negotiation, or legal proceeding.
Handle Legal Communication and Negotiations
If you retain Hilborn and Konduros, Rob can manage legal correspondence and negotiations with the insurer.
Pursue Benefits Through Litigation Where Appropriate
When legal proceedings are warranted, Rob can pursue remedies available under the applicable insurance contract and Ontario law.
Depending on your circumstances, possible resolutions may involve past-due disability payments, reinstatement of ongoing benefits, or a negotiated lump-sum settlement.
No particular result can be guaranteed.
Rob’s role is to pursue an appropriate resolution while helping you understand the decisions affecting your financial future.
Why Choose Robert Konduros for Your Desjardins Long-Term Disability Claim?
Nearly 40 Years of Ontario Litigation Experience
Robert Konduros graduated from Osgoode Hall Law School in 1986 and has practised litigation for nearly four decades.
His experience includes disability benefits disputes, personal injury, insurance litigation, and employment matters.
He has appeared before Ontario courts, including the Superior Court of Justice, Divisional Court, and Court of Appeal for Ontario.
Former Chairperson of the CPP Disability Benefits Tribunal
Rob previously served as Chairperson of the Canada Pension Plan Disability Benefits Tribunal.
This experience contributes to his understanding of disability-related evidence, functional restrictions, and legal decision-making.
CPP Disability and private long-term disability insurance claims involve different legal tests. Each claim must be evaluated under the requirements that apply to it.
Work Directly With Your Lawyer
At Hilborn and Konduros, you have direct access to Rob.
He takes time to understand your medical condition, employment history, and financial concerns.
You can ask questions, discuss your options, and receive straightforward explanations about your case.
No Upfront Legal Fees for Qualifying Claims
Hilborn and Konduros offers contingency-fee representation for qualifying disability claims.
Legal fees under these arrangements generally depend on a successful recovery rather than being charged upfront.
The written agreement will explain the fee structure, applicable taxes, disbursements, and other financial obligations before you decide to retain the firm.
Local Ontario Law Firm With Province-Wide Representation
Hilborn and Konduros is based in Cambridge, Ontario, and represents clients across the province.
Remote consultations are available, and home or hospital visits may be arranged for clients who cannot travel due to medical circumstances.
You deserve legal representation that is personal, experienced, and focused on your rights.
Request Your Free Desjardins LTD Case Review
Desjardins Long-Term Disability Lawyer Serving Cambridge and Across Ontario
Hilborn and Konduros Lawyers represents Ontario residents dealing with disability insurance denials, terminated LTD payments, and disputed entitlement to benefits.
The firm serves clients in Cambridge, Kitchener, Waterloo, Guelph, Hamilton, Burlington, Oakville, Mississauga, Brampton, Toronto, London, Barrie, Ottawa, Windsor, and other Ontario communities.
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