How To Apply for Long-Term Disability Plan Benefits

How To Apply for Long-Term Disability Plan Benefits

Written By: Aidan Vining and Keanin Parish, Student-at-Law

What is Long-Term Disability Insurance?

Long-term disability (LTD) insurance is a form of income replacement.  It protects your income if you have the misfortune of becoming disabled due to injury.  People can purchase disability insurance themselves, or their employers may provide it as a benefit.

Sometimes these benefits can be denied to you.  In fact, many disability claims are either denied at the outset, or payments are terminated before the recipient is capable of returning to work.

Why are LTD Benefits Important?

LTD benefits become available once Short-Term Disability benefits or Employment Insurance are no longer available.  The purpose of these benefits is to protect your income should you lose the ability to work because of disability.

Every year, thousands of Canadians experience an unexpected medical condition or injury: a study by Ontario’s Auditor General found that the Ontario Disability Support Program (ODSP) approves approximately 22,000 claims per year for income support payments.  Without these benefits, individuals who are not able to work may experience a substantial loss of income.  Ensuring you have access to LTD insurance can be crucial in securing financial stability while you recover from your injuries.

What Conditions Qualify for LTD?

Long-Term Disability insurance covers a wide array of medical conditions, most of which are related to physical injuries.  However, LTD insurance can also cover mental injuries. According to a new survey by Mercer, one-third of disability claims in Canada in 2022 are mental-health related.

Different insurance policies may define ‘disability’ differently, and it is necessary to review each policy to see which conditions may qualify.  However, insurance policies generally include a wide range of conditions, such as:

  • Brain injuries
  • Orthopaedic injuries
  • Multiple Sclerosis
  • Cancer
  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • Mood disorders
  • Cardiovascular disease
  • Arthritis
  • Anxiety or Depression

This is not an exhaustive list.  You should always consult your policy to understand what is covered in the event of long-term disability.

How Do I Apply for LTD in Ontario?

Determining how to apply for LTD benefits in Ontario can be daunting.  However, applying for LTD benefits can essentially be reduced to five different points:

  1. Obtain a Claim Form

The first step is to obtain a claim form.  If you have private insurance provided by your employer, your employer should provide you with the form and instructions on how to fill it out.  If you have private insurance, you can get one of these forms from your insurance company or insurance broker.

  1. Obtain Support from your Doctor

To be approved for LTD benefits, you need to prove that you have a disability.  To prove you have a disability, you must obtain medical records or documents from your doctor or health care provider that demonstrate you have a medical condition that causes you to be unable to work.   A health care provider can include: a medical doctor, psychiatrist, physiotherapist, medical specialist, or chiropractor.  At this stage, your doctor or healthcare provider will complete a medical certificate or make recommendations to improve your symptoms.

  1. Complete the Application

The next step is to complete the application.  The application includes forms, such as: a plan member statement, attending physician’s statement, a plan sponsor statement, and a job description.  The purpose of these forms is to: ascertain details about your claim and to get authorization to communicate with your lawyer or doctor; medical information about you; or your duties and responsibilities at work.

  1. Submit the Application

After completing the application, you must submit it to your insurance company.  It is best to contact your insurance provider to determine the way to submit the application, but common methods of submission include mail, email or fax.  One thing to keep in mind is that there are generally time limits or deadlines for submitting.  It is important that you contact your personal injury lawyer or insurance company to verify what these are.

  1. Assessment of your Claim

After you submit the application, your claim will be assessed.  This will be done by a case manager or claim representative, who will make an assessment.  An assessment involves interviewing you to analyze all of the information regarding your claim, including information about your job, your health, or your level of skill to manage basic physical needs.  It normally takes up to a month to complete the assessment and for your benefits to be decided, but this can vary.

How Long Can You Stay on LTD in Ontario?

This question does not necessarily have a straightforward answer, because LTD benefits can end for a number of different reasons.  Some of these reasons may include: recovery from injury, retirement, death, becoming 65 years old, failing to submit proof of ongoing disability, being in prison, refusing to attend a medical examination, or failing to participate in a designated rehabilitation program.  These are just some of the reasons that LTD benefits might end.

How McLeish Orlando Can Help? 

As mentioned above, filing a claim for LTD benefits can be difficult, confusing, and time-consuming.  Every claim is different, and the process by which you apply and receive benefits is not always the same and can vary depending on your circumstances.

It is important to properly file your claim, because improperly filed claims can result in the insurance company denying you access to benefits.  Our team of personal injury lawyers will help you understand your insurance policy, limitations or deadlines, review long, complex documents and generally help guide you through the process.

The experienced LTD lawyers at McLeish Orlando know how to maximize your chances of being successful in obtaining your LTD benefits and know what to do if your insurance company denies your benefits. Contact our office for a free consultation with one of our personal injury lawyers if you or a loved one have been injured and are seeking LTD benefits.

Aidan Vining


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