Employment Law
Disability Claims (Short-Term and Long-Term)
Employment Law
Short-Term and Long-Term Disability Claims Lawyers in Ontario
When illness or injury strips away your ability to work, disability insurance is the financial lifeline standing between you and serious economic hardship—but accessing those benefits is rarely straightforward. This is precisely why consulting a disability lawyer Ontario residents trust can make a meaningful difference in the outcome of your claim. At Nanda & Associate Lawyers, our knowledgeable employment lawyers will help you interpret your policy’s specific definitions before a denial becomes a bigger legal battle.
Having our qualified disability lawyer in your corner changes the equation entirely: keeping track of your limitation period and filing your claims promptly, identifying procedural errors in how your claim was handled, retaining independent medical experts, and negotiating from a position of strength. Insurers settle many claims quietly once they know an experienced advocate is involved—because the cost and scrutiny of a trial rarely serve their interests.
Our Employment Law Services
What Are Disability Benefits?
Disability benefits provide partial income replacement when an illness, injury, or medical condition prevents an employee from performing their work duties. Coverage may be available through an employer-sponsored insurance plan, a private policy, or a government benefit program.
The two common types of workplace disability coverage are the following:
- Short-term disability (STD) benefits: Provide income support during a temporary medical absence, usually after sick leave or an applicable waiting period.
- Long-term disability (LTD) benefits: May begin after STD benefits, sick leave, or an elimination period ends when the employee remains unable to work for an extended time.
Eligibility depends on the wording of the disability policy, including its definition of disability, coverage exclusions, waiting period, and medical-evidence requirements. A diagnosis alone may not establish entitlement. Medical documentation should explain how the employee’s symptoms and functional limitations affect their ability to perform essential job duties.
Disability benefits and employment rights are related but separate. Receiving STD or LTD benefits does not, by itself, determine whether an employee has job-protected leave or a right to workplace accommodation. Employees should review their insurance policy and obtain legal guidance when benefits are delayed, denied, or terminated.
Differences Between Short-Term and Long-Term Disability Benefits
Short-term disability (STD) and long-term disability (LTD) benefits provide partial income replacement when an employee cannot work because of a medical condition. Key differences include the following:
- Coverage period: STD benefits generally cover temporary absences, while LTD benefits support employees with longer-lasting disabilities.
- Starting date: STD benefits may begin after sick leave or a short waiting period. LTD benefits usually start after STD coverage or an elimination period ends.
- Medical evidence: Both require medical support, but LTD claims often need more detailed and ongoing evidence of functional limitations.
- Definition of disability: Some LTD policies initially assess whether employees can perform their own occupation and later whether they can perform any other suitable occupation.
- Ongoing reviews: LTD insurers may periodically review treatment progress, medical records, and the employee’s ability to return to work.
Coverage, payment amounts, exclusions, and eligibility requirements vary by policy. Employees should review their insurance documents carefully and seek legal guidance from an employment lawyer if benefits are denied or terminated.
Total Disability vs Partial Disability
Disability insurance policies may distinguish between total and partial disability when determining an employee’s eligibility for benefits.
- Total disability generally means a medical condition prevents an employee from performing the essential duties of their occupation. It does not necessarily mean the person is completely unable to perform every daily activity.
- Partial disability generally means an employee can perform some work duties or work reduced hours but cannot return to their full pre-disability responsibilities or earnings.
Eligibility depends on the specific policy definition, medical evidence, and the effect of the condition on the employee’s ability to work. Some policies provide partial or residual benefits to help replace a portion of lost income during a gradual return to work.
Employees should review their disability policy carefully and obtain legal guidance if total or partial disability benefits are denied, reduced, or terminated.
Own-Occupation Period vs Any-Occupation Period
Many long-term disability policies apply different eligibility tests as a claim progresses:
- Own-occupation period: During the initial benefit period, the insurer assesses whether the employee’s medical condition prevents them from performing the essential duties of their regular occupation. This period commonly lasts for a defined time stated in the policy.
- Any-occupation period: After the own-occupation period ends, the insurer may assess whether the employee can perform any other occupation for which they are reasonably suited based on their education, training, experience, and functional abilities.
The transition between these periods is often called the change of definition. Before this change, the insurer may review updated medical evidence, work capacity, and possible alternative occupations.
The length of each period and the applicable disability test depend on the policy. Employees should seek legal guidance if their long-term disability benefits are reviewed or terminated at the change-of-definition stage.
Common Reasons Disability Claims Are Denied
Short-term and long-term disability claims may be denied for several reasons, including:
- Insufficient medical evidence: Records may not clearly explain how the condition limits the employee’s ability to perform essential job duties.
- Failure to meet the policy definition: The insurer may decide that the employee does not satisfy the applicable total, partial, own-occupation, or any-occupation disability test.
- Incomplete or inconsistent information: Differences between claim forms, medical records, and reported activities may raise concerns.
- Missed deadlines: Late applications, medical forms, or appeal documents may affect the claim.
- Policy exclusions or limitations: Coverage may be restricted by exclusions involving pre-existing conditions, certain treatments, or specific medical conditions.
- Failure to follow treatment: The insurer may question whether the employee is receiving and following appropriate medical care.
- Insurer medical assessments: A medical consultant or independent examiner may conclude that the evidence does not support continued disability.
- Change in the disability definition: LTD benefits may be terminated when the policy changes from the own-occupation period to the any-occupation period.
A denial is not always the end of a disability claim. Employees should review the denial letter, insurance policy, and medical evidence promptly because appeal and legal deadlines may apply.
How Can Our Employment Lawyers Help You?
Disability claims can involve both insurance coverage and workplace rights. Our Ontario employment lawyers help employees understand their options when short-term or long-term disability benefits are delayed, denied, or terminated.
We can assist by:
- Reviewing your disability policy, eligible benefits, and denial letter
- Assessing the insurer’s reasons for denying or terminating benefits
- Evaluating medical and occupational evidence supporting your claim
- Explaining appeal procedures and applicable legal deadlines
- Communicating and negotiating with the insurer on your behalf
- Advising on medical leave, workplace accommodation, and return-to-work plans
- Addressing disability discrimination, pressure to resign, or employment termination
- Pursuing legal action when appropriate
Every disability and employment matter is different. Contact Nanda & Associate Lawyers to discuss your circumstances and the legal options that may be available.
Key Takeaways
- Short-term and long-term disability benefits may replace part of an employee’s income when a medical condition prevents them from working.
- Eligibility depends on the disability insurance policy, including its definition of disability, waiting period, exclusions, and medical-evidence requirements.
- Strong medical documentation should explain not only the diagnosis but also how the condition limits the employee’s ability to perform essential job duties.
- A denied or terminated disability claim may be challenged, but policy deadlines and legal limitation periods may apply.
- Our Ontario employment lawyer will review the policy, assess the insurer’s decision, and explain the options for an appeal or legal claim.
Get Help With Your Disability Claim
A denied, delayed, or terminated disability claim can place significant financial and emotional pressure on you and your family. Our Ontario disability claims lawyers help employees understand their short-term and long-term disability policies, assess insurer decisions, prepare appeals, and explore available legal options. Contact Nanda & Associate Lawyers to discuss your disability claim and the next steps available based on your circumstances.
Frequently Asked Questions About Ontario Disability Claims
If you have additional questions or need further assistance, please don’t hesitate to reach out to us at hello@nanda.ca. We’re here to help!
What is the difference between short-term and long-term disability benefits?
Short-term disability (STD) benefits generally replace part of an employee’s income during a temporary medical absence. Long-term disability (LTD) benefits may begin after STD benefits, employer sick leave, or when a waiting period ends. LTD coverage is intended for medical conditions that prevent an employee from working for an extended period. Eligibility, payment amounts, waiting periods, and benefit duration depend on the specific disability insurance policy.
Who is eligible for short-term or long-term disability benefits in Ontario?
Eligibility depends primarily on the terms of your employer-sponsored or private disability insurance policy. You may need to demonstrate that you were covered when the disability arose, satisfy the policy’s definition of disability, complete the applicable waiting period, and provide sufficient medical evidence. Being diagnosed with a medical condition does not automatically establish eligibility; the insurer will generally assess how the condition affects your ability to perform your occupational duties.
What medical evidence is required for a disability claim?
Medical evidence may include reports from treating physicians, clinical notes, test results, specialist assessments, treatment plans, medication records, and descriptions of your functional limitations. The information should explain how your symptoms restrict your ability to perform essential work duties. A diagnosis alone may not be enough. Employees should follow recommended treatment, attend medical appointments, and ensure that claim forms are accurate and consistent with their medical records.
Can I receive disability benefits for a mental health condition?
Mental health conditions may qualify for disability benefits when they meet the policy’s definition of disability and are supported by appropriate medical evidence. Claims may involve depression, anxiety disorders, post-traumatic stress disorder, bipolar disorder, or other psychological conditions. Supporting documentation should describe the diagnosis, treatment, symptoms, functional restrictions, and effect on your ability to work. Coverage remains subject to the wording, exclusions, and limitations of the applicable policy.
Why are short-term or long-term disability claims denied?
Claims may be denied because the insurer believes there is insufficient medical evidence, the policy definition of disability has not been met, the employee can perform their occupational duties, or a policy exclusion applies. Other issues may include missed deadlines, incomplete forms, inconsistent information, a pre-existing condition clause, or an insurer’s finding that appropriate treatment was not followed. The denial letter and insurance policy should be reviewed carefully before deciding what to do next.
What should I do if my disability claim is denied?
Request the insurer’s written reasons for the denial and obtain a complete copy of your disability policy and claim file. Keep the denial letter, medical records, employment documents, and all communications with the insurer. You may be able to submit an internal appeal or pursue legal action, depending on the circumstances. Because contractual and legal time limits may apply, consider obtaining legal advice promptly rather than assuming that the insurer’s internal appeal process will extend the deadline.
Can an insurer terminate long-term disability benefits after initially approving my claim?
Yes. An insurer may reassess eligibility based on updated medical information, surveillance, treatment progress, a return-to-work assessment, or a change in the policy’s definition of disability. Some policies initially examine whether you can perform your own occupation and later consider whether you can perform any other suitable occupation. If benefits are terminated, review the decision, policy wording, and supporting evidence promptly to determine whether the decision can be challenged.
Can my employer terminate me while I am receiving disability benefits?
Receiving disability benefits does not create unlimited protection from termination, but Ontario employers must comply with employment standards, contractual obligations, and human rights law. Disability-related discrimination is prohibited, and employers generally have a duty to accommodate disability-related needs to the point of undue hardship. Disability benefits, job-protected leave, and employment status are separate legal issues. Employees facing termination, pressure to resign, or refusal of accommodation should obtain legal advice about their specific circumstances.
Can I receive LTD benefits together with EI sickness or CPP disability benefits?
Possibly, but the interaction depends on the disability policy and the rules of each benefit program. LTD policies often contain provisions allowing the insurer to reduce payments by amounts received from other sources, including CPP disability benefits. EI sickness benefits may assist eligible employees who do not have short-term disability coverage or while other benefits are unavailable. Review the policy carefully to understand coordination, deduction, repayment, and application requirements.
How can an Ontario disability claims lawyer help an employee?
An Ontario disability claims lawyer can review the insurance policy and denial letter, assess medical and occupational evidence, explain applicable deadlines, and communicate with the insurer. A lawyer may also help prepare an appeal, negotiate a resolution, or pursue legal proceedings when appropriate. Legal options depend on the policy, evidence, reason for denial, and stage of the claim. Contact Nanda & Associate Lawyers to discuss your short-term or long-term disability claim and the next steps available.
In Short: In a decision on workplace safety, employee integrity, and just-cause...
In Short: In a landmark ruling in Wigdor v. Facebook Canada Ltd.,...