Understanding Your Rights: Long Term Disability Denial in Ontario and the Right to Sue

Facing a denial of long term disability (LTD) benefits can be overwhelming, especially when you rely on these benefits to support yourself during a difficult time. In Ontario, many people encounter challenges when their LTD claims are rejected. Knowing your rights and the options available, including the possibility of legal action, can make a significant difference in how you handle the situation.

This post explains what happens when your long term disability claim is denied in Ontario, what your rights are, and when you might consider suing to protect those rights.

What Is Long Term Disability Insurance?

Long term disability insurance provides income replacement if you cannot work due to illness or injury for an extended period. Many employers offer LTD coverage as part of their benefits package, or individuals may purchase private plans. The goal is to help you maintain financial stability while you recover or manage a chronic condition.

Why Are Long Term Disability Claims Denied?

Claims can be denied for several reasons, including:

• Insufficient medical evidence to prove disability

• Disagreements over the severity or duration of the disability

• Missed deadlines for submitting claims or paperwork

• Policy exclusions or limitations

• Failure to meet the insurer’s definition of disability

  
  

For example, an insurer might argue that you can perform some work duties despite your condition, leading to a denial. Understanding the specific reason for denial is crucial to deciding your next steps.

Your Rights After a Long Term Disability Denial

When your LTD claim is denied, you have several rights under Ontario law:

• Right to Appeal: You can request a review or appeal the decision within the insurer’s internal process. This often involves submitting additional medical records or evidence.

• Right to Request an Independent Medical Examination (IME): The insurer may require you to undergo an IME to assess your condition. You have the right to be informed and to prepare for this.

• Right to Legal Advice: You can consult a lawyer who specializes in disability claims to understand your options and improve your chances of success.

• Right to Sue: If the insurer unfairly denies your claim or acts in bad faith, you may have grounds to sue for benefits owed and possibly damages.

  
  

When Can You Sue Over a Long Term Disability Denial?

Suing an insurance company is a serious step and usually comes after exhausting internal appeals. You might consider legal action if:

• The insurer denied your claim without a reasonable basis

• They failed to properly investigate your claim

• They delayed processing your claim unreasonably

• They acted in bad faith, such as misrepresenting policy terms or ignoring evidence

  
  

For example, courts have ruled in favor of claimants when insurers ignored clear medical evidence or applied policy terms unfairly. Lawsuits can seek payment of benefits, interest, and sometimes compensation for emotional distress caused by bad faith conduct.

How to Prepare If You Plan to Sue

If you decide to pursue legal action, preparation is key:

• Gather Documentation: Collect all medical records, correspondence with the insurer, claim forms, and denial letters.

• Keep a Record: Note dates of phone calls, meetings, and any promises made by the insurer.

• Consult a Lawyer Early: A lawyer can help identify if you have a strong case and guide you through the process.

• Understand Time Limits: Ontario has strict deadlines for filing lawsuits related to insurance claims, so act promptly.

  
  
  
  

Practical Tips for Handling LTD Denial

• Review Your Policy Carefully: Know the exact terms and definitions used by your insurer.

• Get Strong Medical Support: Detailed reports from your healthcare providers can strengthen your claim.

• Respond Quickly: Meet all deadlines and provide requested information promptly.

• Stay Organized: Keep all documents and communications in one place.

• Seek Support: Disability claims can be stressful; consider support groups or counseling.

  
  

Final Thoughts

A long term disability denial in Ontario can feel like a major setback, but you have rights and options to challenge unfair decisions. Understanding when and how to appeal or sue can help you protect your financial security and well-being. If you face a denial, act quickly, gather evidence, and seek professional advice to improve your chances of success.

Taking control of your situation starts with knowing your rights and being prepared to stand up for them. If you believe your claim was wrongly denied, exploring legal options could be the step that ensures you receive the benefits you deserve.