Disability benefits denied or cut off? The insurer's decision isn't the last word.

We read your policy, the denial letter and your medical records, tell you whether to appeal to the insurer or sue, and deal with the insurer for you.

How can we help?

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We'll call you during office hours, 9 am to 5 pm, 7 days a week. If an appeal or court deadline is in the next few days, call now.

Book a free video meeting now Call (289) 309-3069

Time limits

Two clocks run at the same time.

Your policy sets its own deadlines for claims and appeals. The law sets the deadline to sue. Missing either can cost you the claim.

  • 30

    days to give written notice of a claim under an individual policy

  • 90

    days to send proof of the claim under an individual policy

  • 2

    years, usually, to start a lawsuit after the claim is discovered

  1. Notice of claimIndividual policies: in writing, within 30 days of the claim arising. Group policies set their own terms.
    30 daysIndividual policy
  2. Proof of claimIndividual policies: within 90 days. If that wasn't reasonably possible, as soon as it is, and within 1 year.
    90 daysIndividual policy
  3. Internal appealSet by your policy and usually stated in the denial letter. Read it the day it arrives.
    Check letterPolicy deadline
  4. Start a lawsuitGenerally 2 years from when the claim is discovered, under the Limitations Act, 2002. When the clock started is often disputed.
    2 yearsUsual limit

General information, not legal advice. Your policy wording and the facts of your claim can change these dates. We'll confirm yours.

Your options

Appeal to the insurer, or take it to court.

The denial letter will usually invite you to appeal. That's one option, not the only one. We look at why you were refused and how close the deadline to sue is before picking a path.

Read the full guide: Long-term disability denied in Ontario: appeal, sue or both?.

Internal appeal

Send the insurer new medical evidence and ask it to review its own decision. It costs little, but the insurer decides, and it can take months.

Usually fits whenThe denial turned on a missing report or test result that your doctor can now provide.

Lawsuit

Sue the insurer in court for the benefits owed under the policy. A judge, not the insurer, decides whether you meet the definition of disability.

Usually fits whenThe insurer has already refused an appeal, the evidence is strong, or the two-year limit is getting close.

Ask for the claim file first

Request a copy of your policy and the insurer's file, including the medical reviews it relied on. It shows what the insurer actually based its decision on.

Usually fits whenThe denial letter is vague, or you don't have a copy of the policy or plan booklet.

Settle

A dispute can also end in a negotiated settlement, sometimes a lump sum in place of future monthly payments. We explain what you give up before you agree.

Usually fits whenYou want certainty, or returning to the insurer's monthly reviews isn't workable for you.

The process

How a denied claim is challenged.

Starting a lawsuit doesn't mean you'll end up at trial. It protects your deadline and puts the insurer's decision in front of a court.

Ask about your claim
  1. Review the policy and the letterWe check the definition of disability, the reason for the denial and every deadline in play.
  2. Build the medical evidenceYour treating doctors' records and reports, aimed at the test the policy actually uses.
  3. Appeal, sue, or bothWe file an internal appeal or start a lawsuit, usually within 2 years of the claim being discovered.
  4. Exchange documents and evidenceBoth sides share their files and medical reports, and you may be questioned under oath.
  5. Settlement or trialThe claim can settle at any stage. If it doesn't, a judge decides.

Your policy

The wording of the policy decides a lot.

Two questions matter early: what kind of policy you have, and how it defines disability.

  • Group coverage through workYour employer holds the policy, but you can still enforce it against the insurer in your own name. The plan booklet you were given may not be the full policy, so we ask for both.
  • Individual policyA policy you bought yourself. Ontario's Insurance Act writes statutory conditions into these, including the 30-day notice and 90-day proof of claim rules.
  • "Own occupation"You're disabled if you can't do the essential duties of your own job. Many policies use this test for the first part of a claim.
  • "Any occupation"After a set period in the policy, often the first two years, many policies ask whether you can do any job suited to your education, training or experience. That change is a common point for benefits to stop.

CPP disability

How CPP disability fits with your LTD claim.

Many LTD policies expect you to apply for Canada Pension Plan disability benefits. What CPP pays is usually deducted from your LTD benefit, so the two claims affect each other.

  • The test is stricterCPP disability asks whether your disability stops you from working at any job on a regular basis, and whether it's long-term.
  • Contributions countYou generally need CPP contributions in 4 of the last 6 years, or 3 of 6 if you've contributed for 25 years.
  • 90 days to ask againIf Service Canada refuses you, ask for reconsideration within 90 days of receiving the letter.
  • Then the TribunalIf reconsideration fails, you can appeal to the Social Security Tribunal within 90 days of the new decision.

Your first meeting

What to bring to your meeting.

Bring what you have. If something is missing, we can request it from the insurer or your employer.

  • The denial or termination letterAnd any letters about an internal appeal.
  • Your policy or plan bookletFor group coverage, the booklet from HR or your benefits portal.
  • Medical records and reportsFrom your family doctor, specialists and therapists.
  • Your claim formsWhat you, your employer and your doctor sent the insurer.
  • Your job descriptionWhat your work actually involved, day to day.
  • CPP disability lettersIf you've applied, or been told to apply.
“His guidance was clear, honest, and very reassuring during a stressful time.”
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Questions

Long-term disability claims

Don't see yours? Call (289) 309-3069.

How long do I have to sue my disability insurer?

Usually two years from when the claim is discovered, under Ontario's Limitations Act, 2002. In disability cases, when that clock started is often argued over, and some policies set their own shorter time limits. The safest course is to treat the first denial letter as the start and get advice well before two years pass.

Should I use the insurer's internal appeal?

It can help when the denial turned on a gap in the medical evidence that you can fill. But the insurer runs it, it can take months, and you shouldn't count on it to stop the limitation period. We'll tell you whether to appeal, sue, or both.

What's the difference between own occupation and any occupation?

Under an own-occupation test, you're disabled if you can't do the essential duties of your own job. Under an any-occupation test, the insurer asks whether you can do any job you're reasonably suited for by education, training or experience. Many policies switch from the first test to the second after a set period, so benefits are often cut off at that point.

Do I have to apply for CPP disability benefits?

Many LTD policies require you to apply and then reduce your LTD payments by what CPP pays. Check your policy. If Service Canada refuses your CPP disability claim, you have 90 days from receiving the letter to ask for reconsideration.

My coverage came through work. Can I still sue the insurer?

Yes. Under Ontario's Insurance Act, a person insured under a group policy can enforce their rights under it in their own name.

How do legal fees work?

Either a small amount upfront and the rest only if you're compensated, or no legal fees at all unless you're compensated. The fee is set out in a written contingency fee agreement, plus HST. The first video meeting is free. In-person meetings at First Canadian Place are $100.

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Free video meeting

Benefits denied? Talk to a lawyer before the deadline.

By video (free) or in person at First Canadian Place ($100), 7 days a week.

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Cohen Murison Law
100 King Street West, Suite 5700
First Canadian Place, Toronto, ON M5X 1C7
Open 7 days, 9 am to 5 pm. Closed on public holidays.
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