When illness or injury prevents you from continuing to work, long-term disability benefits can provide income support. Lexera helps people understand their coverage, document their limitations and respond to denied or terminated claims.
Long-term disability coverage is governed largely by the insurance policy or workplace benefit plan. Eligibility depends on the policy’s definition of disability and the medical and functional evidence supporting the claim.
Some plans assess whether a person can perform their regular occupation before later applying a broader test based on other suitable work. The wording and timing of that change depend on the particular policy.
The policy determines the test the claimant must meet. Definitions can focus on the person’s regular occupation or their ability to perform other suitable work.
Medical records should explain the condition, treatment and restrictions affecting the person’s ability to perform the duties required by their occupation.
The insurer may consider concentration, stamina, mobility, pain, attendance and other practical limitations rather than relying on the diagnosis by itself.
The physical, cognitive and scheduling demands of the occupation help connect the medical restrictions to the work the person says they cannot perform.
A medical diagnosis does not automatically establish entitlement to LTD benefits. The evidence must show that the resulting restrictions satisfy the particular definition of disability contained in the applicable policy.
Review the disability definition, waiting period, benefit amount and other provisions that determine what must be shown and when benefits may become payable.
Make sure healthcare providers understand the actual demands of the occupation and describe the activities, attendance or cognitive demands the condition interferes with.
Ongoing treatment notes, specialist assessments and investigation results can help show how symptoms and restrictions continue or change over time.
Keep claim forms, decision letters, requests for information and other communications so the basis for approval, denial or termination remains clear.
Many LTD plans initially assess whether illness or injury prevents the claimant from performing the essential duties of their regular occupation. The exact test and applicable period are determined by the policy.
Some policies later apply a broader definition based on the claimant’s ability to perform another occupation for which they are reasonably suited by education, training or experience.
Medical records, specialist reports and treatment history can help establish the condition and its restrictions. Effective evidence also explains how those restrictions interfere with the specific physical or cognitive demands of the occupation.
Employment information, job descriptions, attendance records and accommodation history can provide the work-side context needed to understand why the claimant cannot reliably perform their duties.
Lexera can review the disability policy, insurer decision and supporting medical evidence to identify the test that applies and the issues affecting entitlement to benefits.
The legal team can also help strengthen the evidentiary record, respond to denied or terminated benefits and assess the appropriate steps for pursuing payment under the policy.
Not necessarily. Disability is assessed using the definition in the policy. Some plans focus on whether the person can perform the essential duties of their regular occupation rather than whether they are incapable of every activity.
Some policies change the disability definition after an initial period. A claimant who qualified under a regular-occupation test may later be assessed against their ability to perform other suitable work.
Review the denial letter and policy carefully. The stated reasons, disability definition and medical evidence can help determine what is disputed and what additional evidence or legal steps may be appropriate.
Yes. Insurance policies contain claim requirements, and Ontario generally imposes limitation periods on court proceedings. Because the applicable deadline depends on the circumstances, it should be assessed promptly rather than assumed.
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