When dealing with legal matters, it’s normal to feel overwhelmed and unsure about what to do next. You may have questions about your rights, the legal process, or what to expect. At Gowland, Boriss, we’re here to help.

These Frequently Asked Questions and Answers sections address some of the most common questions we hear from individuals.

If you need more personalized guidance, our team is just a phone call or email away. We are committed to helping you move forward with clarity and confidence.

 

705.743.7252 | 1.800.808.0189 | info@gowlandboriss.ca

LTD Benefit Disputes FAQs

1. What is long-term disability (LTD) insurance?

Long-term disability insurance provides income replacement if you are unable to work due to illness or injury. These are intended to provide you with “peace of mind” in the event you become disabled from your job. These benefits are usually provided through a group insurance plan from your employer or a private policy you’ve purchased. LTD typically begins after short-term disability (STD) benefits or an initial waiting period has passed.

2. How do I qualify for LTD benefits?

To qualify, you must meet your policy’s definition of “disability,” which usually means proving that you are unable to perform the essential duties of your current job due to a medical condition. After two years, most policies change the definition to whether you can perform any job for which you are reasonably suited by education, training, or experience.

3. How much will I receive in LTD benefits?

Most LTD policies pay 60–70% of your regular income, up to a certain maximum. The exact amount depends on the terms of your plan and whether your benefits are taxable (often depending on who paid the premiums—you or your employer).

4. What should I do if my LTD claim is denied?

If your claim is denied or terminated, you have two main options:

  • Appeal internally through the insurance company, or

  • File a legal claim against the insurer for wrongfully denying your benefits.

While appeals can sometimes work, they often delay your access to justice. In many cases, pursuing legal action gives you the best chance of recovering the benefits you’re entitled to. At Gowland, Boriss, we can help you evaluate your options.

5. How long do I have to sue if my claim is denied?

In Ontario, you generally have two (2) years from the date your claim was denied to commence a legal action. However, this timeline can depend on specific terms in your policy. It’s important to seek legal advice as soon as possible to avoid missing important deadlines.

6. What medical documentation do I need?

You’ll need evidence from your doctor or specialist confirming:

  • Your diagnosis

  • Your treatment plan

  • How your condition affects your ability to work

Strong, consistent medical records are essential to supporting your claim.

7. Can I work while receiving LTD benefits?

Possibly. Some policies allow “partial disability” benefits if you return to work in a limited capacity or reduced hours. However, working without notifying your insurer can risk your benefits being suspended or terminated. Always consult with your lawyer or LTD insurer before returning to any form of work.

8. What if my benefits are cut off after 2 years?

This is common. After 24 months, most policies shift the definition of disability from “own occupation” to “any occupation.” If the insurer believes you can work in another role, they may terminate benefits. If your condition still prevents you from working in any reasonable job, you may still qualify—and you may have grounds to challenge the decision.

9. Do I have to apply for CPP Disability Benefits?

Yes, most LTD policies require you to apply for Canada Pension Plan Disability (CPP-D) benefits. If approved, the amount you receive from CPP-D will often be deducted from your LTD payments. Even though it may reduce your insurer’s payments, it can still benefit you long-term and strengthen your case.

10. Do I need a lawyer to fight a denied LTD claim?

While you’re not legally required to hire a lawyer, having one significantly increases your chances of success. Our experienced lawyers can gather medical evidence, communicate with the insurer, and file a legal claim on your behalf if necessary—all while ensuring you’re treated fairly during a difficult time.

11. How much does it cost to hire an LTD lawyer?

Most LTD lawyers in Ontario work on a contingency fee basis where the fee is a percentage of your settlement or award, and all terms are discussed in advance so there are no surprises. When your matter resolves our firm takes a percentage of the settlement or award for our fees and disbursements. Our lawyers will fully explain our retainer and fee arrangements at your initial consultation before you retain us.

12. What are disbursements?

Disbursements are out-of-pocket expenses paid by a law firm to move your case forward. These can include costs for medical records, court filing fees, expert reports, and other necessary documentation. At our firm, we typically cover these costs upfront and recover them upon settlement.

If you have a question that isn’t answered here, we invite you to contact us. The Gowland, Boriss team is here to listen, support, and guide you through the process—with clarity, compassion, and a strong commitment to your best interests.

705.743.7252 | 1.800.808.0189 | info@gowlandboriss.ca

Disclaimer:

Please note that nothing on this website should be considered legal advice and is being provided for general information purposes only. For legal advice, we encourage consultation with a lawyer to review your specific concerns and situation.