Long-Term Disability Lawyer ยท Insurance Claims
Denied long-term disability in Ontario? You can fight back.
Your LTD policy is a contract you already paid for. When an insurer denies or cuts off benefits while you are sick, that is a legal dispute, not the end of the road. James Moon represents disabled Ontarians against insurance companies, in English and in Korean.
Questions โ
How a long-term disability lawyer fights a denial
Long-term disability benefits exist for the worst moments of your working life. You are too sick or too injured to keep earning a paycheque, and the coverage was supposed to carry you through. When the denial letter arrives, it can feel personal. It is not. It is paperwork, and paperwork can be answered.
Most denials in Ontario come down to how the insurer reads your policy and your medical file. That reading is not the final word. A court, not the insurance company, decides whether a denial was lawful. The job of an LTD lawyer is to make sure your file is built the way a judge needs to see it, and to put real pressure on the insurer well before that point.
Questions
Common questions, answered.
General information, not legal advice. Contact James to find out what applies to your situation.
My long-term disability claim was denied. What should I do first?
Keep the denial letter and your full policy, and do not rely only on the insurer's internal appeal, because it does not pause your deadline to sue. Get a lawyer to assess the denial and the limitation period before you respond. The sooner the policy is reviewed, the more options you have.
How long do I have to take legal action in Ontario?
Generally two years from the date of a clear, final denial, under the Limitations Act, 2002. The exact start date can be argued, and your policy may also set shorter deadlines for notice and proof of claim. Treat the denial letter as starting the clock and get advice right away.
Is an internal appeal to the insurer the same as a lawsuit?
No. An internal appeal is reviewed by the same company that denied you, and it is not a court process. It can sometimes help, but relying on it alone is the most common way people lose the right to sue, because the two-year limitation period keeps running during the appeal.
What does 'own occupation' versus 'any occupation' mean?
For about the first 24 months, most group policies pay if you cannot do your own job (own occupation). After that, the test often changes to any occupation, so the insurer can stop benefits if it decides you could do some other job suited to your training and experience. Many denials happen at this switch.
Is Ontario long-term disability the same as US ERISA?
No. ERISA is a US federal system. In Ontario, LTD is governed by your insurance contract and Ontario insurance law, so US advice about ERISA appeals and federal deadlines does not apply to your claim.
Can I recover more than the unpaid benefits?
Sometimes, yes. In Fidler v. Sun Life, the Supreme Court of Canada allowed damages for the mental distress a wrongful denial causes. In Whiten v. Pilot Insurance, punitive damages were allowed where the insurer acted in bad faith. Punitive awards are uncommon, but mental-distress damages are a real possibility in the right case.
Talk to James.
Tell us what happened, in English or Korean, and we will get back to you shortly.
Call 647 702 9838