Navigating a long-term disability (LTD) claim can be challenging. Whether you’re applying for benefits, approaching the critical two-year mark, or dealing with a denied claim, knowing your rights and the insurer’s rules is essential.
At Verkhovets Law, we have extensive experience helping Canadians win disability claims against LTD insurers. This comprehensive guide will explain how long-term disability works, what happens after two years of receiving benefits, common reasons for denial, and how to successfully appeal.
Table of Contents
Most of the Canadian long-term disability insurers provide policies that are fairly similar and can be divided into a few categories based on how they operate, length of benefits and change of definition particulars. These insurers offer:
Group LTD policies (through employers or associations)
Individual LTD policies (for self-employed professionals and business owners)
Third-party administration of certain disability plans
While most policies follow common general trends, each policy has unique rules, so it's crucial to review your specific LTD policy documents, which include either a group benefits booklet (for group policies) or your individual policy document.
Manulife short-term disability (STD) plans typically cover absences of up to 17 weeks, although specifics depend on your employer’s group plan.
To apply for STD you normally have to take the following steps:
Complete application forms provided by your employer or LTD insurer
Include medical documentation from your doctor
Submit an employer’s statement confirming your absence
If your STD claim is denied, you have a right to appeal—either through your union (if applicable) or directly to LTD insurer.
Submitting Your Claim:
Most insurers these days accept both digital submissions (via their online portal/app) and paper forms.
Access your claim forms through the Member Portal.
Checking Your Claim Status:
Use the online portal to track updates.
Alternatively, contact your assigned claims representative for status updates.
Complaints and Escalations:
First, contact your claims representative or customer service.
If unresolved, escalate to the management.
Next level is the Ombudsman’s Office. Review your insurer’s website. There will be information about e-mail and phone number of their Ombudsman’s Office.
If still unresolved, escalate externally to the OmbudService for Life & Health Insurance (OLHI).
Most LTD policies change the definition of disability after two years from:
“Own occupation” (unable to perform your regular job) to
“Any occupation” (unable to perform any suitable job based on your education, training, or experience).
Before the Two-Year Mark:
Insurers typically gather extensive medical evidence, conducts vocational assessments, and may hire external experts to evaluate your capability to return to any occupation.
After the Two-Year Mark:
Claim denials frequently occur around this point because it's harder to prove you cannot perform “any occupation.” However, denial is not the end. Appeals can succeed, especially with strong medical evidence and expert legal assistance.
Insurers commonly denie disability claims based on:
Alleged lack of sufficient medical evidence.
Disputes about your ability to perform “any occupation.”
Lack of “objective” medical evidence.
Surveillance evidence suggesting your limitations are exaggerated or not genuine.
If denied for these reasons, promptly contact Verkhovets Law to discuss your options.
If your claim is denied, you have two main appeal options:
1. Internal Appeal
Usually insurers send a detailed denial letter outlining reasons.
Review your claim file thoroughly.
Strengthen your medical evidence and address specific issues raised by your insurer.
You have limited opportunities for internal appeals—legal support at this stage greatly improves your chance of success.
2. Legal Appeal (Lawsuit)
If internal appeals fail, filing a lawsuit is your next step.
A lawsuit brings your case before a neutral judge who independently evaluates your claim.
Many lawsuits are settled or resolved in mediation without needing a trial.
Hiring a disability lawyer experienced with LTD cases significantly improves your likelihood of success at both internal and lawsuit stages.
Verkhovets Law specializes in long-term disability cases against insurers. We assist clients by:
Reviewing and reconstructing your claim file thoroughly.
Obtaining strong medical opinions to support your disability.
Preparing compelling legal arguments to challenge unfair claim denials.
Negotiating directly with the insurer or their lawyer to reach a fair settlement or reinstatement.
Representing you fiercely in court when necessary.
With Verkhovets Law, you get experienced, dedicated legal representation to protect your rights and secure your entitled benefits.
Is there one “the worst” disability insurance Company?
There isn’t inherently “the worst insurer”, but their size of there insurer (big/major LTD insurers) and rigorous claims process mean many legitimate claims face denials. Proper evidence and legal advocacy can overcome their resistance.
Do Insurers deny all LTD claims?
No, many claims are approved. Denials typically result from disputes over medical evidence or definitions of disability. Appeals can overturn these denials.
Is an internal appeal worthwhile, or should I proceed directly to a lawsuit?
Internal appeals can be successful, especially with stronger medical documentation. If these fail, a lawsuit can compel your insurer to settle fairly.
Can an Insurer spy on disability claimants?
Yes, insurers use surveillance legally. Always assume they may monitor your activities during a claim.
Are LTD benefits taxable?
Benefits are taxable if your employer paid your premiums. If you paid premiums yourself, the benefits are usually non-taxable. Verify this with your employer or insurer directly.
Has LTD insurer denied your disability claim, or are you worried about your benefits stopping after two years? Verkhovets Law can help.
Our disability lawyers offer free, confidential consultations:
Contact Information:
Website: verkhovetslaw.com
Office: (905) 910-1440
Call/Text/WhatsApp (24/7): (365) 779-1440 | WhatsApp
Fax: (905) 367-6228
Email: [email protected]
Office Address:
3300 Hwy 7, Unit 403
Vaughan, Ontario L4K 4M3
(Driving access via Edgely Blvd, not Hwy 7.)
Office Hours:
Monday–Friday: 9 AM – 5 PM
Evenings & Weekends: By appointment only
Don’t let Manulife wrongly deny your disability benefits.
Contact Verkhovets Law today—we’re here to fight for you.
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Mariya Verkhovets
+1 123 456 7890
421 Allen, Mexico 4233
finazzeconsult@com
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