Applying for long-term disability (LTD) benefits in Ontario, Canada, is a critical step for individuals who can no longer work due to a serious illness or injury. A long-term disability claim provides essential financial support, covering a portion of your lost income when you’re unable to maintain employment over an extended period. Whether you’re covered through an employer-sponsored plan or a private insurance policy, understanding the application process and meeting the necessary requirements are key to ensuring your claim is successful. This guide will walk you through the steps involved in filing a long-term disability claim in Ontario, helping you navigate the complexities with confidence.

1. Understand Long-Term Disability Benefits

Long-term disability insurance is often provided through your employer’s group benefits plan or purchased individually from an insurance company. LTD benefits generally cover between 60% to 70% of your pre-disability income and can last for several years, sometimes until retirement, depending on the terms of your policy.

There are two main types of LTD policies:

• Employer-Sponsored Plans: Many companies offer LTD coverage as part of their employee benefits package. If you’re covered under such a plan, it’s essential to review the policy details, including the waiting period, eligibility criteria, and the amount of coverage.
• Private Insurance Plans: If you’re self-employed or not covered by an employer plan, you may have purchased a private LTD policy. These plans also vary in terms of coverage, so reviewing your policy carefully is necessary.

2. Meet the Eligibility Criteria

To qualify for LTD benefits, you must meet specific eligibility requirements outlined in your policy. Most LTD policies in Ontario have a waiting or “elimination” period, typically lasting from 90 to 120 days, during which you must be continuously disabled.

Disability is usually defined in two ways:

• Own Occupation: Initially, LTD benefits may cover you if you are unable to perform the duties of your own job.
• Any Occupation: After a certain period (usually two years), the definition of disability may change, and you must prove that you are unable to work in any occupation for which you are reasonably qualified based on your education, training, or experience.

3. Collect Medical Evidence

Medical evidence is a critical component of your LTD application. The insurance company will require detailed documentation from your healthcare providers to support your claim. Here’s what you need to do:

• Obtain Medical Records: Request comprehensive medical records from your doctors, specialists, and any healthcare professionals who have treated your condition.
• Provide a Doctor’s Statement: Your doctor must complete an Attending Physician’s Statement (APS), detailing your diagnosis, treatment, prognosis, and how your condition affects your ability to work.
• Include Test Results: If you’ve undergone any tests, such as MRIs, X-rays, or blood tests, provide copies of the results. These can help demonstrate the severity of your condition.
• Consistent Treatment: Ensure that you follow the treatment plan outlined by your healthcare provider, as insurers will assess whether you are taking reasonable steps to recover.

4. Notify Your Employer and Insurer

If you are covered by an employer-sponsored LTD plan, you must inform your employer about your condition and your intention to apply for LTD benefits. Your employer will typically provide you with the necessary forms and submit a portion of the application to the insurance company.

For private insurance plans, contact your insurance provider directly to obtain the required forms and information about the application process.

5. Complete the Application Forms

The LTD application consists of several forms, including:

• Claimant’s Statement: This is your personal statement where you describe your medical condition, how it affects your daily life and work, and your employment history.
• Employer’s Statement: Your employer must complete this form, outlining your job duties, salary, and other relevant information about your employment.
• Attending Physician’s Statement (APS): This is completed by your healthcare provider, as mentioned earlier, and is one of the most crucial elements of your application.

Ensure that all forms are completed accurately and in full. Missing or incomplete information can result in delays or denial of your claim.

6. Submit Your Application

Once all forms are completed and your medical documentation is gathered, submit the application to your insurance company. Be sure to retain copies of everything for your records.

7. Follow Up and Be Prepared for Requests

After submitting your application, the insurance company will review your claim and may request additional information. This could include further medical tests, statements from specialists, or even an Independent Medical Examination (IME) by a doctor chosen by the insurer.

8. Wait for the Decision

The time it takes for an insurer to decide on your claim can vary, but typically it can take several weeks to a few months. During this time, the insurance company will assess the documentation provided and determine if your condition meets the policy’s definition of disability.

9. If Your Claim Is Denied

Unfortunately, not all LTD claims are approved on the first try. If your claim is denied, you have the right to appeal the decision.

• Request a Review: You can submit additional medical evidence or clarify any discrepancies in your application.
• Hire a Lawyer: If the insurer continues to deny your claim, consider consulting with a lawyer specializing in disability claims to review your case and possibly pursue legal action.

10. Keep Track of Your Health and Benefits

Once approved, you will need to continue providing updated medical evidence to the insurance company at regular intervals. Failure to do so may result in the suspension or termination of benefits. It’s essential to maintain consistent medical treatment and document any changes in your condition.