Disability Benefits
A denied long-term disability claim is not the last word, and the policy wording usually decides what happens next. We handle appeals and claims against insurers.
When illness or injury stops you from working, disability benefits are supposed to catch you. Too often they don’t. Insurers deny long-term disability claims, government programs reject applications from people who clearly cannot work, and benefits that were approved are cut off without warning.
At Kabir & Alam, we help people across Ontario get the disability benefits they are entitled to under private insurance, the Canada Pension Plan, and the Ontario Disability Support Program.
Long-term disability (LTD) claims
Most LTD coverage comes through a group plan at work. In the first period of a claim, usually the first two years, you generally qualify if you cannot do your own job. After that, the test typically changes to whether you can do any job you are reasonably suited for by education, training, and experience. Many denials and terminations happen at that change-over point.
Insurers deny LTD claims for many reasons: insufficient medical evidence, surveillance, a paper review by a doctor who never examined you, a claimed pre-existing condition, or a finding that you are not following treatment. Some of these reasons are legitimate. Many are not.
A denied or terminated LTD claim can be challenged through the insurer’s internal appeal process or by lawsuit. Internal appeals rarely succeed and do not stop the limitation clock. In most cases, a lawsuit must be started within two years of the denial, and we recommend getting advice as soon as the denial letter arrives.
CPP Disability
Canada Pension Plan Disability benefits are available to people who have made enough CPP contributions and whose disability is both severe and prolonged: it regularly stops them from doing any substantially gainful work and is expected to last indefinitely or result in death.
A denial can be appealed, first by asking Service Canada to reconsider, then to the Social Security Tribunal. Each stage has a deadline measured in weeks, and the quality of the medical evidence presented at each stage usually decides the outcome. LTD insurers often require claimants to apply for CPP Disability, so the two claims frequently run together.
Ontario Disability Support Program (ODSP)
ODSP provides income support to Ontario residents with a substantial physical or mental impairment that is expected to last a year or more and that restricts their ability to work, care for themselves, or take part in community life.
Applications are often refused on the disability determination. A refusal can be challenged through an internal review and then an appeal to the Social Benefits Tribunal, again with short deadlines at each stage. We also help people whose ODSP has been cut off or reduced.
How we can help
If your disability claim has been denied, cut off, or delayed, we can help you:
- Review the denial and the policy or program rules that apply to it
- Build the medical and vocational evidence the decision-maker needs to see
- Meet the internal appeal, reconsideration, and tribunal deadlines
- Sue an LTD insurer for benefits, and for bad faith where it applies
- Represent you at Social Security Tribunal and Social Benefits Tribunal hearings
You pay no legal fees on LTD claims unless we recover money for you. Our maximum contingency fee percentage is 33% of the amount recovered; the exact percentage and how it is calculated are set out in the Law Society of Ontario standard form contingency fee agreement, which we review with you before you sign anything. Our personal injury practice is led by Muniza Kabir, Managing Partner.
Denied disability benefits? Contact us for a free consultation.
The information on this page is general in nature and is not legal advice. Limitation periods and notice requirements apply to injury claims and can be short. For advice about your own situation, please contact us to arrange a consultation.