What Happens When Your LTD Benefits Are Terminated After Years of Approval?

When long-term disability (LTD) benefits are terminated after years of approval, it usually signals that the insurance company believes you no longer meet the specific definition of disability outlined in your policy.

Many claimants assume that once they are approved, their benefits are secure until retirement age. However, benefit termination is often triggered by the “change of definition” clause at the two-year mark.

Receiving a termination letter can leave you feeling uncertain about your financial stability, especially when you have relied on these payments for an extended period.

A long-term disability lawyer in Toronto can review the insurer’s decision, identify flaws in their reasoning, and help you challenge the denial to reinstate the support you rely on.

If you have questions about what happens when your LTD benefits are terminated after years of approval, contact Preszler Injury Lawyers for a free consultation.

Our team can help you navigate the appeals process and pursue the compensation to which you may be entitled under Ontario law.

Key Takeaways About Why Legal Representation Matters After LTD Benefits Termination

• The “change of definition” is a common trigger for termination. Most policies shift the definition of disability after two years from “own occupation” to “any occupation.” A lawyer can help demonstrate that you remain unable to perform any gainful employment suited to your education, training, or experience, even under this stricter standard.
• Medical evidence is the foundation of a successful appeal. Insurers often cite a lack of objective medical proof when stopping payments. Legal professionals work with medical specialists to provide the necessary evidence for ongoing LTD eligibility, countering the insurer’s claims that you are fit to return to work.
• The Ontario Insurance Act protects your right to fair treatment. Insurers have a duty of good faith and fair dealing when handling your claim. If an insurance company acts in bad faith by terminating benefits without valid grounds, a lawyer can pursue a claim for bad faith damages in addition to the reinstatement of benefits.
• Deadlines for legal action are strict. The limitation period for suing an LTD insurance company in Ontario is typically two years from the date benefits were denied or terminated. Consulting a lawyer promptly preserves your right to take legal action if the internal appeal process fails.

Why Was My Long-Term Disability Terminated in Ontario, Canada?

When LTD benefits are terminated in Ontario, understanding the underlying reasons puts you in a favourable position to respond. Insurers typically cite a reason, but that justification may not always withstand scrutiny.

Common reasons for LTD benefits termination include:

• Change of definition after two years. Most policies shift from “own occupation” to “any occupation,” so benefits end if the insurer believes you can do any suitable work, not just your previous job.
• Insufficient medical evidence. Insurers may claim the available medical records do not clearly support continued disability, or that recent reports indicate improvement.
• Functional capacity or vocational assessment findings. An assessment may suggest that you are suitable for alternative employment, even if your treating doctor disagrees.
• Non-compliance with treatment or policy requirements. Missing appointments, failing to follow medical advice, or not completing insurer forms can sometimes result in the suspension of payments.
• Surveillance or activity reports. Footage or reports showing you engaging in certain activities may be used as evidence that you are not as disabled as reported.

When you receive a termination letter, a lawyer can review every reason cited, challenge weak or unsupported findings, and advocate for your continued LTD coverage under Ontario law.

How to Reinstate LTD Benefits After the Insurance Company Terminated Them?

Reinstating long-term disability benefits after termination requires a strategic approach that addresses the insurer’s reasons for stopping payments. Legal professionals play a critical role in guiding you through this process, ensuring that your claim is supported by strong evidence and that your rights are protected.

Steps to Take After Receiving a Termination Letter

When you receive a long-term disability benefits termination letter, it’s crucial to act quickly and strategically. The following steps can help strengthen your case for reinstatement:

• Request a detailed explanation. Ask the insurer for a complete breakdown of the reasons for termination, including any medical or vocational assessments they relied on to support their decision.
• Gather supporting documentation. Collect updated medical records, treatment plans, and any other evidence that demonstrates your ongoing disability.
• Consult with a lawyer. Legal professionals can review the termination letter, identify weaknesses in the insurer’s reasoning, and advise on the most appropriate course of legal action.

Taking these steps early can set the foundation for a strong appeal or legal challenge, increasing your chances of reinstating your benefits.

Gathering the Evidence Needed to Support Your Claim

Strong evidence is the foundation of any successful reinstatement effort. Legal professionals can help you compile the necessary documentation, including:

• Medical records: Detailed reports from your treating physicians that outline your diagnosis, symptoms, and limitations.
• Vocational assessments: Expert opinions that demonstrate why the suggested alternative jobs are not feasible given your condition.
• Witness statements: Testimonies from family, friends, or colleagues who can attest to the impact of your disability on daily life.
• Rebuttals to surveillance: Contextual explanations for any activities the insurer may have misinterpreted, such as one-time efforts that do not reflect your overall capabilities.

By presenting a comprehensive and well-documented case, your lawyer can challenge the insurer’s decision and advocate for the reinstatement of your benefits.

Deciding Between Internal Appeals and Legal Action

When benefits are terminated, insurers often encourage claimants to file an internal appeal. While this may seem like a straightforward option, it is important to weigh the potential drawbacks:

• The insurer controls internal appeals: The same company that denied your claim will review your appeal, making reversals unlikely.
• Time limitations: Pursuing an internal appeal can delay your ability to file a lawsuit, as the limitation period for legal action continues to run.

A lawyer can assess whether an internal appeal is worthwhile or if initiating legal action is a more effective strategy. In many cases, filing a lawsuit prompts the insurer to engage in meaningful settlement discussions, increasing the likelihood of a favourable outcome.

Exploring Settlement Options

In some cases, reinstating benefits may not be the most effective solution. Instead, a lump sum settlement might provide greater financial security. This option typically includes:

• Arrears: Payments you missed while the dispute was ongoing.
• Future benefits: A portion of the payments you would have received had the claim continued.

Deciding between reinstatement and a lump sum requires careful consideration of your long-term needs. Experienced LTD lawyers can help you evaluate the pros and cons of each option, ensuring that the resolution aligns with your financial and medical circumstances.

Addressing Bad Faith Termination

If the insurer acted unreasonably in terminating your benefits, you may have grounds for a bad faith claim. Examples of bad faith conduct include:

• Ignoring medical evidence provided by your treating physicians.
• Misrepresenting policy terms to justify the termination.
• Using undue pressure to force a settlement.

Ontario courts have awarded punitive and aggravated damages in cases where insurers breached their duty of good faith. A lawyer can review the insurer’s conduct and pursue additional compensation if bad faith is evident.

Protecting Your Financial Future

Reinstating LTD benefits is about more than just recovering lost payments. It’s also about safeguarding your overall financial health. Termination of benefits can affect:

• CPP Disability benefits: Insurers often deduct these payments from LTD benefits, leaving you with less income if LTD stops.
• Life insurance and extended health coverage: Losing LTD status may impact your eligibility for these additional benefits.

Legal counsel can help you navigate these complexities, ensuring that any resolution takes into account the broader impact on your financial stability.

Steps to Support Your Lawyer and Strengthen Your Long-Term Disability Reinstatement Claim

The steps you take during the LTD reinstatement process can significantly impact the strength of your claim. By working closely with your lawyer and avoiding the following common pitfalls, you can help build a strong case for reinstating your benefits:

1. Maintain open communication with your lawyer. Share all updates, correspondence from the insurer, and any new medical developments promptly. Keeping your lawyer informed ensures they have the most accurate and up-to-date information to advocate for you.
2. Follow your treatment plan. Adhering to your doctor’s recommendations demonstrates your commitment to recovery and supports your claim that your condition prevents you from working.
3. Document your daily challenges. Keep a journal detailing how your disability affects your ability to perform everyday tasks. This can provide valuable context for your lawyer when countering the insurer’s arguments.
4. Avoid discussing your case publicly. Refrain from posting about your claim on social media or discussing it with anyone other than your lawyer. Insurers may use your statements against you.
5. Provide thorough and accurate information. Complete all forms and questionnaires from the insurer carefully, ensuring that your responses align with the medical evidence and your lawyer’s guidance.

If you think you may have taken steps that unintentionally hurt your case, speak with a lawyer as soon as possible. Legal professionals can help address any challenges and work to protect your rights throughout the reinstatement process.

Terminated LTD Benefits FAQs

Can the insurance company terminate my benefits without warning?

Insurers typically must provide written notice explaining the reasons for the termination. If your benefits stopped abruptly without explanation, a lawyer can investigate whether the insurer followed proper procedure and demand the necessary documentation to challenge the decision.

Does a return-to-work attempt affect my benefits?

Many policies have “recurrent disability” clauses that allow you to attempt a return to work without losing your right to go back on benefits if the attempt fails within a certain timeframe. A lawyer can review your policy to explain how these clauses apply to your situation and protect your rights during a return-to-work trial.

What happens if I cannot afford a lawyer after my benefits stop?

Many disability lawyers, including Preszler Injury Lawyers, operate on a contingency fee basis, meaning legal fees are a percentage of the money recovered, and you do not pay upfront. This allows you to access legal representation to fight for your retroactive LTD benefits after wrongful termination without adding to your immediate financial burden.

Can I sue for pain and suffering if my benefits were wrongly terminated?

Generally, you cannot sue for pain and suffering for the denial of the benefit itself, as it is a breach of contract claim. However, if the insurer’s conduct caused independent mental distress, you may be able to claim aggravated damages. A lawyer can assess if the facts of your case support a claim for mental distress damages.

What should I do if the insurer requests an Independent Medical Examination (IME)?

If the insurer requests an IME, it’s essential to attend the appointment and prepare carefully. A lawyer can help you understand your rights during the IME process, ensure the evaluation is conducted fairly, and challenge any biased or inaccurate findings that the insurer may use to justify terminating your benefits.

Contact Preszler Injury Lawyers to Challenge Your LTD Termination

Losing your long-term disability benefits after years of relying on them can present a major disruption to your life. The stress of dealing with an aggressive insurance company while trying to manage your health can be paralyzing.

You do not have to accept the insurer’s decision as final. Preszler Injury Lawyers is here to provide the guidance and advocacy you need to help position your claim for a successful outcome under your specific circumstances.

Whether it involves disputing a change of definition assessment, challenging surveillance evidence, or pursuing a bad faith claim, our team is ready to help you secure the financial support you may be entitled to under Ontario law.

Take the first step toward protecting your rights and rebuilding your financial stability after receiving an LTD termination notice. Contact Preszler Injury Lawyers today for a free consultation, and let us help you navigate the path forward.

We’re here to help.