Mississauga Long-Term Disability Lawyers

Long-term disability (LTD) benefits give people in Mississauga financial stability when health conditions prevent them from working. Unfortunately, many people who qualify for these benefits run into roadblocks when dealing with insurance companies. Some receive denials, others see their benefits cut off without explanation, and many feel uncertain about what steps to take next.

Our Mississauga long-term disability lawyers provide support and legal representation so that individuals can pursue benefits with confidence.

If your LTD claim has been denied or delayed, you don’t need to handle the process on your own. Contact us today for a free consultation. We can help you hold insurance companies accountable and increase your chances of obtaining the benefits you need.

Key Takeaways About LTD Benefits in Mississauga

• Long-term disability benefits are available through employer group plans and individual policies under Canadian insurance law
• Insurance companies often deny valid claims or terminate benefits prematurely
• You have legal rights to appeal denied claims and can seek legal representation at no upfront cost
• The limitation period for filing a lawsuit is typically two years from the date of denial or termination
• Medical evidence and proper documentation are crucial to building a strong disability claim

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Since 1959, we’ve helped thousands of Canadians get the compensation they deserve with their long-term disability claims. One of Canada’s oldest personal injury law firms, personal injury law is exclusively what we do. Book a free consultation today with our top-rated personal injury lawyers.

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What is Long-Term Disability Insurance in Canada?

Long-term disability insurance exists to provide income when a serious illness or injury prevents someone from earning a living. Without this coverage, many families in Mississauga struggle to pay for housing, food, and basic needs. LTD insurance fills that gap by providing a steady stream of income while the individual focuses on treatment and recovery.

Coverage Under Employer Group Plans

Employer-sponsored group plans are the most common way Canadians access LTD coverage. Employers in Mississauga often include LTD benefits as part of a broader health package. These plans usually replace a percentage of your monthly income, often between 60 and 70 percent. While this amount is less than your regular paycheque, it provides stability during periods when working isn’t possible.

Group policies may also come with restrictions. For example, coverage might end if employment is terminated. Some plans require that you also apply for Canada Pension Plan (CPP) Disability benefits. Employers in areas such as Clarkson and Lorne Park often provide coverage that coordinates with other benefits, meaning the insurer may deduct other disability income sources from your LTD payments.

Individual LTD Policy Benefits

Some Mississauga residents purchase individual LTD policies to gain additional protection. These policies may be beneficial to self-employed people, small business owners, and professionals such as consultants who don’t have group coverage. Individual policies often cost more in monthly premiums, but they may offer broader terms, higher maximum payments, and longer benefit periods.

Waiting Periods and Benefit Periods

Most LTD plans require you to wait through an elimination period before payments begin. This period usually lasts 90 to 120 days. During this time, many rely on short-term disability coverage, Employment Insurance (EI) sickness benefits, or personal savings. Once LTD payments begin, they can last for a fixed number of years, until you reach retirement age, or for as long as you remain disabled under the policy terms.

The length of the benefit period can significantly impact financial security for claimants. Some policies provide benefits for only two or five years, while others continue until age 65. People working in manufacturing and transportation jobs around the Meadowvale industrial area often rely heavily on policies that provide longer coverage due to the physically demanding nature of their work.

What Qualifies as a Disability in Mississauga LTD Policies?

The definition of disability in LTD policies plays a major role in whether benefits are approved or denied. Insurance companies rely on contractual language to determine if your condition qualifies, and they often interpret these definitions narrowly.

Own Occupation vs. Any Occupation Definitions

The own occupation definition of disability applies during the first two years of receiving benefits. Under this standard, you’re considered disabled if you can’t perform the key duties of your specific job. For example, a mechanic in Mississauga who develops severe back problems may not be able to complete tasks like lifting heavy equipment, even if they might manage lighter work elsewhere.

After two years, most policies switch to the any occupation definition. This standard asks whether you can perform any type of work suited to your education, skills, and experience. Insurers sometimes misuse this definition by pointing to low-paying or unrealistic jobs. For instance, suggesting a person with advanced degenerative disease could work in a sedentary clerical role, even when constant medical treatment makes sustained employment impossible.

Total vs. Partial Disability Classifications

A total disability classification means you can’t reasonably perform the majority of your occupational duties. This doesn’t mean you’re bedridden or incapable of all activities. It simply means your condition prevents you from sustaining regular employment.

Partial disability applies when you can still work, but only in a reduced capacity. Some policies provide partial benefits to cover lost income if you’re working fewer hours. For example, a teacher in Mississauga who can only manage part-time work due to long COVID symptoms may qualify for partial benefits.

Pre-Existing Condition Exclusions

Many LTD policies include pre-existing condition clauses. These typically exclude conditions you received treatment for during the year before coverage began. However, exclusions may expire after you’ve been covered for a continuous period, usually 12 to 24 months. This means someone with controlled asthma or diabetes may eventually qualify for LTD benefits if their condition worsens after that time.

Why Do Insurance Companies Deny Long-Term Disability Claims?

Despite the protective purpose of LTD coverage, insurers deny or cut off claims for a variety of reasons. Denials often stem from a combination of financial motivations and strict policy interpretations.

Insufficient Medical Evidence

Insurers frequently argue that claimants haven’t provided enough medical evidence. They may demand detailed test results, specialist reports, or documentation of functional limitations. A person suffering from chronic migraines may have medical notes confirming the diagnosis, but still face denial if the insurer says the records don’t show how the migraines prevent consistent work attendance.

Surveillance and Independent Medical Examinations

Insurance companies often hire private investigators to conduct surveillance or arrange Independent Medical Examinations (IMEs). Surveillance may involve filming you performing everyday tasks, like grocery shopping at Square One Mall. Even if the activity was brief and painful, insurers may argue the footage shows you’re capable of working. Similarly, IMEs are performed by doctors hired by the insurance company, whose findings often minimize or contradict the opinions of your treating physicians.

Policy Interpretation Disputes

Insurers sometimes deny claims by interpreting vague policy language narrowly. For instance, if your policy covers “any occupation,” the insurer may suggest you could work in a completely different field despite significant medical limitations.

Administrative Errors and Bad Faith Practices

Some denials result from clerical mistakes, such as lost paperwork or misfiled medical records. In other cases, insurers may engage in bad faith conduct, delaying decisions unnecessarily or ignoring supportive medical evidence. These tactics can create financial pressure, forcing claimants to abandon their claims.

What Are Your Rights When Your LTD Claim is Denied?

A denied claim doesn’t end your right to pursue LTD benefits. Ontario law gives claimants several ways to contest an insurer’s decision.

Internal Appeals Process

Many policies offer an internal appeal where you submit additional documents for review. However, insurers control this process, which means decisions often remain the same. Submitting strong new medical reports can sometimes change the outcome, but many people find this step ineffective.

External Review Options

In some cases, following the onset of litigation, external dispute resolution methods may be an option, such as mediation or arbitration. These options allow both sides to present evidence before a neutral third party. Mediation can sometimes resolve disputes, although insurers may still resist fair settlements.

Litigation Under Provincial Insurance Laws

If the insurer refuses to reinstate benefits, claimants can file a lawsuit in an Ontario court. Litigation compels the insurer to provide disclosure of internal records and justify the denial. Courts in Ontario have the authority to order the reinstatement of benefits and award damages when insurers act unreasonably.

How Long Do You Have to Appeal a Denied LTD Claim?

Deadlines for appealing and suing vary, but missing them may end your claim entirely.

Limitation Periods in Ontario

Ontario law usually gives you two years from the denial or termination date to sue.  The policy may extend that period.

Contractual Time Limits for Internal Appeals

Some policies set shorter internal appeal deadlines, often 90 to 180 days. It is important to review the terms of your specific policy to confirm your internal appeal deadline.

Preserving Your Right to Sue

Even if you appeal internally, you must stay within the two-year litigation deadline.

What Evidence Do You Need for a Successful LTD Claim?

The strength of your LTD claim depends on the quality of your documentation. You may consider collecting:

• Medical Documentation Requirements: Your medical records should clearly describe your diagnosis, symptoms, and treatment plan.
• Functional Capacity Evaluations: Doctors sometimes perform these tests to show how your condition limits your ability to work.
• Employment Records and Job Descriptions: Detailed job descriptions demonstrate the specific duties you can no longer perform.
• Expert Medical Opinions: Specialist reports add credibility, especially for conditions that are harder to prove.

Common Challenges in Long-Term Disability Cases

Some conditions lead to unique challenges in LTD cases.

Mental Health and Chronic Pain Claims

Conditions like depression, anxiety, or chronic pain often lack visible symptoms, making insurers question their legitimacy.

Fibromyalgia and Chronic Fatigue Syndrome

These conditions are difficult to measure objectively, but supportive medical opinions carry weight.

Cancer and Treatment-Related Disabilities

Cancer patients may qualify during treatment or while dealing with long-term side effects.

Progressive Conditions and Degenerative Diseases

Conditions such as multiple sclerosis or Parkinson’s disease may worsen over time, requiring ongoing medical updates.

How Our Mississauga Long-Term Disability Lawyers Can Help

Our lawyers assist people in Mississauga by holding insurers accountable and pursuing fair outcomes for disability claims.

Case Evaluation and Claim Review

We carefully review denial letters, medical records, and policy language to identify weaknesses in the insurer’s reasoning. This step gives clients a clear picture of where their case stands and what needs to be done next.

Gathering Medical Evidence and Expert Reports

Our team works closely with doctors, specialists, and other healthcare providers to assemble compelling medical evidence. We may also arrange independent assessments from trusted professionals whose opinions can counter biased insurance evaluations.

Negotiating with Insurance Companies

We handle communication with insurers directly. This prevents clients from being pressured into making statements that could harm their claims. Through persistent negotiation, we seek resolutions supported by the evidence.

Representing You in Court Proceedings

When insurers refuse to act fairly, we present your case in court. Our lawyers advocate on your behalf, using medical documentation, employment records, and expert testimony to demonstrate why benefits should be paid.

Contingency Fee Arrangements

We provide representation without upfront fees or costs. Payment only occurs if your case results in a settlement or court award, making legal representation accessible during financially difficult times.

Contact Our LTD Lawyers in Mississauga Now

People in Mississauga who have had LTD benefits denied or terminated don’t need to fight insurers alone.

At Preszler Injury Lawyers, our Mississauga LTD lawyers offer free consultations and represent clients across Mississauga, including Meadowvale, Cooksville, and Malton. Call 1-888-608-2111 today to schedule your free case evaluation.

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LONG-TERM DISABILITY BENEFITS DENIED OR CUT-OFF IN MISSISSAUGA?