Stirling Long-Term Disability Lawyer

Published: January 29, 2020 | Last Reviewed: September 10, 2026

Have you been severely injured in an accident? Have you developed a chronic illness or debilitating mental health condition? Does your medical condition make it difficult or impossible to continue working?

Depending on your insurance coverage and the terms of your policy, you may qualify for long-term disability benefits.

While coping with a serious medical condition, people living with disabilities can struggle to afford their ordinary costs of living in addition to treatment and care expenses. When an LTD insurer denies or terminates benefits, the loss of income can create additional uncertainty at an already difficult time.

Our Stirling long-term disability lawyers can review the insurance policy, the insurer’s decision, and the evidence supporting your inability to work.

Key Takeaways: Stirling Long-Term Disability Claims

• Eligibility for LTD benefits depends primarily on the wording of the insurance policy and the medical and occupational evidence.
• LTD coverage may be available through an employer-sponsored group plan or an individually purchased disability policy.
• A diagnosis alone may not be enough. Insurers often focus on how symptoms affect the claimant’s ability to perform occupational duties.
• Many LTD policies change their definition of disability after a specified period, often from an “own occupation” test to an “any occupation” test.
• An insurer’s internal appeal process is not necessarily the only option after a denial.
• Limitation periods should be reviewed before repeatedly appealing a claim internally.

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How Long-Term Disability Benefits Work in Stirling

Long-term disability insurance is intended to replace part of a person’s employment income when a qualifying illness or injury prevents them from working for an extended period.

Some employees have access to LTD insurance through a workplace group benefits plan. Others purchase disability insurance privately.

The Financial Consumer Agency of Canada provides general information about disability insurance and how it can replace a portion of income when someone cannot work.

The amount of LTD benefits depends on the policy.

Some policies provide a percentage of pre-disability earnings, subject to contractual limits and possible deductions or offsets. Our information about how LTD monthly payments are calculated explains some of the factors that can affect the amount payable.

Do You Have to Exhaust Other Benefits Before Receiving LTD?

The original terms of the insurance policy determine when LTD benefits begin.

Many policies contain an elimination or waiting period before long-term disability payments become payable. Some workplace plans also coordinate LTD coverage with short-term disability benefits, Employment Insurance sickness benefits, Canada Pension Plan disability benefits, or other sources of income.

However, the rules are policy-specific.

Someone should not assume that every other type of benefit must necessarily be exhausted before an LTD claim can proceed. The actual contract and benefit plan should be reviewed.

Medical Conditions That May Support an LTD Claim

There is no single list of diagnoses that automatically establishes entitlement to long-term disability benefits.

The central question is usually whether the claimant satisfies the policy’s definition of disability.

Depending on their severity and functional effects, disabling conditions can include:

• Chronic pain
• Complex regional pain syndrome
• Back and neck injuries
• Spinal cord injuries
• Neurological disorders
• Cancer
• Autoimmune illnesses
• Cardiovascular conditions
• Traumatic injuries
• Paralysis
• Post-traumatic stress disorder
• Depression
• Anxiety
• Cognitive impairments
• Chronic fatigue
• And other physical or psychological conditions

A claimant may have a serious diagnosis but still face a dispute if the insurer argues that the evidence does not establish an inability to perform occupational duties.

Why LTD Claims May Be Denied

Insurance providers can deny LTD applications for many reasons.

Examples may include:

• Insufficient medical documentation
• Missing forms or information
• Late submission of a claim
• A dispute about the severity of functional limitations
• The insurer argues there is insufficient objective evidence
• The condition does not satisfy the policy’s definition of disability
• A contractual exclusion is raised
• A pre-existing condition provision is relied upon
• The insurer believes the claimant can perform their occupation
• The claimant did not attend an insurer-requested assessment
• Treatment recommendations are disputed
• Surveillance or social-media evidence is relied upon
• And other policy-specific reasons

Some conditions can be particularly challenging because their disabling effects may not appear clearly on imaging or laboratory testing.

Our article about LTD claims involving invisible injuries and illnesses discusses this issue in more detail.

What Is the Own Occupation Test?

Many LTD policies initially define disability by reference to the claimant’s regular or “own” occupation.

The policy may ask whether the medical condition prevents the claimant from performing the essential duties of the job they were doing when they became disabled.

That requires more than looking at a job title.

The actual physical, cognitive, psychological, and scheduling demands of the occupation may be relevant.

For example, a person who can perform certain activities for short periods at home may still be unable to maintain the concentration, attendance, productivity, lifting requirements, physical stamina, or interaction required by their employment.

What Happens When the Definition Changes?

Many policies change the disability test after a specified benefit period.

This is sometimes referred to as the “change of definition.”

After the change, the insurer may assess whether the claimant is unable to perform another occupation for which they are reasonably suited by education, training, or experience.

The exact test varies by policy.

An insurer may therefore approve LTD benefits initially and later terminate them when it believes the claimant no longer satisfies the new contractual definition.

The fact that a change-of-definition date has arrived does not by itself establish that someone is capable of returning to work.

Evidence That Can Strengthen an LTD Claim

A strong LTD claim often involves evidence addressing both the medical condition and its functional effect.

Potentially relevant evidence includes:

• Family physician records
• Specialist reports
• Psychological or psychiatric reports
• Diagnostic tests
• Medication history
• Treatment records
• Functional-capacity assessments
• Occupational therapy assessments
• Job descriptions
• Employer documentation
• Attendance records
• Evidence of unsuccessful return-to-work attempts
• Statements describing functional limitations

Consistency can become particularly important.

An insurer may compare what the claimant reports to physicians, what appears in treatment records, the restrictions identified by health-care providers, job demands, surveillance, and other evidence.

LTD Claims Following an Accident in Stirling

Some long-term disability claims develop after an accident.

Someone injured in a motor vehicle collision may have an LTD insurance claim in addition to accident benefits or a negligence claim. Our Stirling car accident lawyers provide information about Ontario motor vehicle claims.

Likewise, a person injured in a slip and fall, recreational accident, or another incident caused by negligence may have a separate personal injury claim. Those claims are now addressed through our Stirling personal injury lawyers.

The claims serve different purposes.

An LTD claim generally arises from an insurance contract and focuses on whether the policy’s disability requirements are satisfied. A negligence claim examines whether another party is legally responsible for causing an injury.

What Should You Do After an LTD Denial?

An LTD denial letter should generally identify why the insurer has decided not to pay benefits.

The reasons should be reviewed carefully.

Potential next steps may include:

• Obtaining the insurance policy
• Reviewing the definition of disability
• Reviewing exclusions and limitations
• Comparing the insurer’s reasons with the medical evidence
• Obtaining additional treatment or specialist documentation
• Clarifying occupational duties
• Reviewing appeal provisions
• Identifying applicable limitation periods

Many insurers offer an internal appeal process.

An internal appeal can make sense in some cases, particularly if significant new evidence is available. However, it is not necessarily the only possible response to a denied claim.

Depending on the circumstances, legal action may also be considered.

What May Be Claimed in an LTD Lawsuit?

Where an insurer has failed to pay benefits that are contractually owed, a lawsuit may seek unpaid benefits and other amounts available under the policy.

Additional damages can sometimes be claimed where the facts and applicable law support them.

However, damages such as aggravated or punitive damages are not automatic merely because an insurance claim was denied.

Every dispute must be assessed on its own evidence.

Stirling Long-Term Disability FAQs

How Much Do LTD Benefits Pay?

The amount depends on the policy.

Many policies replace a percentage of pre-disability earnings up to a stated monthly maximum. Other sources of income may reduce the amount payable if the policy contains offset provisions.

Can Mental Health Conditions Qualify for LTD Benefits?

Potentially.

Depression, anxiety, PTSD, and other psychological conditions can be disabling. Eligibility depends on the policy definition and whether the evidence supports an inability to perform the required occupational duties.

Can Chronic Pain Qualify for Long-Term Disability?

Potentially.

Chronic pain may interfere with sitting, standing, lifting, concentration, sleep, attendance, and stamina. The claim generally requires evidence of how those symptoms affect functional capacity rather than simply proof of a diagnosis.

What If My Insurer Says There Is No Objective Evidence?

Some disabling conditions do not produce a single diagnostic test that demonstrates the full extent of impairment.

Clinical records, specialist reports, consistent treatment, functional evidence, occupational information, medication history, and other evidence may still be relevant.

Can My Insurer Terminate Benefits After Two Years?

Potentially, depending on the policy.

Many policies change their definition of disability around that point, although the timing and wording vary.

An insurer must still apply the actual policy definition to the claimant’s circumstances.

Do I Have to Appeal the Denial Internally?

Not necessarily.

Some claimants pursue an internal appeal, while others may consider litigation. The appropriate strategy depends on the evidence, policy wording, insurer’s reasons, and applicable deadlines.

Can I Receive LTD Benefits After a Car Accident?

Potentially.

If you have applicable LTD insurance and your accident-related medical condition satisfies the policy definition of disability, you may have an LTD claim in addition to automobile insurance or personal injury claims.

Can I Receive LTD Benefits If I Have Not Been Hospitalized?

Hospitalization is not necessarily required.

The relevant issue is generally whether the medical condition satisfies the disability test in the insurance policy.

What If My Condition Prevents Me From Working but the Insurer Says I Can Do Another Job?

That issue may arise after a policy’s definition of disability changes.

The analysis can involve your education, training, work experience, medical restrictions, functional abilities, and the wording of the particular policy.

Contact Our Stirling Long-Term Disability Lawyers Today

When a medical condition prevents you from working, losing access to disability income can create significant financial pressure.

If your LTD claim has been denied or your benefits have been terminated, our Stirling long-term disability lawyers can review your policy, insurer correspondence, medical evidence, occupational duties, and potential options.

To arrange a free initial consultation, contact Preszler Injury Lawyers or call 1-888-608-2111.

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