Eligibility for Long Term Disability in Ontario – How It Works (2025)
Hi, David Pipe here — founder of WealthTrack. If you’re facing a serious illness or injury that’s keeping you from work, every day without income feels like a ticking clock. Long term disability (LTD) insurance can be your lifeline — but only if you know how to prove you qualify.
In Ontario, the eligibility rules can be complex and confusing, leaving many deserving people without the financial support they urgently need.
In this 2025 guide, I’ll cut through the confusion and show you exactly what insurers look for, how to gather the right evidence, and how to avoid the common traps that cause claims to be denied. Read on to take control of your LTD claim and protect your financial future.
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What is Long Term Disability Insurance?
Long term disability insurance is designed to replace a portion of your income if you’re unable to work due to illness or injury that lasts beyond the short-term period (typically 3-6 months).
In Ontario, LTD coverage often comes from:
Employer-sponsored group insurance plans
Individual private insurance policies
Unlike government disability benefits, LTD plans are private contracts between you and an insurance company — meaning eligibility and benefit rules vary based on your specific plan.
Who Is Eligible for Long Term Disability Benefits?
Eligibility for LTD depends mainly on the terms outlined in your insurance policy, but there are some common elements insurers typically look for:
1. You Must Have a Disability That Meets the Plan’s Definition
Most LTD policies define disability in one of two ways:
Own Occupation: You are considered disabled if you cannot perform the duties of your specific job. This is common in the first few years of benefits.
Any Occupation: After a set period (often 2 years), many plans require you to show that you cannot work any job suited to your education, experience, or training.
Your medical condition must prevent you from working according to the policy’s disability definition to qualify.
2. You Must Be Under the Age Limit
Most LTD plans have an age limit, often around 65, after which benefits stop or convert to retirement income.
3. You Must Have Served the Elimination Period
The elimination period is a waiting time (usually 90 to 180 days) from the onset of disability before benefits begin. You must be disabled throughout this period to qualify.
4. You Must Submit Required Medical Evidence
Your insurer will require comprehensive medical documentation proving your disability, including:
Diagnoses and prognoses from your doctors or specialists
Functional assessments showing how your condition limits work ability
Details of treatments and compliance
5. You Must Comply with the Terms of the Policy
This includes cooperating with medical examinations, attending rehab programs if required, and promptly providing requested information.
How Does the LTD Eligibility Process Work in Ontario?
The application and eligibility process can feel complex, but here are the basic steps:
Step 1: Notify Your Employer or Insurer
Start by informing your employer or insurance company about your disability as soon as possible. They will provide you with claim forms and outline the documentation you’ll need.
Step 2: Submit Your Application
Complete the claim forms, and submit detailed medical evidence from your healthcare providers. Accuracy and completeness here are crucial.
Step 3: Wait for Insurer Review
The insurance company will review your medical documents and may require additional information or independent medical exams (IMEs).
Step 4: Eligibility Decision
You’ll receive a decision confirming approval or denial. If approved, your benefits will begin after the elimination period.
Step 5: Appeals if Denied
If your claim is denied, you have the right to appeal. This usually involves submitting new evidence or clarifications and may require legal or professional assistance.
Common Reasons LTD Claims Are Denied
Understanding common denial reasons can help you avoid pitfalls:
Insufficient medical evidence
Condition doesn’t meet the policy’s disability definition
Failure to meet elimination period requirements
Non-compliance with policy terms (e.g., missed medical appointments)
Return to work or earning income inconsistent with disability
Tips for Improving Your Chances of Qualifying
Keep detailed records of symptoms, treatments, and how your disability affects daily functioning.
Work closely with your healthcare providers to ensure they provide thorough and clear medical reports.
Be proactive and organized with paperwork and deadlines.
Consider consulting a disability specialist or lawyer if your case is complex or if you face denial.
What Happens If You Don’t Qualify?
If your LTD claim is denied, don’t lose hope. You can:
Appeal the decision with additional evidence
Explore other benefits like CPP Disability or provincial disability support
Look into private disability insurance options
Seek legal advice for complex cases
Final Thoughts
Navigating long term disability eligibility in Ontario can be daunting, but understanding how the process works and what insurers look for puts you in a better position to secure the benefits you need.
If you or a loved one is facing this challenge, take the time to prepare carefully, gather strong medical evidence, and don’t hesitate to seek professional help.
