How Long Is Long-Term Disability Insurance Coverage?
For individuals facing serious illness or injury, long-term disability (LTD) benefits often represent more than income. They provide a form of stability during a period of significant personal and professional disruption. Yet, understanding how long those benefits will last is not always straightforward. The question, how long is long-term disability, depends on a range of factors, many of which are outlined not in legislation, but in insurance contracts.
Most long-term disability plans in Canada provide a percentage of your regular income. The percentage could range from 50% to 70%. However, the duration of those payments is usually tied to how your insurer defines “disability.” Many LTD plans begin by assessing whether your injury or illness stops you from performing the duties of your own occupation, and then after two years, shift to a broader standard, evaluating whether you can perform any occupation. You can find more information on this distinction from the Financial Consumer Agency of Canada here.
If you’re unsure how your insurer is interpreting these terms, or facing delays or denials, reviewing your disability insurance claim with legal support can clarify your entitlements and next steps.
Duration of Long-Term Disability Benefits
How long you can remain on long-term disability in Ontario depends on the specifics of your insurance policy. Some LTD plans provide coverage until age 65. Others limit coverage to a specified period, such as two or five years. Even within those timelines, coverage is conditional on your continued eligibility as defined by the policy.
A typical structure involves a two-year period during which you must demonstrate you are unable to perform the essential tasks of your current job. After that, the test becomes more difficult: are you unable to work in any role that aligns with your experience, training, and education? At this point, the policy language often becomes more nuanced and more contested.
What Happens to my Long-Term Disability Claim After Two Years?
The two-year threshold is commonly a point of reassessment (the “Change of Definition” period). Disability insurance companies often require updated medical evidence, and some initiate functional capacity evaluations or seek third-party medical examinations. The shift from “own occupation” to “any occupation” eligibility can result in claims being discontinued, even when the individual’s underlying condition hasn’t changed.
When long-term disability claims are reassessed, the focus is put on whether there are theoretical jobs the individual could perform. This is often where legal challenges emerge. If you are told that your long term disability benefits will end because you are “fit” to perform a role you haven’t done, or couldn’t reasonably do, it may be worth challenging the decision.
What If Long-Term Disability Benefits End?
If your insurance company discontinues benefits, the implications are significant, but not necessarily final. Alternative avenues for financial assistance may be available, depending on your medical status and employment history:
- CPP disability benefits, if your condition is “severe and prolonged”
- Ontario Disability Support Program (ODSP), for individuals with limited income due to disability
- Employment Insurance (EI) sickness benefits, which provide temporary support (typically for up to 26 weeks)
- Legal action or appeal, if you believe your claim was wrongly denied
Common Reasons LTD Claims Are Discontinued
Besides reaching the end of the policy’s maximum coverage period, benefits can be discontinued for several reasons:
- Insufficient or inconsistent documentation about your medical condition
- Non-compliance with the policy’s requirements (e.g., not attending evaluations)
- A return to work (whether full-time or modified)
- The insurer determines you can return to work based on its own medical assessments
Understanding the legal implications of these determinations often requires a review of both your medical history and the underlying long-term disability coverage. We advise clients not to assume that a denial is the end of the matter.
How Short-Term Disability Fits In
Long-term disability coverage doesn’t begin immediately. Most policies include a waiting period,often referred to as an elimination period,which typically ranges from 90 to 180 days. During this time, individuals may rely on short term disability benefits through their employer’s plan or employment insurance to help manage lost pre-disability income.
The transition from short term disability insurance to long term disability is a critical stage. Consistency in your medical records, supporting documentation, and a treatment plan can significantly influence whether you continue to receive benefits under your disability insurance policy. This stage can also reveal gaps in insurance coverage, especially when different insurance providers are involved or when the insurance company denies a claim based on technicalities or procedural oversights (i.e.: late filing).
Legal Considerations: Should You Get Help?
Applying for LTD or responding to a reassessment may seem administrative, but the outcomes can impact your access to ongoing medical benefits, your financial stability, and your long-term ability to recover. A denial based on vague interpretations of whether you’re totally disabled, or a narrow reading of your policy’s definition of disability, can leave you without income and support.
Our team at Whitten & Lublin regularly assists clients who need help with:
- Understanding the scope and limitations of their LTD coverage
- Addressing inconsistencies between treating physicians and insurer assessments
- Challenging claims where the insurance company denies a legitimate request
- Appealing reductions or terminations of long term disability benefit
Whether you’re navigating the application process or your long term disability payments are under review, working with an experienced disability lawyer early can ensure your claim meets the evidentiary and procedural expectations of your insurance provider.
What If You’re Able to Work Again?
Some LTD policies allow for partial return-to-work plans, particularly if you can resume some, but not all, of the essential duties of your role. Being able to work in a limited capacity doesn’t necessarily disqualify you from continuing to receive benefits, provided that your efforts align with the terms of your disability benefit and you remain classified as totally disabled under the insurer’s criteria.
Returning to work before completing your treatment plan or obtaining clearance from your physician can put your benefits at risk. If the insurance company approves your return-to-work program, it should be documented carefully and aligned with any structured rehabilitation programs.
A coordinated, insurer-supported plan helps maintain compliance with your disability insurance policy and reduces the risk of losing long term disability payments unexpectedly.
Take the Next Step with Confidence
For many people, navigating the intersection of employment rights, contract interpretation, and medical documentation without guidance is difficult, especially when they are focused on recovery.
If you are facing a denied long-term disability insurance claim or want to better understand your rights under your current policy, Whitten & Lublin can help. We provide strategic, informed guidance grounded in extensive experience handling disability insurance claims.
Contact our team of Toronto disability lawyers today at 416-640-2667. We’ll help you understand your options and move forward with a clear strategy.