Disability, for the purposes of insurance, isn’t about labels, it’s about function. If your condition interferes with your ability to perform the essential tasks of your job, you may qualify for benefits.

Disability insurance claims are not just for visible injuries or acute illnesses, but also chronic conditions, episodic illnesses, and mental health conditions. A person with severe anxiety who can no longer manage workplace interactions is no less entitled than someone who is totally disabled while recovering from surgery. The law recognizes both.

Insurers, however, often take a narrower view. They may argue that your condition isn’t severe enough or that the medical documentation doesn’t support your claim. When that happens, the guidance and support of an experienced Ontario disability lawyer can help you make sense of the situation and find the best path forward.

Short-term disability (STD) provides income replacement in the initial phase, often the first 15 to 26 weeks after you leave work due to illness or injury. Short-term disability benefits are usually accessed through your employer’s group insurance plan and are intended to cover temporary absences.

Long-term disability (LTD) benefits begin after that short-term coverage ends. If approved, it can provide support for several years, sometimes until retirement age. But LTD claims are more complex. After two years, most policies shift their definition of disability. At that point, you must demonstrate that you’re not just unable to perform your own job, but unable to do any job for which you’re reasonably suited by way of education, training or experience.

This is a common flashpoint. Many claimants are cut off at the two-year mark, not because their condition has improved, but because the insurer is applying a stricter standard. That’s when legal support becomes critical.

First: don’t panic, and don’t rush into an appeal without understanding your options.

Insurers offer internal appeal processes, but those are rarely impartial. What’s more effective is a clear legal strategy. At Whitten & Lublin, we start by reviewing the denial in detail, looking at the insurer’s reasoning, the medical evidence on file, and the language of your policy. We assess the legal strength of your position and determine the best course forward.

That may involve gathering additional medical documentation or consulting with specialists to strengthen your case. It may mean initiating formal legal action, such as filing a statement of claim to demonstrate that you’re prepared to litigate. Or it may involve strategic negotiation, backed by a clear legal position, that puts the insurer at risk of reputational or financial exposure if they continue to deny benefits without cause.