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how serious does my medical condition have to be to qualify for long-term disability benefits?

long-term disability (ltd) insurance in ontario covers a wide range of medical conditions, both physical and mental.

by nainesh kotak
published jan 16, 2025
read time 3 minute read
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read time 3 minute read
join the conversation
disabilities that include severe arthritis, chronic back pain, and injuries resulting from accidents can all qualify for long-term disability benefits. getty images
if you’re a working person dealing with a serious medical issue, you may wonder, how serious does my medical condition have to be to qualify for long-term disability benefits? long-term disability (ltd) insurance in ontario covers a wide range of medical conditions, both physical and mental. chronic illnesses such as cancer, heart disease, diabetes, and multiple sclerosis are commonly recognized as qualifying conditions. these illnesses often require extensive treatment and long recovery periods, making it difficult for individuals to maintain regular employment.
mental health conditions are also a significant category for ltd qualification. disorders such as depression, anxiety, bipolar disorder, borderline personality disorder, and post-traumatic stress disorder (ptsd) can severely impact a person’s ability to work. not surprisingly, insurance companies generally require thorough medical documentation from healthcare providers to substantiate claims related to mental health.
if you have a condition that prevents you from working, you are not alone. according to the 2023 canadian survey on disability, almost 62 per cent of people experienced pain related disabilities. other prevalent types included flexibility, mobility and mental health-related disabilities.

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how long you are entitled to receive long-term disability benefits depends on the wording of your insurance policy.

approaching 65? review your insurance policy before benefits change or disappear
a majority of workplaces cut or reduce employee disability insurance once employees reach their 65th birthday, even if they're still working.
according to statistics canada's 2023 labour report, about 900,000 people were working past the age of 65.
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that same national survey showed that in 2022, 24 per cent of working-aged adults, ages 25 to 64, had a disability of some kind.
those disabilities include musculoskeletal disorders, including severe arthritis, chronic back pain, and injuries resulting from accidents, which can all qualify for ltd benefits. these conditions often limit mobility and physical capability, making it challenging to perform job-related tasks, especially in physically demanding roles.
respiratory conditions such as chronic obstructive pulmonary disease (copd) and severe asthma may also be considered for ltd, as they make it hard to sustain employment, as do autoimmune diseases such as lupus, fibromyalgia, rheumatoid arthritis and crohn’s disease.
so how do you go about obtaining long-term disability payments through your insurance provider?
the application process for long-term disability (ltd) in ontario typically begins with notifying your employer and insurance provider about your condition. it’s crucial to do this as soon as possible to ensure that you meet any deadlines set by your policy. your employer will usually provide you with the necessary forms to start the application process.
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the application forms generally include sections for both the employee and the employer. the employee’s section will require detailed information about your medical condition, how it affects your ability to work, and any treatments you have undergone.
your employer’s section of the application will typically include information about your job duties, your employment history, and any accommodations that were attempted before applying for ltd. this helps the insurance company understand the nature of your work and how your condition impacts your ability to perform your job.
the physician statement is crucial and will outline your diagnosis, prognosis and any limitations or restrictions you may have, plus the treatment plan you are undergoing.
specialist reports are also crucial. if you have been referred to specialists, such as neurologists, psychiatrists, or orthopedic surgeons, their detailed reports and treatment notes should be included. these documents add significant weight to your claim.
medical imaging and test results are additional pieces of evidence that can strengthen your ltd claim. these may include x-rays, mris, ct scans, blood tests, and other diagnostic tests that provide objective evidence of your medical condition.
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you should be aware that the insurance company may request additional information or clarification from you, your employer, or your healthcare providers. cooperation with these requests is essential for the timely processing of your application.
remember, if the medical records do not clearly demonstrate your inability to work, the claim may be rejected.
in the event of a claim denial, an experienced disability lawyer can help by conducting a thorough review of your case. he or she will examine the reasons for the denial, scrutinize your insurance policy, and gather all necessary medical and employment documentation to build a strong case, identifying any errors or omissions that may have led to the denial.
a good lawyer will provide personalized support throughout the entire process and can help you through this challenging time, so you can focus on your health and well-being.
nainesh kotak, is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he was past chair of the long-term disability section of the ontario trial lawyers’ association.

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