Receiving a denial or termination of your disability benefits can be devastating. In a city like Toronto—where the cost of living is high and financial pressure escalates quickly—losing long-term disability (LTD) or short-term disability (STD) benefits can put your home, health, and family security at risk.
If your disability claim has been denied or your benefits have been cut off, it’s important to understand this from the outset: a denial does not mean your claim is weak. In many cases, it simply means the insurance company believes the decision will go unchallenged. Knowing your legal options early can make the difference between losing your income permanently and having your benefits reinstated.
Why Do Insurers Deny Disability Claims in Toronto?
Insurance companies deny or terminate disability claims every day—often for reasons that have little to do with your real ability to work.
Common reasons include:
- Allegations of “insufficient objective medical evidence”
- Claims that you can work in any occupation, not just your own
- Surveillance footage taken out of context to misrepresent your abilities
- File reviews by insurer-paid doctors who never examine you
- Missed deadlines or minor paperwork technicalities
- Heightened scrutiny at the 24-month “any occupation” changeover
Toronto claimants are frequently targeted aggressively because insurers assume many people will feel forced to return to work due to financial necessity.
The 24-Month “Any Occupation” Cut-Off: A Critical Turning Point
Most long-term disability policies contain a two-stage definition of disability:
- Own Occupation (first 24 months): You are disabled if you cannot perform the essential duties of your specific job.
- Any Occupation (after 24 months): You must prove you cannot perform any job for which you are reasonably suited by education, training, or experience.
This shift is one of the most common reasons disability benefits are terminated in Toronto, even when a person’s medical condition has not improved—or has worsened. Insurers often rely on theoretical jobs that ignore real medical restrictions or do not exist in the current Toronto labour market.
What Are Your Legal Options After a Denial?
When your disability benefits are denied or cut off, you generally have two possible paths. Understanding the risks and advantages of each is crucial.
- Internal Appeal with the Insurance Company
Insurers often invite claimants to submit an “internal appeal.” While this may sound reasonable, it is a process entirely controlled by the insurer.
Key concerns:
- There is no independent decision-maker
- The insurer is reviewing its own denial
- Appeals can delay matters and may risk missing legal limitation periods
For many claimants, internal appeals simply confirm the original denial.
- Legal Action (Often the Strongest Option)
Starting a legal claim against the insurance company often provides far greater leverage and protection.
Legal action allows for:
- Independent scrutiny of the insurer’s conduct
- Access to the insurer’s internal documents and claim notes
- Proper evaluation of medical and vocational evidence
- Real pressure that can lead to reinstated benefits or settlement
Many Toronto disability claims resolve through negotiation or mediation once a lawsuit is commenced.
Case Example: Reinstating Benefits for a Toronto Office Manager
A Toronto office manager was on long-term disability due to chronic back pain that prevented her from sitting for extended periods. Her doctors consistently supported her inability to work.
At the 24-month mark, her insurer terminated benefits after a paper review claimed she could perform a sedentary “any occupation” role. Feeling financial pressure, she considered returning to work against medical advice.
Instead, she sought legal help. Her claim was challenged, additional specialist evidence was obtained, and flaws in the insurer’s assessment were exposed. The result was a negotiated settlement that restored her financial security and allowed her to focus on her health.
A Critical Warning About Limitation Periods in Ontario
Disability claims in Ontario are subject to strict limitation periods. In many cases, the clock starts running the moment your benefits are denied or terminated—not when you decide to take action.
Waiting too long can permanently bar your right to sue, no matter how strong your medical evidence may be. Delay is one of the insurer’s greatest advantages.
Should You Return to Work After a Denial?
Many Toronto claimants feel compelled to return to work immediately due to financial pressure. Unfortunately, this can seriously undermine your claim.
Returning to work too soon may:
- Worsen your medical condition
- Be used as evidence that you are capable of working
- Damage your ability to challenge the denial effectively
Before making any return-to-work decision, it’s important to understand the legal consequences.
How Kotak Law Helps Toronto Disability Claimants
At Kotak Law, disability law is not a side practice—it is our primary focus. We represent individuals across Toronto whose LTD or STD benefits have been denied, terminated, or unfairly reduced.
We regularly help clients who:
- Were cut off after months or years of receiving benefits
- Were told they could work despite strong medical support
- Were subjected to surveillance or paper reviews
- Are facing pressure to return to work prematurely
We act only for claimants—never insurance companies.
A Denial Is Not the End of Your Claim
An insurance denial is often a strategic business decision, not a final medical conclusion. Many Toronto disability claims are successfully resolved through reinstatement of benefits, retroactive payments, or lump-sum settlements.
The most important step is understanding your rights before time runs out.
If your disability benefits were denied or cut off in Toronto, contact Kotak Law for a free consultation. There is no fee unless we win.
