Has OTIP Denied your Long Term Disability (LTD) Claim?

Has OTIP Denied your Long Term Disability (LTD) Claim?

Ontario Teachers Insurance Plan (OTIP)

The Ontario Teachers Insurance Plan (OTIP) provides employee group benefits, including long term disability (LTD) insurance for unionized teachers in Ontario. OTIP is the plan administrator, which provides assistance with enrolment, eligibility, benefits and premiums, as well as claims for life, health and dental care. OTIP assesses each long term disability (LTD) claim and determines whether the claimant is eligible for benefits, meaning they have the authority to deny and terminate claims. The claims payer for LTD benefits is Teachers Life.

How Does OTIP Define Long Term Disability (LTD)?

According to OTIP, being disabled can be defined as if you are unable to carry out the duties of your specific assignment during the qualifying period (sick leave) and the following 24 months, due to illness or injury. After the 24 month period, you are considered disabled if you are unable to be gainfully employed, due to illness or injury (OTIP, 2020).

Stress and Mental Health

The everyday stress teachers experience, coupled with the unprecedented effects COVID-19 is having on the workplace can lead to negative mental health outcomes, such as anxiety disorders and depression, which can be debilitating and constitute a long term disability.

The president of the Ontario History and Social Science Teachers’ Association has stated that teachers have been putting their students well being over their mental health in this new environment, which will end up causing long term problems with stress (Alhmidi, 2020). Teachers are experiencing high levels of stress from the fear of getting sick, combined with the challenges of adapting to a new hybrid teaching system. According to a survey of 250 high school teachers conducted by the Association for Canadian Studies, 78% of the respondents were afraid of catching COVID-19 in the workplace, while only 40% felt confident in upholding safety protocols within their classroom (Alhmidi, 2020). In an article published by The Canadian Press, an Ottawa region teacher expressed that returning to the classroom this fall has caused her more stress and exhaustion than she has ever felt in 27 years of teaching high school (Alhmidi, 2020).

The symptoms of anxiety and depression can prevent teachers from performing duties of their regular assignment and prevent gainful employment, which meets OTIP’s definition of a long term disability (LTD). If you are finding it difficult to cope at work and your mental health is suffering it is important to consult your physician about your symptoms. Having medical records and documentation of the severity of your symptoms can help prevent OTIP from denying your claim.

It is important to follow the recommendations of your treating doctors to prevent a denial of LTD benefits on the basis that you aren’t seeking appropriate rehabilitation.

OTIP’s Long Term Disability (LTD) Claims Process

If you are unable to work due to stress and meet the definition of having a long term disability (LTD), you should initiate a LTD claim with OTIP. To initiate your claim you will need to submit three forms to OTIP, being a Member’s Statement, Plan Administrator’s Statement and an Attending Physician’s Statement. You can request these forms from your school board,  federation or association, or an OTIP representative. You should also submit any medical documentation related to your condition since it will give your claim a better chance of being approved.

Once your forms have been reviewed by OTIP, you will be contacted for an initial assessment, which usually occurs over the phone. After the assessment, OTIP will inform you verbally and in writing if your claim has been approved or denied. If your claim is approved you will start receiving benefits after the waiting period. A Disability Analyst will follow up with you every two to six months, as a part of an ongoing claims management process. OTIP may request documentation from your attending physician and require an independent medical evaluation (IME) if they suspect you no longer meet the definition of having a LTD.


What Happens when OTIP Denies or Terminates a Claim?

Many of our clients at Kotak Law have been surprised and frustrated when OTIP has denied or terminated their disability insurance claim. Sometimes they are told that there is insufficient medical evidence or that the test for total disability has changed and there is some other job that they can do. It is important to seek legal representation to assist you with disputing a denial or termination, as a lawyer can help guide you through the process and advocate on your behalf, while you focus on recovery.

At Kotak Law, our disability insurance lawyers have been successful in suing OTIP and securing large lump sum settlements for our clients who suffer from illnesses such as chronic pain, depression, anxiety, fibromyalgia, colitis, cancer or even stress alone. We offer free consultations and don’t charge until your case is resolved.  We represent people throughout Ontario and we offer consultation by telephone, Skype, zoom, email or WhatsApp.


We understand that being denied short term disability or long term disability benefits can be devastating.  Your time to fight your disability insurance company is limited.  Please do not delay in calling a short and long term disability claim lawyer at Kotak Personal Injury Law. We have successfully sued numerous disability insurance companies including Manulife, Sunlife, Desjardins, Cigna, Great West Life, Equitable Life, Empire Life, London Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance, Canada Life, Fenchurch, OTIP, Teachers Life and more.

Call your trusted long term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents).  Our consultation is free and we don’t get paid until you do.  We represent disabled people throughout Ontario and Alberta, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Keswick, Kingston, Ottawa, Banff, Brooks, Calgary, Edmonton, Fort McMurray, Grande Prairie, Jasper, Lake Louise, Lethbridge, Medicine Hat, Red Deer, Saint Albert and other locations.