Representing Individuals Across Canada in Long-Term Disability Insurance Disputes
If your long-term disability benefits have been denied, delayed, reduced, or terminated, you may be worried about how you will support yourself and your family. After years of paying insurance premiums, many people are shocked to learn that obtaining or continuing disability benefits is not always straightforward.
At Kotak Law, we help individuals challenge disability benefit denials by some of Canada’s largest insurance companies, including Manulife, Canada Life, Sun Life, Desjardins, RBC Insurance, Blue Cross, The Co-operators, Industrial Alliance and others.
While our primary practice is based in Ontario and Alberta, we have assisted individuals from across Canada in navigating complex disability insurance disputes. Whether your claim involves a mental health condition, chronic pain, fibromyalgia, cancer, a neurological disorder or another disabling medical condition, our team is committed to helping you understand your rights and options.
Led by Nainesh Kotak, a Lexpert-recognized disability lawyer, Vice President of the Ontario Trial Lawyer’s Association and former Chair of the Ontario Trial Lawyers Association Long-Term Disability Section, our firm focuses on helping disabled individuals secure the benefits they deserve.
We understand that disability claims are about more than insurance policies. They are about protecting your income, your family, your independence and your future.
Contact us today for a free consultation. There are no legal fees unless we recover compensation for you.
On This Page
- Why Choose Kotak Law for Your Disability Claim?
- Meet Nainesh Kotak
- Why Long-Term Disability Claims Are Denied
- Understanding the Own Occupation Definition
- Understanding the Any Occupation Definition
- Medical Conditions That May Qualify for Long-Term Disability Benefits
- Insurance Companies We Frequently Deal With
- What To Do If Your Disability Claim Is Denied
- Why Internal Appeals Often Fail
- How Long-Term Disability Lawsuits Work
- How Disability Settlements Work
- How Much Does a Disability Lawyer Cost?
- Frequently Asked Questions
- What Clients Say About Kotak Law
- Contact Our Disability Lawyers
Why Choose Kotak Law for Your Disability Claim?
When disability benefits are denied, you are often facing a large insurance company with significant resources and experience handling claims. Having knowledgeable legal representation can help level the playing field.
Individuals choose Kotak Law because:
- We focus on disability and personal injury litigation.
- We represent claimants, not insurance companies.
- Nainesh Kotak is recognized in the Canadian Lexpert Directory for disability law.
- Nainesh Kotak served as Chair of the Ontario Trial Lawyers Association Long-Term Disability Section and is OTLA’s Vice President
- We have extensive experience handling disability disputes involving Canada’s largest insurers.
- We offer free consultations.
- There are no legal fees unless we recover compensation.
Our firm is regularly consulted by media organizations on disability law issues and is committed to helping clients navigate disability claims with clarity and confidence.
Meet Nainesh Kotak
Nainesh Kotak has dedicated much of his legal career to representing individuals whose disability benefits have been denied, delayed, reduced, or terminated.
His credentials include:
- Called to the Ontario Bar in 1994
- Called to the Alberta Bar in 2022
- Recognized in the Canadian Lexpert Directory for disability law
- Former Chair of the Ontario Trial Lawyers Association Long-Term Disability Section
- Vice President of the Ontario Trial Lawyers Association
- Frequent media commentator on disability law issues
- Represented thousands of disability claimants
Mr. Kotak is regularly consulted by media organizations regarding disability law developments and has appeared in television, radio, print and online media discussing issues affecting disabled Canadians.
Why Long-Term Disability Claims Are Denied
Many people assume that if their doctor confirms they are unable to work, disability benefits will automatically be approved.
Unfortunately, disability insurers often take a different view.
Long-term disability claims may be denied or terminated because:
- The insurer believes there is insufficient medical evidence.
- The insurer concludes you can return to work.
- The insurer relies on an independent medical examination.
- The insurer believes you can perform another occupation.
- The insurer disputes the severity of your symptoms.
- The insurer claims treatment recommendations have not been followed.
- Surveillance or social media evidence is used against you.
- The insurer questions the reliability of your reported symptoms.
Many valid claims are initially denied and later resolved through legal advocacy.
Understanding the Own Occupation Definition of Disability
Most disability policies begin with an own occupation definition of disability.
During this period, the issue is whether you can perform the essential duties of the occupation you were working in when you became disabled.
A nurse, lawyer, teacher, executive, tradesperson or healthcare worker may qualify for benefits if their condition prevents them from performing the substantial duties of their specific occupation.
Many disability claims are approved during this stage because the focus remains on the claimant’s actual job.
For example, a lawyer suffering from severe depression, cognitive impairment, chronic pain, or a neurological condition may no longer be able to safely manage client files, court appearances, deadlines, and complex decision-making. Similarly, a nurse suffering from chronic pain or PTSD may no longer be able to safely provide patient care.
The focus during the own occupation period is not whether you can perform any work. The focus is whether you can perform the occupation you were performing when you became disabled.
Understanding the Any Occupation Definition of Disability
Most disability policies transition to an any occupation definition after approximately 24 months.
At this stage, the insurer asks whether you can perform any occupation for which you are reasonably suited by education, training or experience.
This transition is one of the most common reasons benefits are terminated.
Many disability disputes arise because insurers believe a claimant can perform alternate work while the claimant’s treating physicians disagree.
Insurers may rely on vocational assessments, transferable skills analyses, surveillance, independent medical examinations, and paper reviews to support their position.
Many claimants who lose benefits at the any occupation stage continue to satisfy the disability definition and may have valid claims for ongoing benefits.
Understanding how this transition works is often critical to protecting your rights and preserving your entitlement to benefits.
Medical Conditions That May Qualify for Long-Term Disability Benefits
Long-term disability benefits are not limited to a specific diagnosis. The central question is whether your medical condition prevents you from meeting the disability definition contained in your policy.
Mental Health Conditions
Mental health conditions are among the leading causes of disability claims in Canada.
Common mental health disability claims involve:
- Depression
- Major depressive disorder
- Anxiety
- Generalized anxiety disorder
- Social anxiety disorder
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Obsessive-compulsive disorder
- Burnout and occupational stress injuries
Mental health conditions can affect concentration, memory, decision-making, emotional regulation, attendance, reliability and the ability to tolerate workplace stress.
Many individuals with mental health disabilities appear physically healthy while struggling with significant limitations that interfere with employment. These cases frequently involve evidence from family physicians, psychologists, psychiatrists, therapists and occupational specialists.
Mental health disabilities can be every bit as disabling as physical illnesses.
Chronic Pain and Fibromyalgia
Chronic pain conditions are among the most misunderstood disability claims.
Unlike a broken bone or other visible injury, chronic pain often cannot be fully measured through diagnostic imaging or laboratory testing. As a result, insurers frequently challenge these claims despite the very real limitations experienced by claimants.
Common chronic pain conditions include:
- Fibromyalgia
- Chronic pain syndrome
- Chronic fatigue syndrome
- Complex regional pain syndrome (CRPS)
- Myofascial pain syndrome
- Persistent post-concussion syndrome
Individuals suffering from chronic pain often experience:
- Ongoing pain
- Fatigue
- Sleep disruption
- Reduced stamina
- Cognitive difficulties
- Difficulty sitting, standing or concentrating for prolonged periods
Canadian courts have repeatedly recognized that chronic pain can be profoundly disabling. The focus is often not on the diagnosis itself, but on how symptoms affect a person’s ability to function in the workplace.
Cancer and Long-Term Disability Claims
A cancer diagnosis can have a significant impact on an individual’s ability to work.
While some individuals are able to return to work following treatment, others continue to experience physical, emotional and cognitive limitations long after treatment ends.
Disability claims involving cancer may arise from:
- Chemotherapy side effects
- Radiation treatment complications
- Surgical recovery
- Cancer-related fatigue
- Cognitive impairment (“chemo brain”)
- Chronic pain
- Anxiety and depression associated with treatment
Many individuals experience ongoing symptoms that make a safe and sustainable return to work difficult or impossible.
Multiple Sclerosis (MS)
Multiple sclerosis is a chronic neurological condition that can affect mobility, balance, cognition, vision and energy levels.
Common symptoms include:
- Fatigue
- Weakness
- Balance issues
- Cognitive difficulties
- Visual disturbances
- Mobility impairments
One of the challenges associated with MS claims is that symptoms often fluctuate. A person may appear capable on some days while experiencing significant impairment on others.
This unpredictability can make maintaining consistent employment extremely difficult.
Parkinson’s Disease
Parkinson’s disease is a progressive neurological disorder that affects movement and motor control.
Symptoms may include:
- Tremors
- Muscle rigidity
- Slowed movement
- Balance problems
- Fatigue
- Cognitive difficulties
As symptoms progress, many occupations become increasingly difficult to perform safely and effectively.
Traumatic Brain Injury and Concussion Claims
Concussions and traumatic brain injuries can have long-lasting consequences even when diagnostic imaging appears normal.
Common symptoms include:
- Headaches
- Memory problems
- Concentration difficulties
- Dizziness
- Sleep disturbances
- Fatigue
- Anxiety
- Depression
Many individuals who appear physically recovered continue to struggle with cognitive demands that interfere with employment.
Stroke and Acquired Brain Injury
A stroke or acquired brain injury can have significant physical, cognitive and emotional consequences.
Individuals may experience:
- Memory impairment
- Reduced concentration
- Executive functioning difficulties
- Speech challenges
- Fatigue
- Emotional regulation difficulties
Many professionals discover that cognitive impairments make it difficult to return to occupations requiring sustained focus, judgment and decision-making.
Lupus and Autoimmune Disorders
Autoimmune disorders occur when the body’s immune system attacks healthy tissue.
Conditions commonly associated with disability claims include:
- Lupus
- Rheumatoid arthritis
- Sjögren’s syndrome
- Psoriatic arthritis
- Ankylosing spondylitis
Symptoms often include:
- Chronic pain
- Fatigue
- Joint inflammation
- Reduced mobility
- Cognitive difficulties
The unpredictable nature of autoimmune conditions can create substantial workplace challenges.
Crohn’s Disease and Ulcerative Colitis
Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis can significantly affect daily functioning.
Symptoms may include:
- Abdominal pain
- Urgent bowel movements
- Fatigue
- Weight loss
- Medication side effects
Many individuals experience unpredictable flare-ups that interfere with attendance, productivity and the ability to maintain a consistent work schedule.
Heart Disease and Cardiac Conditions
Heart disease and cardiovascular conditions may significantly affect a person’s ability to work safely.
Examples include:
- Coronary artery disease
- Heart failure
- Cardiomyopathy
- Arrhythmias
- Recovery from cardiac surgery
Common symptoms include:
- Fatigue
- Shortness of breath
- Reduced exercise tolerance
- Chest discomfort
- Dizziness
Even sedentary occupations can become difficult when cardiac symptoms are significant.
Respiratory Conditions
Respiratory illnesses can interfere with a person’s ability to work, particularly in physically demanding environments.
Examples include:
- Chronic obstructive pulmonary disease (COPD)
- Severe asthma
- Pulmonary fibrosis
- Long-term respiratory complications
Common symptoms include:
- Shortness of breath
- Fatigue
- Reduced stamina
- Difficulty with exertion
The Diagnosis Alone Does Not Determine Eligibility
Many people ask whether a particular diagnosis automatically qualifies them for disability benefits.
The answer is usually no.
Disability insurers focus on how your symptoms affect your ability to function and perform work-related duties.
Two individuals with the same diagnosis may experience very different levels of impairment.
The key issue is whether your condition prevents you from meeting the disability definition contained in your policy.
Insurance Companies We Frequently Deal With
Our disability lawyers regularly assist individuals whose claims involve many of Canada’s largest insurance companies.
These include:
- Manulife
- Canada Life
- Sun Life
- Desjardins Insurance
- RBC Insurance
- Blue Cross
- The Co-operators
- Industrial Alliance
- Equitable Life
- Empire Life
- Beneva
- Cigna
- Green Shield Canada
Every insurer has its own claims procedures, documentation requirements, policy wording and approach to disability assessments.
Our experience dealing with disability insurers allows us to identify common issues and advocate effectively on behalf of clients whose claims have been denied, delayed or terminated.
Whether your claim involves a group disability policy, an individual disability policy, or a dispute regarding ongoing entitlement to benefits, understanding how insurers evaluate disability claims can be an important part of protecting your rights.
What To Do If Your Disability Claim Is Denied
Receiving a denial letter can be stressful and overwhelming.
However, there are important steps you can take to protect your rights.
If your disability claim has been denied:
- Keep a copy of the denial letter.
- Request a complete copy of your disability policy.
- Gather medical records and supporting documentation.
- Continue following your healthcare providers’ recommendations.
- Avoid assuming the insurer’s decision is final.
- Seek legal advice as soon as possible.
Many individuals are surprised to learn that valid disability claims are often denied.
A denial does not necessarily mean that you are not entitled to benefits.
Obtaining legal advice early can help preserve evidence, protect limitation periods and provide clarity regarding your options.
Why Internal Appeals Often Fail
Many disability insurers encourage claimants to pursue internal appeals.
While every case is different, internal appeals frequently result in the original denial being upheld.
This occurs for several reasons.
The appeal is reviewed by the insurer itself. Important legal issues may not be addressed. Valuable time may pass while limitation periods continue to run.
This does not mean that internal appeals are never appropriate. However, before relying exclusively on an internal appeal process, it may be worthwhile to obtain independent legal advice regarding all available options.
Many individuals discover that pursuing an internal appeal simply results in months of delay without changing the outcome.
Understanding your legal rights early in the process can help you make informed decisions about how to proceed.
How Long-Term Disability Lawsuits Work
Many disability disputes are ultimately resolved through litigation.
While every case is different, most long-term disability lawsuits follow a similar process.
Initial Consultation
The process begins with a review of the denial letter, disability policy, medical records and other relevant information.
An experienced disability lawyer can help assess the strengths and weaknesses of the claim and explain available options.
Commencing the Claim
If legal action is appropriate, a lawsuit is commenced against the insurer.
The claim typically seeks payment of disability benefits that have been denied or terminated, along with any other damages that may be available.
Exchange of Documents
Both parties exchange relevant records and information.
This often includes:
- Medical records
- Disability claim files
- Employment records
- Insurer documentation
- Surveillance materials
- Internal insurer notes
Examinations for Discovery
Each side has an opportunity to question the other under oath.
This stage often provides important insight into the insurer’s position and the evidence being relied upon.
Mediation
Most disability claims participate in mediation before trial.
A neutral mediator assists the parties in attempting to reach a settlement.
Many disability cases resolve at this stage.
Settlement or Trial
If the parties are unable to reach a resolution, the case may proceed to trial.
While most disability lawsuits settle before trial, it is important to have legal representation prepared to proceed through the litigation process when necessary.
How Disability Settlements Work
Many individuals ask whether their disability claim will settle.
The reality is that most disability disputes resolve through negotiated settlements.
Settlement discussions often consider factors such as:
- Past unpaid benefits
- Future disability benefits
- Age
- Occupation
- Medical prognosis
- Policy wording
- Litigation risks
- The strength of the medical evidence
There is no universal formula for calculating settlement value.
Every case is unique.
An experienced disability lawyer can help assess the potential strengths and weaknesses of a claim and explain the factors that may affect settlement discussions.
How Much Does a Disability Lawyer Cost?
Many people hesitate to contact a lawyer because they are concerned about legal fees.
At Kotak Law, disability claims are generally handled on a contingency fee basis.
This typically means:
- No upfront legal fees
- No hourly billing
- Legal fees are payable only if compensation is recovered
During your free consultation, we are happy to explain our fee structure and answer any questions you may have.
Our goal is to ensure that individuals have access to experienced legal representation regardless of their financial circumstances.
Frequently Asked Questions
How long do I have to sue after a disability denial?
Limitation periods vary depending on the circumstances of your claim and the province involved. It is important to seek legal advice promptly after receiving a denial.
Can depression or anxiety qualify for long-term disability benefits?
Yes. Mental health conditions such as depression, anxiety, PTSD and other psychiatric illnesses may qualify for disability benefits if they prevent you from meeting the disability definition contained in your policy.
Can chronic pain or fibromyalgia qualify for disability benefits?
Yes. Canadian courts have repeatedly recognized that chronic pain and fibromyalgia can be disabling conditions. The focus is often on how symptoms affect your ability to function and work.
What happens when my benefits change from own occupation to any occupation?
Many policies change after approximately 24 months. At that point, the insurer may assess whether you are capable of performing another occupation for which you are reasonably suited by education, training or experience.
Can I work part-time and still receive disability benefits?
Possibly. The answer depends on the wording of your policy and your particular circumstances. Some policies allow limited work activity while others contain different restrictions.
What happens if the insurer sends me for an independent medical examination?
The insurer may rely on the results of the examination when assessing your claim. You should carefully review any requests for assessments and consider obtaining legal advice regarding your rights and obligations.
Should I pursue an internal appeal?
Every case is different. While internal appeals may be appropriate in some situations, they are frequently unsuccessful. Before pursuing an internal appeal, it is often worthwhile to obtain independent legal advice.
How long does a disability lawsuit take?
The timeline varies depending on the complexity of the case, the insurer involved and whether the matter settles or proceeds to trial. Many disability claims resolve through settlement before trial.
How much is my disability claim worth?
There is no universal formula. Factors such as age, occupation, policy wording, medical prognosis and the value of future benefits can all affect claim value.
How much does it cost to hire a disability lawyer?
At Kotak Law, disability claims are generally handled on a contingency fee basis, meaning legal fees are typically payable only if compensation is recovered.
What Clients Say About Kotak Law
We are proud of the trust our clients place in us during some of the most difficult periods of their lives.
Client Review #1
I cannot express enough gratitude to Kotak Law for the outstanding work they did in helping me get my claim approved.
I would especially like to thank Avinaash, Nainesh whose wisdom, professionalism, and commitment to helping people were evident throughout my case. They are not only excellent lawyers but also genuinely kind and compassionate individuals who care deeply about their clients. They took the time to understand my situation, answered my questions patiently, and guided me through every step of the process.
I would also like to recognize Emily, for her kindness, professionalism, and constant support. She was always courteous, responsive, and willing to help.
What impressed me most about this team was that they never made me feel like just another file. They are truly dedicated to serving people and helping those who are going through difficult times. I felt that they genuinely cared about my well-being and my future rather than their own benefit.
The relief and security that this approval has brought to me and my children are beyond words. I will always be grateful to Nainesh and Avinaash and the entire team for giving me hope when I had almost lost it. I truly feel like I have been given a new life.
I highly recommend this law firm to anyone struggling. Their expertise, compassion, integrity, and dedication make all the difference. Thank you for changing my life.”
Client Review #2
Kotak Law, specifically Kaity & Klara were amazing to work with and got results way beyond what we expected after having such a difficult and lengthy experience with my son’s disability claim. I would highly recommend their service. They are professional and empathetic. We always knew they had our best interest at heart. Kaity is a master negotiator, too! We would have had nothing without their help!
Client Review #3
Huge shout out and compliments to the staff at Kotak Law. Specifically Avinaash, Mr. Kotak & Emily. Choosing to take a leap of faith with this firm to handle my case, proved how dedicated they were. Avi took the time and care to answer my questions and most importantly spoke to me in language I understood. He’s exceptional to work with. Emily quickly relayed information, and brought a kind, sweetness in her calls and emails. Mr. Kotak was a gentle soul who saw my case and knew I needed someone to fight for me. His kindness and expertise wrapped everything up with ease. I’m forever grateful for everyone who believed in me and got me to the end on a positive note. Thank you!
Client Review #4
I have had some time pass since my last interaction with KOTAK so this review is my honest opinion.
My initial contact with Alix was professional and warm. There were no promises made except “we will do the best we can to help you” and that was just what I needed. Caroline always made me smile when I called in and meeting her in person was the same. I then would liaise with Gurbcan, one of the law clerks, who is the most patient and bravest person I’d met on the phone up until then because I was in crisis mode and difficult to deal with but she was amazingly kind and I always came off our calls in a better mood.
My Barrister was Avinaash.
Let me gush a bit, kindness during this extremely emotional and dark time, was an unknown high priority. I didn’t know it was what I needed. I wanted big bucks and vengeance. What I got was reassurance, understanding, the ultimate levels of respect. At times we thought he had to be reading our minds. A very proactive firm they would call with updates regularly and he was detailed and forth coming with information. I was asked my permission or level of comfort in how we would proceed each time beforehand. I truly stopped worrying about my outcome, I knew it was being handled. My anxiety began to level out. I was able to start taking care of myself with a new perspective. I can not thank you enough Avi for all your help and care during this time. May your basket never be empty and only filled with good things.
Nainesh’s confidence is absolutely infectious!
I am beyond satisfied with my outcome and highly recommend KOTAK Law. 🙏🏿❤️
Thank you all once again🙏🏿
Client Review #5
I am writing this with the intention of helping someone who really needs some help to fight the insurance industry for his/her disability claim. I had to help someone close to me get legal help wrt LTD and/or CPPD claim. While searching and reviewing many lawyers in town and their initial consultation/responses, I came across Kotak law led by Nainesh. In my experience in the past, most lawyers over promise and under deliver. However, my experience with Kotak law was completely different. They are competent, humble and very emphatic to your specific issue. Their fees are also transparent and more competitive than other lawyers. They analyzed the scenario and gave us complete breakdown of how they are going to approach the matter and timelines. Everything took place in the manner they explained in a timely fashion. I am grateful for their service. My advice to anyone needing LTD or CPPD related legal help, set aside your skepticism, go to Kotak law, have confidence and belief in them. They are good and competent people and want people like that on your side in a time of need ………
We encourage prospective clients to review our Google reviews and testimonials to learn more about the experiences of individuals we have helped.
Speak With an Experienced Long-Term Disability Lawyer
If your disability benefits have been denied, delayed, reduced or terminated, you do not have to face the insurer alone.
The disability lawyers at Kotak Law help individuals understand their rights, evaluate their options and pursue the benefits they deserve.
Whether your claim involves a mental health condition, chronic pain, fibromyalgia, cancer, a neurological disorder, or another disabling medical condition, we are here to help.
Contact Kotak Law today for a free consultation.
Our team serves clients throughout Ontario and Alberta and assists individuals from across Canada in appropriate disability insurance matters.
There are no legal fees unless we recover compensation for you.
Call us today or complete our online consultation form to learn how we may be able to help.
