What Conditions Qualify for Long Term Disability Claims

What is Long Term Disability?

Long term disability (LTD) is a type of insurance benefit that provides ongoing income replacement to individuals who are unable to work for an extended period of time due to a serious illness, injury, or medical condition. It is designed to help cover essential living expenses, alongside the insurance premiums, when a person can no longer perform their regular job or, in some cases, any job.

Key Features:

Benefit Duration: LTD benefits typically begin after a waiting period (usually 90 to 180 days) and may continue for two years, five years, or until the retirement age, depending on the policy.

Income Replacement: Most LTD plans pay 60-70% of your pre-disability income.

Eligibility: Requires medical documentation proving that your condition prevents you from working.

Sources of Coverage: LTD coverage can come from an employer sponsored group insurance plan or a privately purchased insurance policy.

Common conditions that qualify include cancer, chronic pain, mental illness, neurological disorders, and permanent disabilities resulting from an injury.

Long term disability benefits play a vital role in providing financial stability for individuals facing prolonged health challenges. If your LTD claim is denied or terminated, speaking with a disability lawyer can help protect your rights and secure the support you need.

Eligibility for Disability Benefits

Determining eligibility for disability benefits is a crucial first step for anyone considering a claim. To qualify for long term disability benefits in Canada, individuals must meet specific legal, medical, and residency requirements. Understanding these criteria can help ensure your application is complete, minimize delays, and improve your chances of approval with your insurance company.

Who is Eligible for Disability Benefits?

To qualify for disability benefits in Canada, an individual must meet several key eligibility requirements:

Residency: You must be a resident of Canada for the purposes of the Income Tax Act (determine your residency status with the Canada Revenue Agency).

Disability Tax Credit (DTC): You have been approved for the Disability Tax Credit.

Age: Must be between 18-64 years old.

Tax Filing: Have filed an income tax return with the Canada Revenue Agency (CRA) for the previous tax year. For example, to receive benefits for July 2025-June 2026, the 2024 tax return must be filed.

Legal Status: Be one of the following:

• Canadian citizen
• Permanent resident
• Protected person
• Temporary resident who has lived in Canada for at least 18 months
• Someone registered or entitled to be registered under the Indian Act.

If married or in a common law relationship, the person’s spouse or partner must also have filed a CRA income tax return for the prior year.

In certain cases, Service Canada may waive the tax return requirement for the spouse or common law partner such as when:

• The spouse or partner is not a Canadian resident under the Income Tax Act.
• The couple is separated for reasons beyond their control (e.g., one partner lives in a long term care facility).
• Asking the spouse or partner to file would be unsafe.

Types of Conditions That May Qualify for Disability Benefits

Understanding what conditions qualify for long term disability benefits is vital for anyone considering a long term disability claim. Whether you hold group disability insurance through your employer, individual disability insurance, or are applying through Ontario Disability Support Program (ODSP) or the Canada Pension Plan Disability (CPP Disability) program, it is essential to know which medical conditions may make you eligible for disability benefits and financial support.

Common Medical Conditions That Qualify for Long Term Disability Benefits

The following medical categories are commonly seen in long term disability insurance claims. Each condition may impact your ability to perform essential job duties, making you eligible for LTD benefits, income replacement, or even a lump sum settlement under your insurance company’s policy.

Musculoskeletal Issues (Arthritis, Sciatica, Scoliosis, Fibromyalgia, Carpal Tunnel, Spinal Stenosis, Back, Degenerative Disc, etc.)

Musculoskeletal conditions can significantly affect your ability to work, often leading to long term disability coverage or short term disability benefits. Chronic pain, limited mobility, and physical restrictions may prevent you from fulfilling your own occupation or even any occupation, depending on your insurance policy.

To succeed in a disability insurance claim, you’ll need strong medical records, documentation of how your condition limits your job duties, and support from your healthcare provider. In some cases, an independent medical examination may be required from the insurance company.

Personal Injuries (Accident, Slip & Fall, Penetrating Head Injury, Brain Injury, Trauma, Fractured Spinal Injury)

Serious personal injuries such as accidents, slip and falls, and head or spine injuries, can result in long lasting disability, making you eligible for long term disability insurance or workers compensation. If you have suffered a traumatic brain injury, fractured spine, or permanent damage from an accident, it is essential to file a long term disability claim with detailed medical report forms and medical certificates.

Your employers’ group insurance plan or individual disability insurance policy may provide income replacement during your recovery or throughout an extended period if you cannot return to work. A disability lawyer can help you navigate complex claims and negotiate with the insurance provider.

Chronic Pain (Back Pain, Fibromyalgia, Arthritis, IBS, Nerve Pain, Sciatica)

Chronic pain is one of the most difficult medical issues to prove in a long term disability claim because insurance companies often challenge the severity and impact on essential duties. Whether caused by degenerative disc disease, fibromyalgia, or sciatica, chronic pain can result in lost wages, increased medical expenses, and a need for long term financial support.

Having detailed medical records, a thorough treatment plan, and a supportive healthcare provider is key to securing disability benefits. If your claim is denied due to insufficient medical evidence, a long term disability lawyer can assist you in appealing the decision.

Mental Health & Psychological Illnesses (PTSD, Anxiety, Depression, Schizophrenia, Bipolar Disorder)

Mental health disorders such as depression, anxiety, and PTSD are increasingly recognized in long term disability insurance claims. If your condition prevents you from performing your job duties or requires an extended period of leave, you may be entitled to disability benefits under your insurance plan.

Providing comprehensive medical records, regular updates from your healthcare provider, and, if needed, undergoing an independent medical examination are critical. For individuals struggling with mental health conditions, working with a disability lawyer can help you overcome denials and secure LTD insurance benefits or income replacement.

Cardiovascular Conditions (Hypertension, Chronic Heart Disease, Heart Attack, Stroke, Coronary Artery Disease)

Cardiovascular conditions can be life threatening and may leave you unable to perform duties at work. Whether you have experienced a heart attack, stroke or live with chronic heart disease, you may be eligible for long term disability benefits through your group insurance coverage or individual disability insurance policy. Filing a successful disability insurance claim requires a detailed record of your medical treatment restrictions on activity and confirmation from your health care provider.

If you are dealing with a cardiovascular condition, or any disability discussed in this article, and need legal help, consider reaching out to the experienced team at Grillo Law’s Long Term Disability Lawyers in Toronto. They can help you secure the financial support you deserve and protect your rights when dealing with your insurance company.

Neurological Disorders (Stroke, Parkinson’s Disease, Multiple Sclerosis, ALS, Epilepsy)

Neurological conditions such as multiple sclerosis (MS), ALS, Parkinson’s disease, and epilepsy can profoundly impact mobility, speech, and cognitive function. These impairments often qualify for long term disability coverage and may also be eligible under the Disability Tax Credit or employment insurance. Successful claims require detailed medical evidence, often including a medical certificate, neurological testing results, and a prognosis outlining your ability to fulfill your job duties.

Respiratory Conditions (COPD, Chronic Lung Disease, Asthma)

Respiratory disorders, including chronic obstructive pulmonary disease (COPD) and chronic lung disease, can make routine activities, let alone employment, nearly impossible. If your condition requires constant treatment or severely limits exertion, you may be eligible for long term disability benefits, CPP disability, or other disability insurance policies. To avoid delays or denials, your disability claim should include evidence of your treatment plan, lung function tests, and restrictions provided by your healthcare provider.

Other Medical Conditions That May Qualify

In addition to the conditions already discussed, several chronic illnesses and medical issues may qualify you for long term disability benefits under your disability insurance plans. Understanding these can help ensure you get the financial support you need, even if your insurance company denies your initial disability claim.

Digestive System Disorders

Digestive disorders such as Crohn’s disease, ulcerative colitis, irritable bowel syndrome (IBS), and chronic liver disease can severely affect your ability to work. These chronic illnesses often require ongoing treatment and may make you eligible for disability insurance coverage through your employer’s group insurance plan or individual disability insurance coverage. If your claim is denied, an experienced benefits administrator, insurance broker, or disability lawyer can help appeal the decision and secure the coverage you deserve.

Hematologic Diseases

Hematologic diseases, including anemia, hemophilia, sickle cell disease, thrombocytopenia, and leukemia, can significantly impact a person’s health, ability, to work, and overall quality of life. These chronic illnesses often require ongoing medical care, frequent hospital visits, or intensive treatments, making it difficult to fulfill essential job duties, especially when dealing with the insurance company .

Individuals facing these conditions may qualify for long term disability benefits under their disability insurance plans, whether through an employer’s group insurance plan or an individual disability insurance policy. However, insurance companies sometimes challenge or deny these claims, often citing insufficient medical evidence or failure to meet specific policy definitions.

To strengthen your disability insurance claim, it is vital to provide detailed medical records, a comprehensive treatment plan from your healthcare provider, and clear documentation of how the condition affects your ability to work.

Skin Disorders

Several skin disorders, such as psoriasis, eczema, lupus, scleroderma, and extensive burns, can cause chronic pain, infection risk, and physical limitations that interfere with daily tasks and essential job duties. These conditions can be physically and emotionally exhausting, sometimes making it impossible to maintain regular employment.

Individuals with debilitating skin disorders may qualify for long term disability benefits under their disability insurance plans, whether through an employer’s group insurance plan or an individuals insurance policy. Unfortunately, it is not uncommon for an insurance company to deny these claims, often arguing that the condition is not severe enough or lacks adequate medical evidence.

To improve your chances of approval, you will need detailed medical records, reports from your healthcare provider, and clear documentation showing how the condition limits your ability to work. If you are struggling with a denied claim, a disability lawyer, insurance agent, or insurance broker can help guide you through the appeals process and ensure you receive the financial support you are entitled to. Remember, even when your monthly premiums for coverage, you may need to advocate firmly for your right to benefits.

Applying for Long Term Disability Benefits

The process of applying for long term disability benefits can feel overwhelming, especially when you are managing a serious medical condition. Understanding each step can improve your chances of a successful long term disability claim and help unnecessary delays or denials from your insurance company.

Getting a Diagnosis and Gathering Medical Documents

The first step in the application process is obtaining a formal diagnosis from your healthcare provider. Whether you are dealing with a chronic illness, mental health disorder, or physical injury, thorough medical records, including test results, treatment plans, and a clear outline of how your condition limits you job duties, are critical. Without this documentation, your disability insurance claim may be weakened, and the insurance provider could cite insufficient medical evidence when evaluating your case.

Completing the Application Form and Following Up

Next, you will need to complete the long term disability insurance application forms provided by your employer’s group insurance plan or individual disability insurance policy. Pay careful attention to deadlines, waiting periods, and required forms like the medical certificate or medical report form. After submitting the application, it is essential to follow up with the benefits administrator, insurance agent, or insurance broker to ensure your claim is progressing and no additional documents are needed.

Reviewing the Decision and Seeking Legal Advice

Once a decision is made, carefully review the approval or denial letter from the insurance company. If your claim is denied, don’t panic. Many initial disability claims are denied due to technicalities or missing information. This is when consulting with an LTD lawyer becomes crucial. A lawyer can help you understand your rights, strengthen your appeal, and fight for the monetary support you need under your disability insurance coverage.

If you need legal guidance at any stage of the process, whether you are applying for long term disability benefits, appealing a denied claim, or navigating complex issues with your insurance company, the experienced team at Grillo Law is here to help. Our dedicated lawyers will work to protect your rights, guide you through every step of the claims process, and advocate on your behalf to help you secure the financial support you deserve.